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The Severn Bridge, completed in 1966, was the first suspension bridge to adopt a streamlined box girder deck that reduced the dead weight and improved aerodynamic performance. The 988 m span bridge crosses the estuary of the River Severn and is an important asset within the UK highway network. In 2006, the UK's Highways Agency, through the concessionaire Severn River Crossing plc, commissioned a programme of internal intrusive examination of the main suspension cables of the Severn Bridge with Faber-Maunsell/Weidlinger acting as consultants for the inspection. The information obtained during these investigations provided the basic data for use in a formal strength assessment of the suspension cables undertaken by Mott MacDonald, the UK government's representative for the Severn Crossings concession. Analytical techniques developed over the past 3 years have enabled the adoption of limit state principles for the assessment in line with UK practice. In addition, deterioration modelling has been developed to improve understanding of the current condition of the cables and to assist in the future management of the bridge. In parallel with the strength assessment, process maintenance management strategies have been developed and implemented that have enabled the continued safe operation of the bridge. [ABSTRACT FROM AUTHOR]

Retirement ages are rising in many countries to offset the challenges of population ageing, but osteoarthritis is an age-associated disease that is becoming more prevalent and may limit capacity to work until older ages. We aimed to assess the impact of osteoarthritis on healthy working life expectancy (HWLE) by comparing HWLE for people with and without osteoarthritis from ages 50 and 65 nationally and in a local area in England. Mortality-linked data for adults aged ≥ 50 years were used from six waves (2002-13) of the English Longitudinal Study of Ageing and from three time points of the North Staffordshire Osteoarthritis Project. HWLE was defined as the average number of years expected to be spent healthy (no limiting long-standing illness) and in paid work (employment or self-employment), and was estimated for people with and without osteoarthritis and by sex and occupation type using interpolated Markov chain multi-state modelling. HWLE from age 50 years was a third lower for people with osteoarthritis compared to people without osteoarthritis both nationally (5.68 95% CI [5.29, 6.07] years compared to 10.00 [9.74, 10.26]) and in North Staffordshire (4.31 [3.68, 4.94] years compared to 6.90 [6.57, 7.24]). HWLE from age 65 years for self-employed people with osteoarthritis exceeded HWLE for people without osteoarthritis in manual or non-manual occupations. Osteoarthritis was associated with a significantly shorter HWLE. People with osteoarthritis are likely to have significantly impaired working ability and capacity to work until older ages, especially in regions with poorer health and work outcomes., (© 2022. The Author(s).)

UK state pension age is rising in response to life expectancy gains but population health and job opportunities may not be sufficient to achieve extended working lives 1-3 . This study aimed to estimate future trends in healthy working life expectancy (HWLE) from age 50 to 75 for men and women in England. Using the 'intercensal' health expectancy approach, annual period HWLE from 1996 to 2014 was estimated using cross-sectional Health Survey for England data and mortality statistics 4-7 . HWLE projections until the year 2035 were estimated from Lee-Carter forecasts of transition rates 8 . Projections of life expectancy from age 50 showed gains averaging 10.7 weeks (0.21 years) and 6.4 weeks (0.12 years) per calendar year between 2015 and 2035 for men and women respectively. HWLE has been extending in England but gains are projected to slow to an average of 1 week per year for men (0.02 years) and 2.8 weeks (0.05 years) per year for women between 2015 and 2035. Modest projected HWLE gains and the widening gap between HWLE and life expectancy from age 50 suggest that working lives are not extending in line with policy goals. Further research should identify factors that increase healthy working life., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The new NHS requires transformational leadership; people with the knowledge and motivation to make effective change combined with an understanding of the system they work in. The aim of the Practice Leaders' Programme (PLP) is to generate the conditions needed to focus the energy and collaborative creativity required for innovation to enhance leadership skills across the health economy improving patient care. The PLP engaged 60 local leaders from central England in a new approach enabling them to influence others. It has informed educational policy and practice and helped change professional behaviours. Each participant implemented improvements in care and participated in six action learning sets (ALS) and up to six coaching sessions. Evidence of progress, learning and impact was identified in project reports, reflective diaries and evaluations. The ALS brought together key individuals from clinical and management disciplines across a diverse organisation to redesign a system by developing a shared vision for improving the quality of patient care. The links forged, the projects initiated, and the skills cultivated through the PLP produced ongoing benefits and outcomes beyond the course itself. Coaching sessions helped participants focus their efforts to achieve maximum impact and to become resilient in managing service change effectively. The programme has evolved over four years, building on recommendations from external evaluation which identified statistically significant increases in leadership competences. Further enhancement of this programme secured an International Health Improvement Award. Three key findings of positive impact have emerged; personal growth, service improvement, and legacy and sustainability.

Since their arrival in Britain most Vietnamese mothers have abandoned traditional infant feeding practices for 'modern' methods which are unsatisfactory and expensive. Health staff are not perceived as a source of information or support. This paper emphasizes the need for culturally sensitive initiatives to reverse this trend.

This literature review traces the recognition of child abuse and ends where many texts begin with the publication of Henry Kempe's paper in 1962, where the term, "battered child syndrome," was used for the first time. Starting with the first known treatise in pediatrics, the review examines evidence produced throughout the centuries on the recognition of physical child abuse. Many of the references are medical and show how while the early physicians found it easy to accept that those caring for children might injure them, by the end of the 19th century, more obscure diagnoses were being sought to explain the lesions. However, even during the time some physicians were pursuing "scientific" etiologies, there are publications that demonstrate a continuing acknowledgment of the problem of child abuse. No review of this type can claim to be complete, and the author hopes others will be sufficiently interested to seek out further historical references.

Fifty children referred to the Park Hospital because of actual or threatened abuse were compared with 50 controls born at the same maternity hospital. Five factors were significantly more common in the abused group than among their controls: (a) mother aged under 20 at birth of first child, (b) evidence of emotional disturbance, (c) referral of family to hospital social worker, (d) baby's admission to special care baby unit, (e) recorded concern over the mother's ability to care for child. Thirty-five of the abused group had two or more of these factors compared with only five of the control group. As these data were collected from information recorded routinely at the maternity hospital, it is possible to identify most abusing families when the child is born. Such identification must lead to a comprehensive assessment of each case followed by constructive preventive action.