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Needle and syringe (NS) provision is a proven intervention for reducing harms associated with injecting drug use, such as infections, but impact is coverage-dependent. We characterised people who injected drugs (PWID) in England and Wales who had insufficient NS in the past month to meet their injecting requirements. This study utilised 2017–2019 data from the annual Unlinked Anonymous Monitoring (UAM) Survey of PWID recruited through specialist services. Logistic regression was used to identify factors associated with inadequate NS coverage. Of 2,442 PWID surveyed who had injected in the past month, 34% reported inadequate NS coverage (or as high as 51% if including unsuccessful injections). Younger PWID (adjusted odds ratio: 2.18, 95% confidence interval: 1.35–3.52), those who began injecting in the past three years (1.46, 1.09–2.00), and those who reported sharing injecting equipment (1.46, 1.22–1.75) had greater odds of having inadequate NS coverage. PWID currently prescribed Opioid Substitution Treatment (OST) had lower odds of inadequate NS coverage (0.60, 0.49–0.73). Given the poor reported coverage of NS provision in England and Wales, there is urgent need to address inequity in accessing sufficient NS and increase coverage among this vulnerable group to reduce injecting-related harms. [ABSTRACT FROM AUTHOR]

Background: It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Methods: Remote qualitative semi-structured interviews with 26 communitybased healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. Results: A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. Conclusion: These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group. [ABSTRACT FROM AUTHOR]

Simple Summary: The distribution of ticks is expanding across Europe and the incidence of human and animal tick-borne disease is increasing. This trend is set to continue due to predicted changes in the climate and land use, which alter the interlinked environmental factors required for the feeding and breeding activities of the tick. Babesia divergens is a tick-borne piroplasm which poses a major disease threat to cattle in Great Britain and can also cause significant illness in humans. Surveillance of B. divergens infection in cattle is currently limited, rendering disease monitoring and mitigation strategies against evolving environmental conditions impossible. This surveillance project collected spatial and temporal data on B. divergens infection in British cattle and analysed the risk factors for disease. B. divergens was detected in 47.4% of submitted samples. The infections occurred throughout the grazing season. The majority of the cases were diagnosed in South West England; however, other geographical risk areas were identified. These data support future assessment of disease dynamics in the face of evolving environmental conditions. No significant herd- or animal-level disease risk factors were identified. The PCR methods used in this case offer improvements in identifying Babesia at species level and offer compatibility with current human diagnostic guidelines. Babesia divergens is a zoonotic piroplasm that infects both cattle and humans in Europe. Disease transmission occurs through Ixodes ricinus tick bites, a species that is increasing in abundance and distribution across Europe in response to climate and land-use changes. Developments in agri-environment policy and changing consumer demands may also have unintended consequences on tick-borne disease rates. Currently, B. divergens surveillance in British cattle is limited, rendering temporal trend analysis and the detection of potential zoonotic hotspots impossible. The objective of this study was to assess syndromic surveillance as a means of determining babesiosis distribution in British cattle, and to evaluate the intrinsic disease risk factors in order to respond to disease threats posed by changing environments. Samples from 95 clinically affected cattle on 70 unique holdings were screened for Babesia spp., using established blood smear examination techniques and a B. divergens-specific PCR method, between April and December 2021. B. divergens was detected in 45/95 animals (47.4%), with PCR offering the advantage of identification at species level. Infection with Anaplasma phagocytophilum was detected in 19/95 animals (20%). Co-infection was detected in five animals. The cases were recorded across multiple geographic regions and throughout the sampling period. Univariate logistic regression analysis failed to identify any statistically significant risk factors for B. divergens presence. This study demonstrates that bovine babesiosis is geographically widespread throughout England and Wales, placing a large proportion of the cattle population at risk of infection, with the potential for zoonotic transmission to humans. [ABSTRACT FROM AUTHOR]

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

Introduction: The objective of this study was to use a prospective error analysis method to examine the process of dispensing medication in community pharmacy settings and identify remedial solutions to avoid potential errors, categorising them as strong, intermediate, or weak based on an established patient safety action hierarchy tool. Method: Focus group discussions and non-participant observations were undertaken to develop a Hierarchical Task Analysis (HTA), and subsequent focus group discussions applied the Systematic Human Error Reduction and Prediction Approach (SHERPA) focusing on the task of dispensing medication in community pharmacies. Remedial measures identified through the SHERPA analysis were then categorised as strong, intermediate, or weak based on the Veteran Affairs National Centre for Patient Safety action hierarchy. Non-participant observations were conducted at 3 pharmacies, totalling 12 hours, based in England. Additionally, 7 community pharmacists, with experience ranging from 8 to 38 years, participated in a total of 4 focus groups, each lasting between 57 to 85 minutes, with one focus group discussing the HTA and three applying SHERPA. A HTA was produced consisting of 10 sub-tasks, with further levels of sub-tasks within each of them. Results: Overall, 88 potential errors were identified, with a total of 35 remedial solutions proposed to avoid these errors in practice. Sixteen (46%) of these remedial measures were categorised as weak, 14 (40%) as intermediate and 5 (14%) as strong according to the Veteran Affairs National Centre for Patient Safety action hierarchy. Sub-tasks with the most potential errors were identified, which included 'producing medication labels' and 'final checking of medicines'. The most common type of error determined from the SHERPA analysis related to omitting a check during the dispensing process which accounted for 19 potential errors. Discussion: This work applies both HTA and SHERPA for the first time to the task of dispensing medication in community pharmacies, detailing the complexity of the task and highlighting potential errors and remedial measures specific to this task. Future research should examine the effectiveness of the proposed remedial solutions to improve patient safety. [ABSTRACT FROM AUTHOR]

Direct‐acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled‐up in England since 2017. To assess early impacts, we investigated trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self‐reported treatment access. Bio‐behavioural data from an annual, national surveillance survey of PWID (2011–2018) estimated trends in viraemic prevalence among HCV antibody‐positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection. Between 2011 and 2016, viraemic prevalence among antibody‐positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p < 0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio [aOR] 0.79, 95% CI 0.65–0.94) and 2018 (aOR 0.79, 95% CI 0.66–0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95% CI 1.53–1.86), geographical region, injecting in past year (aOR 1.26, 95% CI 1.13–1.41), imprisonment (aOR 1.14, 95% CI 1.04–1.31) and homelessness (aOR 1.17, 95% CI 1.04–1.31). Among non‐viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p < 0.001) and 2018 (38.9%, p < 0.001) compared to 2016 (14.5%). In conclusion, there has been a small reduction in HCV viraemia among antibody‐positive PWID in England since 2016, alongside DAA scale‐up, and some indication that treatment access has improved in the same period. Population‐level monitoring and focus on harm reduction is critical for achieving and evaluating elimination. [ABSTRACT FROM AUTHOR]

Background The European Centre for Disease Prevention and Control, National Institute for Health and Care Excellence and Public Health England have all endorsed the use of antivirals for the treatment and prophylaxis of influenza for care home residents. However, implementing these guidelines in practice is often challenging. This article aims to explore what factors impact the management of care home flu outbreaks in England according to national guidelines and highlight opportunities for change. Methods Qualitative data from notified outbreaks between September 2017 to April 2018 in the South East of England were analyzed, applying the Greenhalgh framework for barriers to guideline implementation. Summary statistics on outbreak characteristics were generated. Stakeholders were mapped out using Eden and Ackermann's grid of interest and influence. A process map was developed to describe operational pathways. Results There was often a delay in notifying potential outbreaks to Public Health England. Clinicians cited a lack of robust evidence for the use of antivirals and the available guidelines being too unwieldy as reasons for not implementing prescribing guidance. Many high interests and high influence stakeholders are involved in the sometimes complex care pathway, requiring coordinated work and agreement before antivirals can be prescribed. Conclusions Our findings highlight points in the care pathway that stakeholders can target to improve quality of care and increase the likelihood of national guidance being implemented. The principles described in this article can also be applied to other challenges of translating evidence into practice and cross-organisational working. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to evaluate the current service provision offered by a mental health service in a young offenders institute (YOI) in England. Design/methodology/approach: A qualitative exploratory approach was adopted. Five prison officers (POs) (four male and one female) with direct experience supporting young people through mental health intervention were interviewed using semi-structured interviews. Data was analysed using thematic analysis (Braun and Clarke, 2006), which allowed evaluation of the current mental health provision to evolve. Findings: Five overarching themes (process of referrals; intervention and its impact; role and function of the health and well-being team; collaboration and involvement; and feedback, communication and intervention) were found to be highly salient when evaluating service provision. Notably all themes interrelated with one another, demonstrating that changes or improvements made to the service need to consider all factors individually and collectively. Research limitations/implications: This study was based on a small sample of POs in only one YOI in England, and therefore cannot be generalised to the entire prison estate. However, it does offer a rich insight into local service provision from the perspective of a group whose opinion is rarely sought. Practical implications: POs' perspectives of service provision are important in informing service developments. Lessons can be learnt from their unique insight into how prison mental health services are run to improve processes and collaborative working in the management of young offenders with mental health difficulties. Originality/value: This preliminary and exploratory study is, to the best of the authors' knowledge, the first study evaluating service provision by using the perspectives of POs. The findings suggest that POs make valuable contributions to the service development and should be involved in similar evaluations in future. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the IJHG Review is to enable readers to gain a quick overview of articles contained in an individual issue. Design/methodology/approach: All current articles are read by the Review Editor who then prepares the Review. Findings: Common themes are identified and key concepts are extracted from each article. Practical implications: The Review enables readers to prioritize articles of the greatest interest to them. Originality/value: The originality value of the IJHG Review is that no other Emerald Journal offers a Review section of this kind. [ABSTRACT FROM AUTHOR]

Background: Bovine babesiosis, commonly known as redwater fever, is a sporadic tick-borne disease in the United Kingdom. Outbreaks occur during the spring, summer and autumn months when ticks are active. This study reports the findings of an investigation of an outbreak of bovine babesiosis during the winter month of February, 2019. Methods: DNA from blood, organ and tick samples taken from affected cattle were tested for the presence of piroplasm and Anaplasma phagocytophilum DNA using PCRs directed to the 18S rRNA gene and msp2 gene respectively. The species of piroplasm was confirmed by sequencing. Results: Babesia divergens DNA was detected in the blood of five cattle displaying clinical signs of babesiosis within a herd of twenty. This parasite was also detected in three of ten ticks removed from one of the affected cattle. In addition, A. phagocytophilum was detected in three cattle tested and two of ten of the ticks. Conclusions: An outbreak of bovine babesiosis during February is unusual as the tick vector, Ixodes ricinus, does not generally become active until temperatures rise later in the year. February of 2019 was unusual as average temperatures during the first week of the month reached over 10 °C, well above historical averages that are typically below 5 °C, and a temperature at which ticks can become active. This unusual weather event is likely to have triggered tick questing, that combined with a co-infection with two tick-borne pathogens caused the severe outbreak of disease. [ABSTRACT FROM AUTHOR]

Purpose: There are significant health inequalities experienced by women in prison. They face distinct challenges and have particular and complex needs, specifically with regard to their physical and mental health. The purpose of this paper is to describe the approach taken to develop a set of health and wellbeing standards for the women's prison estate in England, which can be applied elsewhere.Design/methodology/approach: A structured literature review of standard healthcare databases and grey literature was used to inform development of suggested standards. A multidisciplinary expert panel provided consensus on the standards through an online survey and women with a history of contact with the criminal justice system were consulted through consensus groups.Findings: A total of 549 papers were included in the final review. From this, 127 standards were identified for inclusion in the Delphi process. Consensus was achieved on all standards; this, combined with the analysis of qualitative feedback provided by both the survey and the consensus groups, resulted in the development of 6 overarching principles and 122 standards, across ten topic areas.Originality/value: These standards are the most extensive that are known to exist for health and wellbeing of women in prison and the first to be developed in England. The process used ensures the standards have high validity, acceptability and feasibility and can be used to support those developing similar methodologies. There are few papers which document the development of standards to improve health and to the authors knowledge, only one other paper has been published detailing the development of health standards in prison settings specifically. [ABSTRACT FROM AUTHOR]

Objective  Tuberculosis (TB) can affect young children, resulting in serious disease at a young age or reactivation later in life. Identifying cases of latent TB infection (LTBI) in children exposed to active cases is important to prevent morbidity and mortality. There is currently limited guidance on appropriate testing methods in situations involving mass screening of children in low TB incidence settings such as England. This study describes case reports of two separate occasions in which nursery-age children in England underwent LTBI screening and explores the decisions involved in choosing the most appropriate test and screening process. Methods  A literature search, review of health protection case and incident management notes, and interviews with key stakeholders were conducted. Results  Two different tests—tuberculin skin testing and interferon gamma release assay—were used in each respective screening situation and the decision between the two was taken based on cohort, organizational, and index case risk factors. Screening took place in dedicated secondary care clinics. No cases of LTBI were identified from either screening incident. Conclusion  Our study highlights the lack of definitive guidance for mass LTBI screening of young children and presents the approaches to decision making that can be adopted by others. Further research is required to test the approach suggested in this article and to ensure that evidence-based national guidance provides a consistent and effective approach to such incidents. [ABSTRACT FROM AUTHOR]

Objective: To explore the factors contributing to prescribing error in paediatric intensive care units (PICUs) using a human factors approach based on Reason's theory of error causation to support planning of interventions to mitigate slips and lapses, rules-based mistakes and knowledge-based mistakes.Methods: A hierarchical task analysis (HTA) of prescribing was conducted using documentary analysis. Eleven semistructured interviews with prescribers were conducted using vignettes and were analysed using template analysis. Contributory factors were identified through the interviews and were related to tasks in the HTA by an expert panel involving a PICU clinician, nurse and pharmacist.Results: Prescribing in PICU is composed of 30 subtasks. Our findings indicate that cognitive burden was the main contributory factor of prescribing error. This manifested in two ways: physical, associated with fatigue, distraction and interruption, and poor information transfer; and psychological, related to inexperience, changing workload and insufficient decision support information. Physical burden was associated with errors of omission or selection; psychological burden was linked to errors related to a lack of knowledge and/or awareness. Social control through nursing staff was the only identified control step. This control was dysfunctional at times as nurses were part of an informal mechanism to support decision making, was ineffective.Conclusions: Cognitive burden on prescribers is the principal latent factor contributing to prescribing error. This research suggests that interventions relating to skill mix, and communication and presentation of information may be effective at mitigating rule and knowledge-based mistakes. Mitigating fatigue and standardising procedures may minimise slips and lapses. [ABSTRACT FROM AUTHOR]

Background: There is a need to ensure that the risks associated with medication usage in primary health care are controlled. To maintain an understanding of the risks, health‐care organizations may engage in a process known as "mindful organizing." While this is typically conceived of as involving organizational members, it may in the health‐care context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety. Method: Qualitative focus groups and interviews were carried out with 126 members of the public in North West England and the East Midlands. Participants were taking medicines for a long‐term health condition, were taking several medicines, had previously encountered problems with their medication or were caring for another person in any of these categories. Participants described their experiences of dealing with medication‐related concerns. The transcripts were analysed using a thematic method. Results: We identified 4 themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with health‐care professionals; and the relationship between patients and the health‐care system (in particular, mutual trust). Conclusions: Mindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and are strengthened by) patients' engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement. [ABSTRACT FROM AUTHOR]

England has one of the highest rates of TB in Western Europe and significant disease burden exists within prisons. International efforts to advance the prevention and control of TB in prisons have culminated in new system-wide strategies being implemented in English prisons to identify and treat the disease. This article summarises these developments with the aims to inform those working in relevant healthcare or policy roles, and to promote best practice internationally. A review of national and international policy was conducted, and expert advisors in the field of health and justice and TB were approached through Public Health England professional networks to contribute evidence. [ABSTRACT FROM AUTHOR]

Objective Hypothyroidism is more frequently diagnosed in women and older individuals. It has been suggested that the prevalence of hypothyroidism and the number of prescriptions for thyroid hormones are increasing. However, despite hypothyroidism being a common medical condition, contemporary data on prevalence, particularly across the various age groups, is limited. Design Information regarding number of individuals diagnosed with treated hypothyroidism (defined as patients prescribed levothyroxine) across ten General Practices (total population of 66 843) in the North-East of England in 2016 was obtained in an anonymized manner. Total as well as age group-specific point prevalence rates were calculated. In addition, corresponding population data for the United Kingdom were acquired, and national total and age-specific hypothyroidism prevalence rates were estimated. Results The overall prevalence of hypothyroidism in this community sample was 4.5% (n = 3004). Prevalence increased across the age groups from 0.1% in children aged 0-10 years to 15.1% in those aged more than 90 years. After adjusting for demographic differences between the North-East England and UK populations, it is estimated that the total UK-wide prevalence of hypothyroidism in 2016 is 3.6%; affecting more than 2.3 million individuals including nearly 800 000 individuals aged >70 years. Conclusions Hypothyroidism affects millions of individuals in the UK and is currently a prevalent diagnosis in more than 1 in 10 individuals aged above 70 years. As the population ages this number is likely to increase. The clinical and economic effects of current management strategies for hypothyroidism, particularly in the older population, need to be evaluated. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgery remains the gold standard for patients with resectable nonsmall cell lung cancer. Current guidance identifies patients with poor pulmonary reserve to fall within a high-risk cohort. The aim of this study was to determine the clinical and quality of life outcomes of anatomical lung resection in patients deemed high risk based on pulmonary function measurements. METHODS: A retrospective review of patients undergoing anatomical lung resection for nonsmall cell lung cancer between January 2013 and January 2015 was performed. All patients with limited pulmonary reserve defined as predicted postoperative forced expiratory volume in 1 s or transfer factor of the lung for carbon monoxide of <40% were included in the study. Postoperative complications, admission to the Intensive Care Unit, length of stay, and 30-day in-hospital mortality were recorded. The European Organization for Research and Treatment of Cancer quality of life questionnaire lung cancer 13 questionnaire was used to assess quality of life outcomes. RESULTS: Fifty-three patients met the inclusion criteria. There was no in-hospital mortality, and 30-day mortality was 1.8%. No complications were seen in 64% (n = 34), minor complications occurred in 26% (n = 14), while 9% had a major complication (n = 5). Quality of life outcomes were above the reference results for patients with early stage lung cancer. CONCLUSION: Anatomical lung resection can be performed safely in selected high-risk patients based on pulmonary function without significant increase in morbidity or mortality and with acceptable quality of life outcomes. Given that complications following lung resection are multifactorial, fitness for surgery should be thoroughly assessed in all patients with resectable disease within a multidisciplinary setting. High operative risk by pulmonary function tests alone should not preclude surgical resection. [ABSTRACT FROM AUTHOR]

Background: Monitoring for potentially hazardous prescribing is increasingly important to improve medication safety. Healthcare information technology can be used to achieve this aim, for example by providing access to prescribing data through surveillance of patients' electronic health records. The aim of our study was to examine the implementation and adoption of an electronic medicines optimisation system that was intended to facilitate clinical audit in primary care by identifying patients at risk of an adverse drug event. We adopted a sociotechnical approach that focuses on how complex social, organisational and institutional factors may impact upon the use of technology within work settings.Methods: We undertook a qualitative realist evaluation of the use of an electronic medicines optimisation system in one Clinical Commissioning Group in England. Five semi-structured interviews, four focus groups and one observation were conducted with a range of stakeholders. Consistent with a realist evaluation methodology, the analysis focused on exploring the links between context, mechanism and outcome to explain the ways the intervention might work, for whom and in what circumstances.Results: Using the electronic medicines optimisation system could lead to a number of improved patient safety outcomes including pre-emptively reviewing patients at risk of adverse drug events. The effective use of the system depended upon engagement with the system, the flow of information between different health professionals centrally placed at the Clinical Commissioning Group and those locally placed at individual general practices, and upon variably adapting work practices to facilitate the use of the system. The use of the system was undermined by perceptions of ownership, lack of access, and lack of knowledge and awareness.Conclusions: The use of an electronic medicines optimisation system may improve medication safety in primary care settings by identifying those patients at risk of an adverse drug event. To fully realise the potential benefits for medication safety there needs to be better utilisation across primary care and with a wider range of stakeholders. Engaging with all potential stakeholders and users prior to implementation of such systems might allay perceptions that the system is owned centrally and increase knowledge of the potential benefits. [ABSTRACT FROM AUTHOR]

This paper uses the notion of the body to frame an archaeology of sexual violence policy in England and Wales, applying and developing Pillow's ideas. It argues that the dominant construction is of sexual violence as an individualized crime, with the solution being for a survivor to report, and with support often instrumentalized in relation to criminal justice objectives. However, criminal justice proceedings can intensify or create further trauma for sexual violence survivors. Furthermore, in addition to criminalizing the violent body and supporting the victimized one, there is a need for policy to produce alternative types of bodies through preventative interventions. Much sexual violence is situated within (hetero)sexual dynamics constructing a masculine aggressor and a feminine body which eventually yields. Prevention must therefore focus on developing embodied boundaries, and narratives at the margins of policy could underpin such efforts. [ABSTRACT FROM AUTHOR]

The article focuses on Constance Louisa Maynard, the first mistress of Westfield College in London, England. According to the author, Maynard has written various considerable books, both published and unpublished. She started her writings at the age of 16 in 1866 mainly to document her progress as a Christian. In 1871, her writing became her outlet for her passion about love, complex dealings with faith, desire, and sexual identity. It further notes that Maynard's frankness in disclosing her feelings through her writings adds distress and great historical value to her personal accounts.

A single specimen of a new species of oribatid mite belonging to the genus Jureremus Krivolutsky, in Krivolutsky and Krassilov 1977 , previously described from the Upper Jurassic of the Russian Far East, is described as J. phippsi sp. nov. The mite is preserved by iron pyrite replacement, and was recovered by sieving from the Oxford Clay Formation (Jurassic: Upper Callovian) of South Cave, Yorkshire. It is the first record of a pre-Pleistocene mite, and the second species record of the family Cymbaeremaeidae, from the British Isles; also, it is only the third record of Acari from the Jurassic Period. The presence of a terrestrial mite in a sedimentary sequence of open marine origin is noteworthy, and suggestions for its mode of transport to the site of deposition are discussed. [ABSTRACT FROM AUTHOR]

The article reviews the Barnsley Education Support Training scheme which provides opportunities for continuing professional development for general practitioner principals contracted to Barnsley Primary Care Trust in England The scheme aims to encourage reflective evaluation and self-directed learning. It also enables the pursuit of professional development in a style that is most appropriate to the learner. The validity of the approach for the current climate is examined.

The article presents a study on the comparisons of health outcomes for children living in Canada, England, Norway, and the U.S. Results of the study indicated that Norwegian children have better health than children in the other three countries but Canadian children have better over-all parental assessed status. However, U.S. children rank ahead in terms of anxiety, hyperactive behavior and depression while English children have better outcomes for less likely to have accidents and injuries.

The article presents information about the history of subscription library, the London Library in London, England. The London Library is an independent subscription lending library has been providing a wide range of books on humanities to its members since 1841. The books and periodicals on applied art and the history of art in European languages is the most important feature of this library. The London Library was set up in 1841 and based on the objective of Victorian philanthropy for promoting education, learning and knowledge by preserving and developing an open-access lending library. When the London Library's commenced its operations at that time it has only few thousand books and was serving to few hundred subscribing members but its growth was rapid and by the end of first decade it was shifted to its present building in the north-west corner of St James's Square. The London Library is a registered educational charity organization and governed by a group of volunteer trustees. The collections of books `Needlework', `Embroidery', `Tapestry' and `Lace' sections are amongst valuable research resource of applied arts of the library.

This paper examines Eliza Lynn Linton's experience as a result of her conflicting sentiments about English Victorian gendered norms. Linton's “male” ambition facilitated her entrance into the male work sphere, yet her writing preached the values of domesticity while denigrating women such as herself, who sought careers. Eliza's gender dilemma was best projected in her autobiographical novel, The Autobiography of Christopher Kirkland (1885). This text, which evokes the ambivalence between her acclamation of femininity and her “mannish” behaviour, indicates the tenuous structure of gender and emotional norms. The “role” Eliza assumes as a male suitor, while suggesting interesting meanings about her real-life male and female relationships, hints at the multifaceted nature of her desire. This study of culture may inform current considerations of gender and sexual identity. [ABSTRACT FROM AUTHOR]

During 2022–2023, the UK found itself in the midst of a domestic energy crisis, with the average domestic gas and electricity bill rising by 75% between 2019 and 2022. As a result, the use of hot water bottles, radiant heaters, and electric blankets increased. An unintended consequence of this may be an increase in burn injuries caused by misfortune, misuse, or the use of items in a state of disrepair. The aim of this study was to explore any increase in referrals to a single burns centre in England for injuries caused by hot water bottles, radiant heaters, or electric blankets. This was a retrospective study of a prospectively maintained database of referrals. All referrals between January 2022 and January 2023 were selected and compared with the same period from 2020–2021 (before the rise in energy prices). Referrals were screened for the terms "hot water bottle," "electric heater," "electric blanket," and "heater." Total referrals in each period, demographic data (age, gender), anatomical location and the mechanism of injury were compared between cohorts. We found a statistically significant increase in the number of burns relating to heating implements between 2020/21 and 2022/23, rising from 54 to 81 (p = 0.03) – a 50% increase in injuries. Injuries in working age adults increased significantly (52% to 69%, p < 0.05). The most frequently injured area was the leg (30%) followed by the hand (18%). The commonest type of injury described was scald (72%). We found a moderately-strong correlation between the number of referrals and the average cost of energy in 2022–23. The number of injuries sustained by people using personal heating equipment is significantly increasing, which correlated with the rise in domestic energy prices. The most affected demographic appears to be working age adults, with wider implications around lost work-time yet to be explored. Further prospective, population-based work is indicated to assess the strength of the correlation seen in this study. • The number of injuries caused by personal heating equipment (hot water bottles, heaters, heat pads etc) has increased • This increase appears to correlate with the increase in price of domestic gas and electricity • There is a need for public health messaging on personal safety when using this equipment [ABSTRACT FROM AUTHOR]

Examines the relation of fetal and infant growth to plasma fibrinogen and factor VII concentrations on adult life in England. Follow-up on men born during 1920 to 1930; Measurement of plasma fibrinogen and factor VII concentrations; Influence of restricted growth in early life.

In this article the author discusses the London Library, a private library in London, England. He notes that in the age of the Internet the London Library remains devoted to the continuing use of printed books. The history of the institution, from its founding by Thomas Carlyle in 1841, through to 2007. The London Library's unique system of book classification is described. The author observes that the London Library had a significant impact on the profession of indexer. The governance and membership of the library is described.

The aim of the study was to describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland. This is a cross-sectional Unlinked Anonymous Monitoring (UAM) Survey of PWID. People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease 2019 (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared with data from the 2019 UAM Survey, where possible. Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 than in 2019; cocaine injection in the preceding four weeks increased from 17% (242/1456) to 25% (33/130). One in five PWID (19%; 35/188) reported difficulties in accessing HIV and hepatitis testing, and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting. Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services owing to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities. • People who inject drugs (PWID) in England/Northern Ireland are at risk of coronavirus disease 2019. • Patterns of psychoactive drug use have shifted over the course of the pandemic. • Of particular concern, access to essential services for PWID has been restricted. [ABSTRACT FROM AUTHOR]

Introduction: In the United Kingdom, the incidence of assault by burning and of self inflicted burns increased significantly over the last decade. This has major implications both for service providers and society as a whole. Our aim was to investigate the differences in patients' characteristics, management and outcome following a burn sustained by either an assault or self immolation., Methods: Acute admissions to a tertiary Burn Centre were retrospectively reviewed over an 11 year period (1994-2005). Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of the patients were collected., Results: Over an 11 year period, 1745 patients were admitted to the tertiary Burn Centre. Of this total, 41 patients (mean age 29 years+/-16) sustained burns following an assault, a further 86 patients (mean age of 37 years+/-12) had self inflicted burn injuries; males were preponderant in both groups. In this series, a history of alcohol or substance abuse was present in 25% of both cohorts, 63% of the patients with self inflicted injuries having a previously diagnosed psychiatric disorder. Petrol, accelerants and other flammable liquids were the main agents chosen to inflict injury in both the assault and self inflicted groups. The burn depth and surface area distribution was greater in the self inflicted group compared to those assaulted (29% versus 21%). A difference was also noted in the pattern of distribution of burns between the two groups, as well as between genders although this difference was not significant. Two-thirds (67.4%) of the self immolated patients and 56% of the assaulted group required surgery. The length of hospital stay was similar for both groups, averaging 20 days. The crude mortality for the self inflicted group was 29%, whereas in the assaulted patients, the overall mortality was 4.9%., Conclusion: Although the incidence of burns caused either by assault or attempted suicide is low, the affected patients require a multidisciplinary approach. Their management requires significant medical, psychological occupational and social support. Increased awareness and education of those vulnerable individuals maybe of benefit to help prevent self inflicted injuries by burning.