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Objectives: Tissue diagnosis prior to thoracic surgery with curative intent is vital in thoracic lesions concerning for lung cancer. Methods of obtaining tissue diagnosis are variable within the United Kingdom. Methods: We performed a model-based analysis to identify the most efficient method of diagnosis using both a health care perspective. Our analysis concerns adults in the UK presenting with a solitary pulmonary nodule suspicious for a primary lung malignancy, patients with more advanced disease (for example lymph node spread) were not considered. Model assumptions were derived from published sources and expert reviews, cost data were obtained from healthcare research group cost estimates (2016-17). Outcomes were measured in terms of costs experienced to healthcare trusts. Results: Our results show that CT guided percutaneous lung biopsy using an ambulatory approach, is the most cost-effective method of diagnosis. Indeed, using this approach, trust experience approximately half of the cost of an approach of surgical lung biopsy performed at the time of potential resection ('frozen section'). Limitations and conclusions: Whilst this analysis is limited to the specific scenario of a solitary pulmonary nodule, these findings have implications for the implementation of lung cancer screening in the UK, which is likely to result in increased numbers of patients with such early disease.

Spelling is a prerequisite to expressing vocabulary in writing. Research has shown that children with dyslexia are hesitant spellers when composing. This study aimed to determine whether the hesitant spelling of children with dyslexia, evidenced by frequent pausing, affects vocabulary choices when writing. A total of 31 children with dyslexia, mean age 9 years, were compared to typically developing groups of children: the first matched by age, the second by spelling ability. Oral vocabulary was measured and children completed a written and verbal compositional task. Lexical diversity comparisons were made across written and verbal compositions to highlight the constraint of having to select and spell words. A digital writing tablet recorded the writing. Children with dyslexia and the spelling-ability group made a high proportion of spelling errors and within-word pauses, and had a lower lexical diversity within their written compositions compared to their verbal compositions. The age-matched peers demonstrated the opposite pattern. Spelling ability and pausing predicted 53% of the variance in written lexical diversity of children with dyslexia, demonstrating the link between spelling and vocabulary when writing. Oral language skills had no effect. Lexical diversity correlated with written and verbal text quality for all groups. Practical implications are discussed and related to writing models. [ABSTRACT FROM AUTHOR]

Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods. [ABSTRACT FROM AUTHOR]

Although there has been much general discussion in the academic literature about the influence of cross-media adaptations on the success or otherwise of the additional media outputs that result, there has been less actual empirical investigation of this hypothesized link using quantitative data to test the arguments being made. This article consequently examines the commercial effects of the release of film adaptations on the sales and printing of the original books in question, by first analysing data on the outputs of two well-known popular novelists of the inter-war period (A. E.W. Mason and Baroness Orczy). It then examines this topic from a company history perspective, documenting the fate of a specific British film production company (Stoll Picture Productions Limited) that specialized in this type of literary adaptation. Finally, some more general observations about the cultural economics of cross-media productions are deduced. [ABSTRACT FROM AUTHOR]

There is a widespread academic and policy debate about public responses to precaution in public health campaigns. This paper explores these issues in relation to the precautionary stance adopted in the UK around the regulation of mobile telecommunications. The aim of the paper is to examine the nature of attitudes to precaution, and the way in which these, along with other relevant variables, relate to the intention to adopt relevant behaviours. The results from an experimental study (n = 173) indicate that people distinguish between two dimensions of precaution: firstly in relation to its value or necessity per se and secondly as anchored to notions of governance. The two variables differentially relate to other variables including trust and uncertainty, and are predictive of intended behaviour change indirectly, through worry about mobile phone risks. Precautionary advice was generally interpreted as causing concern rather than providing reassurance. The results suggest that precaution may be considered a valuable stance but this does not mean that it is seen as good governance or that it will reduce concern. Whilst the discourse of precaution is aimed at reducing concern, it appears that the uptake of relevant behaviours is largely triggered by worry. [ABSTRACT FROM AUTHOR]

Background: Previous health research has often explicitly excluded individuals from minority ethnic backgrounds due to perceived cultural and communication difficulties, including studies where there might be language/literacy problems in obtaining informed consent. This study addressed these difficulties by developing audio-recorded methods of obtaining informed consent and recording data. This report outlines 1) our experiences with securing recruitment to a qualitative study investigating alternative methods of data collection, and 2) the development of a standardised process for obtaining informed consent from individuals from minority ethnic backgrounds whose main language does not have an agreed written form. Methods: Two researchers from South Asian backgrounds recruited adults with Type 2 diabetes whose main language was spoken and not written, to attend a series of focus groups. A screening tool was used at recruitment in order to assess literacy skills in potential participants. Informed consent was obtained using audio-recordings of the patient information and recording patients' verbal consent. Participants' perceptions of this method of obtaining consent were recorded. Results: Recruitment rates were improved by using telephone compared to face-to-face methods. The screening tool was found to be acceptable by all potential participants. Audio-recorded methods of obtaining informed consent were easy to implement and accepted by all participants. Attrition rates differed according to ethnic group. Snowballing techniques only partly improved participation rates. Conclusion: Audio-recorded methods of obtaining informed consent are an acceptable alternative to written consent in study populations where literacy skills are variable. Further exploration of issues relating to attrition is required, and a range of methods may be necessary in order to maximise response and participation rates. [ABSTRACT FROM AUTHOR]

The article reflects on the role of pharmacists in informing people about the benefits and the risks of using opioid medicines. It mentions three areas where pharmacists can promote safer use of opioids for chronic non-cancer pain which include addressing the knowledge gap; regular reviews; and involving patients. It states that British Pain Society recommends that the maximum dose of an opioid for chronic non-cancer pain should be 120 milligram ‘morphine equivalent dose' (MED) per day.

This article situates the analysis of fair-trade consumption in the context of debates about civic activism and political participation. It argues that fair-trade consumption should be understood as a political phenomenon, which, through the mediating action of organizations and campaigns, makes claims on states, corporations, and institutions. This argument is made by way of a case study of Traidcraft, a key player in the fair-trade movement in the United Kingdom. The study focuses on how Traidcraft approaches and enrolls its supporters. The Political Rationalities of Fair-Trade Consumption in the United Kingdom. [ABSTRACT FROM AUTHOR]

The article discusses the incidents of bee poisoning in Great Britain in 1994 up to 2003. This paper focuses on the effects of pesticides to honeybees (Apis mellifera, L.) and bumblebees (Bombus terrestris, L.) monitored by the UK Agriculture Departments for over twenty years. This is in part of the Wildlife Incident Investigation Scheme (WIIS). The results gathered by these organizations were reviewed for pesticide regulatory process. Trends in the span of twenty years look promising as reported incidents of bee poisoning are slowly decreasing in number. The possible reasons in the circumstances are discussed.

Objective To survey the Leonberger, a numerically small breed in the UK, for the presence of cataract and find statistical support for the possible presence of inherited forms of cataract. Methods Ocular examinations were carried out by the first author between September 1996 and September 1998 on 211 Leonbergers; results of the ocular examination of further 228 Leonbergers examined between January 1990 and September 1998 by members of the British Veterinary Association/KC/ISDS eye scheme (BVA/KC/ISDS eye scheme) panel were analyzed. Data from all dogs examined were pooled in a composite database of 365 Leonbergers and the relationships between offspring and parents for the identified forms of cataract were examined with appropriate statistical methods. Results Cataracts were diagnosed in 90 Leonbergers, the majority being nuclear (40) or posterior polar subcapsular (31). A subgroup of nuclear cataracts, diagnosed in 11 dogs, is described and named as ‘posterior nuclear cataract.’ For posterior polar cataract, a positive association between offspring and parents was made in the logistic regression model, supporting the suggestion of inheritance. Conclusions The presence of several types of cataract in the UK Leonberger population is described. Statistical support for the inheritance of posterior polar subcapsular cataract is given. [ABSTRACT FROM AUTHOR]

Recent developments in UK higher education are turning attention to the undergraduate curriculum. Drawing on Lyotard's concept of performativity, this paper explores broad patterns of curriculum change in five subject areas. The curriculum is understood as an educational project forming identities founded in three domains: knowledge, action and self. Curriculum models are proposed that identify these components and their relationships with each other. The evidence suggests that the weightings and levels of integration of these components vary between the sciences and technology subjects, the arts and humanities, and professional courses. Attempts to develop curriculum strategies should take account of the patterns of curriculum components as they vary between the subject areas. [ABSTRACT FROM AUTHOR]

Background: Lowering energy (calorie) intake is essential in managing a healthy weight. One method of doing this is substituting sugar with low/no-calorie sweeteners. The safety of sweeteners has been debated, but little is known about how they are perceived by professionals responsible for weight management advice. We sought to explore dietitian perceptions of sweeteners and to identify the practical advice they provide about them. Methods: We collected data in France, Germany, Hungary, Portugal and the United Kingdom. We used face-toface interviews and a novel online tool designed to engage people with online content in a way that approximates everyday processes of making sense of information. Results: We identified four approaches to sweeteners that dietitians took: (1) sweeteners should not be used, (2) they should be limited and used primarily as a transitional product, (3) sweetener use was decided by the client and (4) sweeteners should be recommended or at least allowed. Where dietitians are reticent to recommend sweeteners this is because they feel it is important for consumers to reduce their attachment to sweet tastes and of evidence linking the consumption of sweeteners to increased appetite. There is also uncertainty about the possible negative health effects of sweeteners. Conclusions: Dietitians' perceptions about sweeteners are uncertain, ambivalent and divergent, sometimes explicitly being linked to fears about adverse health effects. Clear and authoritative guidance is required on scientific evidence around sweeteners as well as the ways in which they can be used in dietetic practice. [ABSTRACT FROM AUTHOR]

Background: Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment, and intervention provide valuable information for practitioners. However these are directed primarily at German-speaking countries and focus on work with children. Aim: The aim of this project was to consider the application of these guidelines in the UK and to extend them for use with adults with DCD. Methods: Individuals with DCD, parents, and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials. Results: A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets was produced to disseminate this information to health and education professionals, parents, and employers. Conclusions: This work will raise awareness of the condition across different professional groups. It provides information to help those working with children and adults with DCD in the UK to assist in the process of diagnosis, assessment, and intervention. [ABSTRACT FROM AUTHOR]

Understanding how consumers react to what is happening as a crisis evolves is crucial for those charged with risk management and risk communication. Responsibility, blame and accountability are important concepts in any crisis, particularly when consumer confidence has been damaged. In this article, we examine to what extent, and to what effect, responsibility, blame and accountability figure in consumer reactions in the immediate aftermath of a food crisis. The data we draw on in this article is derived from an online engagement study that took place in ‘real time’ as the crisis unfolded. Through this study, we were able to explore how consumers responded to the adulteration of processed beef products with horsemeat in early 2013 in Ireland and the UK. We found that consumers attributed causal responsibility and allocated blame for the adulteration to three factors: the deliberately deceitful practices of the food industry, the complexity of the food supply chain and demand from (other) consumers for cheap food. We found that consumers were willing to begin the process of rebuilding their confidence in the food system and accountability was viewed as the primary means for restoring confidence. [ABSTRACT FROM AUTHOR]

The article discusses research about the optimization of distributing re-usable prosthetics from Great Britain to Sri Lanka. Topics mentioned include the initiative of Meththa Foundation to provide free prosthetic and orthopedic services to low-income community in Sri Lanka, benefits of mobile satellite clinics and improvement of a modular limb system equipped with a Jaipur-type foot, and quality of life indicators for service users.

Analysis of short tandem repeats ( STR) is the predominant method for post-transplant monitoring of donor engraftment. It can enable early detection of disease relapse, level of engraftment and provide useful information on the graft-versus-host disease ( GVHD)/graft-versus-tumour ( GVT) effect, facilitating therapeutic intervention. Harmonization and standardization of techniques and result interpretation is essential to reduce the impact of laboratory variability on both clinical management and the results of multi-centre clinical trials. However, the United Kingdom National External Quality Assessment Service for Leucocyte Immunophenotyping ( UK NEQAS LI) has highlighted significant issues inherent in STR testing that impact upon inter- and intra- laboratory variation. We present here consensus best practice guidelines and recommendations for STR chimerism testing, data interpretation and reporting that have been drawn up and agreed by a consortium of 11 UK and Eire clinical laboratories. This document uses data obtained from the UK NEQAS LI Post-Stem Cell Transplant ( SCT) Chimerism Monitoring Programme. [ABSTRACT FROM AUTHOR]

The article presents a comparative analysis for criticism received for the use of military commission in the U.S. and diplock courts in Great Britain. Topics discussed include the Revolutionary War, background on civil war military commission and comments of Kevin Boyle, a human rights activist and member of the Northern Ireland Civil Rights Association, regarding the same.

Aims To investigate concordance with medication, as assessed at baseline and at 1- and 2-year follow-up, and to examine factors associated with non-concordance in a UK-resident South-Asian population. Methods Data from the UK Asian Diabetes Study were analysed. Concordance with medications was assessed and recorded at three time points during the study. Multiple logistic regression was used to investigate the factors associated with non-concordance; the associations of baseline factors with year 1 concordance and baseline plus year 1 factors with year 2 concordance. Results Data for 403 patients from seven practices participating in the UK Asian Diabetes Study were analysed. The numbers of patients who were non-concordant were: 63 (16%) at baseline; 101 (25%) at year 1; and 122 (30%) at year 2. The baseline-measured variables that were significantly associated with year 1 non-concordance included diabetes duration, history of cardiovascular disease, components of the EuroQol quality of life questionnaire, the EQ-5D score, and number of medications prescribed. In multivariable analyses, the most important determinant of year 1 non-concordance was baseline non-concordance: odds ratio 13.6 (95% confidence limits 4.7, 39.9). Number of medications prescribed for blood pressure control was also significant: odds ratio 1.8 (95% confidence limits 1.4, 2.4). Similar results were observed for year 2 non-concordance. Conclusions Non-concordance with medications was common and more likely in people prescribed more medications. The current target-driven management of risk factor levels may lead to increasing numbers and doses of medications. Considering the high cost of medications and the implications of poor health behaviours on morbidity and mortality, further investigation of prescribing behaviours and the factors affecting patient concordance are required. [ABSTRACT FROM AUTHOR]

The article discusses the political debate in Great Britain related to regulation of the media and wonders whether the newly elected Conservative Party government will take action on it. It refers to the British press's criticism of Labour Party leader Ed Miliband due to his views in support of media regulation. The article also discusses media regulation agencies in Great Britain and the media's coverage of elections in the country.

Objectives: To estimate the real-use contraceptive effectiveness of the combined oral contraceptive (COC) containing dienogest and oestradiol valerate (DNG/oEV) compared to other combined oral contraceptives (oCOC) and particularly, levonorgestrel-containing OCs (LNG). Methods: Prospective, non-interventional cohort study with two main exposure groups and one exposure subgroup: new users of DNG/oEV and oCOC, with the subgroup, LNG. In a planned secondary analysis, pregnancy outcomes were investigated, including contraceptive failure. The influence of age, parity and OC-type were assessed. Results: 30,098 COC users were followed for a total oral contraceptive exposure time of 68,362 woman-years (WY) and 287 unintended pregnancies were reported. The overall contraceptive failure rate in the European population was 0.4 events/100 WY (95% CI, 0.4-0.5). DNG/oEV showed lower contraceptive failure rates compared to the comparators. This difference was maintained when the study population was restricted to women aged 18-35 years; the pearl index (PI) for this demographic for DNG/oEV was 0.37 (95% CI 0.24-0.54) and 0.76 (95% CI 0.56-1.01) for LNG. The hazard ratios (HRs) adjusted for age, parity, smoking and BMI were 0.7 (95% CI, 0.5-0.98, p  = .04) and 0.5 (95% CI, 0.3-0.8, p  < .01) for DNG/oEV versus oCOC and LNG, respectively. The corresponding adjusted HRs in women aged 25 years or younger were 0.6 (95% CI 0.4-1.1) and 0.4 (95% CI, 0.2-0.8), respectively. Conclusions/discussion: DNG/oEV showed improved contraceptive effectiveness compared with oCOC and particularly LNG-COC when adjusted for age, parity, user status and smoking.

Background: Cytomegalovirus (CMV) endotheliitis is a significant cause for acute corneal allograft rejection in East Asian populations, where there is a high CMV seroprevalence. To determine how frequently CMV is associated with corneal graft failure in the UK, we looked for the presence of CMV DNA in grafts that had failed and had been removed at repeat keratoplasty. We also looked for CMV DNA in corneal rims discarded after corneal transplantation., Methods: In this retrospective study, we identified 54 cases of corneal graft failure following endothelial rejection and 38 control grafts that had failed without a history of endothelial rejection. For these groups archived formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved. We also prospectively examined 80 non-fixed cornea rims following transplantation surgery. In all samples nested quantitative PCR was used to identify CMV, herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA. We also used in situ hybridisation to examine for CMV DNA in the FFPE samples., Results: No CMV or VZV DNA was detected in any of the archived case or control FFPE tissues. One corneal rim from the control group was positive for HSV. In situ hybridisation for CMV was negative for CMV in all FFPE samples. No CMV, VZV or HSV DNA was detected in the donor corneal rim samples., Conclusion: CMV DNA was not identified in excised failed corneal tissue or from tissue prior to transplantation. We infer that CMV infection is not a significant factor risk for corneal graft failure in the United Kingdom.

Background: Evidence suggests that black, Asian and minority ethnic (BAME) groups have an increased risk of involuntary psychiatric care. However, to our knowledge, there is no published meta-analysis that brings together both international and UK literature and allows for comparison of the two. This study examined compulsory detention in BAME and migrant groups in the UK and internationally, and aimed to expand upon existing systematic reviews and meta-analyses of the rates of detention for BAME populations., Methods: For this systematic review and meta-analysis, we searched five databases (PsychINFO, MEDLINE, Cochrane Controlled Register of Trials, Embase, and CINAHL) for quantitative studies comparing involuntary admission, readmission, and inpatient bed days between BAME or migrant groups and majority or native groups, published between inception and Dec 3, 2018. We extracted data on study characteristics, patient-level data on diagnosis, age, sex, ethnicity, marital status, and occupational status, and our outcomes of interest (involuntary admission to hospital, readmission to hospital, and inpatient bed days) for meta-analysis. We used a random-effects model to compare disparate outcome measures. We assessed explanations offered for the differences between minority and majority groups for the strength of the evidence supporting them. This study is prospectively registered with PROSPERO, number CRD42017078137., Findings: Our search identified 9511 studies for title and abstract screening, from which we identified 296 potentially relevant full-text articles. Of these, 67 met the inclusion criteria and were reviewed in depth. We added four studies after reference and citation searches, meaning 71 studies in total were included. 1 953 135 participants were included in the studies. Black Caribbean patients were significantly more likely to be compulsorily admitted to hospital compared with those in white ethnic groups (odds ratio 2·53, 95% CI 2·03-3·16, p<0·0001). Black African patients also had significantly increased odds of being compulsorily admitted to hospital compared with white ethnic groups (2·27, 1·62-3·19, p<0·0001), as did, to a lesser extent, south Asian patients (1·33, 1·07-1·65, p=0·0091). Black Caribbean patients were also significantly more likely to be readmitted to hospital compared with white ethnic groups (2·30, 1·22-4·34, p=0·0102). Migrant groups were significantly more likely to be compulsorily admitted to hospital compared with native groups (1·50, 1·21-1·87, p=0·0003). The most common explanations for the increased risk of detainment in BAME populations included increased prevalence of psychosis, increased perceived risk of violence, increased police contact, absence of or mistrust of general practitioners, and ethnic disadvantages., Interpretation: BAME and migrant groups are at a greater risk of psychiatric detention than are majority groups, although there is variation across ethnic groups. Attempts to explain increased detention in ethnic groups should avoid amalgamation and instead carry out culturally-specific, hypothesis-driven studies to examine the numerous contributors to varying rates of detention., Funding: University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre, NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The aim of this study was to compare radiology-based prediction models in rheumatoid arthritis-related interstitial lung disease (RAILD) to identify patients with a progressive fibrosis phenotype.RAILD patients had computed tomography (CT) scans scored visually and using CALIPER and forced vital capacity (FVC) measurements. Outcomes were evaluated using three techniques, as follows. 1) Scleroderma system evaluating visual interstitial lung disease extent and FVC values; 2) Fleischner Society idiopathic pulmonary fibrosis (IPF) diagnostic guidelines applied to RAILD; and 3) CALIPER scores of vessel-related structures (VRS). Outcomes were compared to IPF patients.On univariable Cox analysis, all three staging systems strongly predicted outcome (scleroderma system hazard ratio (HR) 3.78, p=9×10 -5 ; Fleischner system HR 1.98, p=2×10 -3 ; and 4.4% VRS threshold HR 3.10, p=4×10 -4 ). When the scleroderma and Fleischner systems were combined, termed the progressive fibrotic system (C-statistic 0.71), they identified a patient subset (n=36) with a progressive fibrotic phenotype and similar 4-year survival to IPF. On multivariable analysis, with adjustment for patient age, sex and smoking status, when analysed alongside the progressive fibrotic system, the VRS threshold of 4.4% independently predicted outcome (model C-statistic 0.77).The combination of two visual CT-based staging systems identified 23% of an RAILD cohort with an IPF-like progressive fibrotic phenotype. The addition of a computer-derived VRS threshold further improved outcome prediction and model fit, beyond that encompassed by RAILD measures of disease severity and extent., Competing Interests: Conflict of interest: J. Jacob reports advisory board fees from Boehringer Ingelheim, outside the submitted work. Conflict of interest: N. Hirani reports personal fees from Boehringer Ingelheim, Intermune, Roche, Galecto and UCB, outside the submitted work. Conflict of interest: C.H.M. van Moorsel has nothing to disclose. Conflict of interest: S. Rajagopalan reports grants (provided to Mayo Clinic for supporting the handling and processing of the CT datasets used in the study) from Royal Brompton Hospital, during the conduct of the study; and that Mayo Clinic has received royalties from Imbio, LCC towards licensing CALIPER, outside the submitted work; in addition, S. Rajagopalan has a patent Systems And Methods For Analysing In Vivo Tissue Volumes Using Medical Imaging Data licensed to Imbio, LLC. Conflict of interest: J.T. Murchison has nothing to disclose. Conflict of interest: H.W. van Es has nothing to disclose. Conflict of interest: B.J. Bartholmai reports grants (provided to Mayo Clinic for supporting the handling and processing of CT datasets used in the study) from Royal Brompton Hospital, during the conduct of the study; and that Mayo Clinic has received royalties from Imbio, LCC towards licensing CALIPER, outside the submitted work; in addition, B.J. Bartholmai has a patent Systems And Methods For Analysing In Vivo Tissue Volumes Using Medical Imaging Data licensed to Imbio, LLC. Conflict of interest: F.T. van Beek has nothing to disclose. Conflict of interest: M.H.L. Struik has nothing to disclose. Conflict of interest: G.A. Stewart has nothing to disclose. Conflict of interest: M. Kokosi has nothing to disclose. Conflict of interest: R. Egashira has nothing to disclose. Conflict of interest: A.L. Brun has nothing to disclose. Conflict of interest: G. Cross has nothing to disclose. Conflict of interest: J. Barnett has nothing to disclose. Conflict of interest: A. Devaraj reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: G. Margaritopoulos has nothing to disclose. Conflict of interest: R. Karwoski reports grants (provided to Mayo Clinic for supporting the handling and processing of CT datasets used in the study) from Royal Brompton Hospital, during the conduct of the study; and that Mayo Clinic has received royalties from Imbio, LCC towards licensing CALIPER, outside the submitted work; in addition, R. Karwoski has a patent Systems And Methods For Analysing In Vivo Tissue Volumes Using Medical Imaging Data licensed to Imbio, LLC. Conflict of interest: E. Renzoni reports lecture fees from Roche and Takeda, and lecture fees and advisory board fees from Boehringer, outside the submitted work. Conflict of interest: T.M. Maher has, via his institution, received industry-academic funding from GlaxoSmithKline R&D, UCB and Novartis and has received consultancy or speakers fees from Apellis, Astra Zeneca, Bayer, Biogen Idec, Boehringer Ingelheim, Cipla, GlaxoSmithKline R&D, Lanthio, InterMune, ProMetic, Roche, Sanofi-Aventis, Takeda and UCB. Conflict of interest: A.U. Wells reports advisory board and speaker fees from Intermune, Boehringer Ingelheim, Roche and Bayer, advisory board fees from Gilead and MSD, and speaker fees from Chiesi, outside the submitted work., (Copyright ©ERS 2019.)

Background: The standardized test within the Movement Assessment Battery for Children-2nd edition (MABC-2) is used worldwide to assess motor problems in children. Ideally, any country using a test developed in another country should produce national norms to ensure that it functions effectively in the new context., Aim: The first objective of this study was to explore the differences in motor performance between Italian and British children. The second was to examine the structural validity of the test for the Italian sample., Method: A total of 718 Italian (IT) and 765 British (UK) children, aged 3-10 years, were individually tested on the age-appropriate items of the MABC-2 Test., Results: Developmental trends emerged on every task and differences between IT and UK children were obtained on 11 of 27 task comparisons. Interactions between age and country indicated that differences were not consistently in favor of one culture. Confirmatory factor analysis generally supported the proposed structure of the MABC-2 Test., Conclusion: Although the differences between the IT and the UK children were relatively few, those that did emerge emphasize the need for population specific norms and suggest that cultural diversity in motor experiences should be considered when evaluating motor abilities in children., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV-antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway., Study Design: To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken., Methods: All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016., Results: RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody-positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively., Conclusion: This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV., (Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare stem cell disorder causing, in untreated patients, symptoms that include renal damage, thrombosis and increased mortality. When correctly diagnosed and treated, patients have reduced symptoms and normal life expectancies. Historically PNH testing resided within blood transfusion laboratories using techniques that were insensitive, for example, the Ham test. However, technology has evolved and flow cytometry is now regarded as the gold standard methodology. Given the clinical importance of diagnosing PNH correctly, we undertook a study to examine PNH testing procedures in blood transfusion laboratories within the UK and Ireland to determine implementation of best practices. An online survey was issued to 386 blood transfusion laboratories in the UK and Ireland requesting details of their current PNH testing practices and procedures. There were 143 responses, representing a 37% response rate. Of these, we identified seven laboratories undertaking PNH testing using obsolete methodologies. Furthermore, multiple centres did not refer samples for confirmatory testing by national PNH reference centres and inclusion on the national PNH disease registry. Staff handling requests for PNH testing should ensure that all samples are tested in accordance with current best practices using only flow cytometry., (© 2017 British Blood Transfusion Society.)

The author discusses aspects of efficiency in the extension of design governance to the urban design decision making in Great Britain. He is critical on the implementation of the urban design or architectural design concept. Also investigated is the impact of government intervention on the design of the built environment or natural environment preservation.

Existing evidence suggests that offenders tend not to specialize in sexual offending in general but that there is some specialization in particular types of sexual offending. This study examined the sexual histories and reoffending of a large, national data set of offenders convicted of a sexual offense and managed in England and Wales by the National Offender Management Service (N = 14,804). The study found that specialization in sexual offending compared to nonsexual offending was most evident for offenders with convictions for accessing indecent images. We also found considerable evidence of specialization within sexual offending, most notably for noncontact offenders, especially again indecent images offenders. Crossover between sexual offense types was very rare for those with contact adult offenses and for noncontact offenders although those with child contact offenses sometimes crossed over to indecent images reoffending. If specialization within sexual offending exists, the use of single risk assessment instruments to predict all types of sexual recidivism may be less effective than previously assumed. A comparison of different prediction models indicated that some items presently used in one-size-fits-all risk tools to predict any sexual reoffending only effectively predict certain subtypes of sexual offending. Statistically there appear to be some potential benefits to creating specialist risk predictors for different subtypes of offending, but further work is needed to justify the implementation demands that would be caused by abandoning one-size-fits-all tools. [ABSTRACT FROM AUTHOR]

Communication around chronic dietary risks has proved challenging as dietary health risks are ostensibly met with attenuated perceptions of their likelihood and consequences. In this article, we examine the strategies that an online public use to negotiate risk messages from expert stakeholders that may be incongruent with their own position on a risk. Progressing from conceptualisations of amplification as laid out in the social amplification of risk framework, we are particularly interested in understanding whether and how amplifications of risk may be attributed towards other stakeholders. The article presents an analysis of comments posted on a website oriented to a British audience. These comments were left by members of the public in reply to two online media articles published in 2012 reporting on an epidemiological study carried out in the United States on the risks of red meat consumption. We found that the comments generally expressed resistance to the risk message, embodied in two main strategies. The first strategy was to discount the message itself by deploying rules of thumb that undermined the applicability of the general risk message to the particularities of the individual. The second strategy was to undermine the risks by casting doubt on the credibility of the message source. Together, these strategies allowed the commenters to argue that the risks and the process of communicating them resulted in an exaggerated picture. These findings highlight that by attributing amplification to others, further polarisation of risk views between stakeholders may occur. Thinking about amplification as an attribution provides a distinct and significant conceptual contribution to the study of incongruent risk responses. [ABSTRACT FROM AUTHOR]

Objective: In 2006, food industry self-regulatory efforts aimed to balance the mix of food advertisements to limit children's exposure to unhealthy food products. An update to these efforts proposed to eliminate all unhealthy advertisements during peak child viewing times and implement uniform nutrition criteria by December, 2013. Marketing techniques are not currently addressed in self-regulatory efforts. The food industry's pledge prompted researchers to conduct a content analysis to assess nutritional quality and presence of persuasive marketing techniques in child-directed food and beverage advertisements. Study design: Content analysis. Methods: 32 h of children's television programming were recorded in February, 2013. Three independent coders assessed the nutritional content of food and beverage advertisements using the UK Nutrition Profiling System and assessed presence of persuasive techniques (PTs) using a rating form developed for this study. Results: Overall, 13.75% of advertisements promoted a food or beverage product. Most food advertisements, 54.6%, represented unhealthy products and 95.48% of food advertisements contained at least one PT. The number of PTs was not significantly different for healthy (M = 4.98, SD = 2.07) and unhealthy food advertisements (M = 4.66, SD = 1.82) however food advertisements aimed at children used significantly more PTs (M = 5.5, SD = 1.43) than those targeting adults (M = 1.52, SD = 1.54), t (153) = 11.738, P < 0.0001. Saturday morning children's programming showed significantly fewer food advertisements compared to weekday morning children's programming. Conclusions: While a majority of food-related advertisements represented unhealthy items, advertisements airing during Saturday morning programming featured fewer food advertisements overall and were more frequently for healthier items compared to weekdays. Industry self-regulation may not be effective for reducing overall unhealthy ad exposure but may play a role in reduced exposure on weekends. Despite policy efforts, additional changes are needed to improve ad exposure experienced by children with a focus on addressing the persistent use of persuasive marketing techniques in food advertising intended for children. [ABSTRACT FROM AUTHOR]

The mode of operation of a computer-based information system designed to link information about drug usage to diagnostic data is described. Details of the cost of this system are given. It is shown that the running costs are approximately £20 000 per year. Examples are given of the uses made of the data collected. [ABSTRACT FROM AUTHOR]

The alarming epidemic of obesity and physical inactivity at paediatric age urges societies to rise to the challenge of ensuring an active lifestyle. As one response to this, business enterprises are increasingly engaged in promoting sport and physical activity (PA) initiatives within the frame of corporate social responsibility (CSR). However, comparative analyses among industry sectors of CSR strategies for PA promotion with a particular focus on children are still lacking. This study aimed to explore (i) what are the CSR strategies for PA promotion adopted in different industry sectors and (ii) whether corporate engagement in promoting PA for children is supportive of children's rights to play and be physically active. Corporate pledges pertaining to CSR initiatives to promote PA were analysed. The hypothesis was that companies from different sectors employ different CSR strategies and that companies with a higher profile as regard to public health concerns for children tend to legitimate their action by adopting a compensatory strategy. Results show that the issue of PA promotion is largely represented within CSR commitments. CSR strategies for PA promotion vary across industry sectors and the adoption of a compensatory strategy for rising childhood obesity allows only a limited exploitation of the potential of CSR commitments for the provision of children's rights to play and be physically active. Actors within the fields of public health ethics, human rights and CSR should be considered complementary to develop mainstreaming strategies and improve monitoring systems of PA promotion in children. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding., Objectives: To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS., Design: Evidence syntheses with stakeholder engagement., Review Methods: Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops., Results: We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence., Limitations: There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics., Conclusions: 'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK., Future Work: Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies., Study Registration: This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/)., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

As a result of the phone-hacking scandal and evidence of other serious journalistic abuses by some newspapers, the government set up the Leveson Inquiry to hear evidence from victims and to make recommendations for a new and effective system of press regulation. Leveson's recommendations for independent self-regulation overseen by a 'recogniser' was seen as a moderate solution which would uphold the principle of an unfettered press while providing appropriate protection from unscrupulous or unethical press behaviour. After historic cross-party agreement, Parliament passed a resolution accepting a Royal Charter which adopted the great majority of his recommendations. In response, Britain's main national newspapers have pursued a campaign of systematic misinformation and distortion, aimed at discrediting the inquiry, its supporters and the cross-party Charter, while promoting a different system which would remain almost wholly controlled by the industry and would in practice be little different from the discredited Press Complaints Commission. After decades of ineffectual political response to press abuse and press power, there is now a historic opportunity for Parliament to assert its sovereign power. Over the next 12-18 months, we will see whether we have reached a genuine milestone in British public life or whether the British press will remain the last bastion of unaccountable power. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) is a significant public health threat in the UK, and is both underdiagnosed and undertreated. The treatment episode takes between 12 and 48 weeks. In the UK, HCV management is undertaken in secondary and tertiary centres. This does not meet the needs of all patients; they may have to travel long distances, incur travel costs, wait a long time to be seen and negotiate time off work while not divulging their illness. Providing care at home can increase patients' access to and acceptability of treatment, especially in areas remote from specialist centres. This paper describes the feasibility, safety and efficacy of treating HCV-infected patients at home through a partnership between secondary care and a clinical home care company. The home care model had a significantly higher attendance rate than the clinic model. It allowed the trust to improve care at no extra cost. This model can optimise specialist nurses' time, allowing them to focus on patients with more complex needs. [ABSTRACT FROM AUTHOR]