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Background Recent studies have shown a decrease in CD4 count during adolescence in young people with perinatally acquired human immunodeficiency virus (HIV, PHIV). Methods Young people with PHIV in the United Kingdom, followed in the Collaborative HIV Paediatric Study who started antiretroviral therapy (ART) from 2000 onward were included. Changes in CD4 count over time from age 10 to 20 years were analyzed using mixed-effects models, and were compared to published CD4 data for the gerneral population. Potential predictors were examined and included demographics, age at ART start, nadir CD4 z score (age-adjusted) in childhood, and time-updated viral load. Results Of 1258 young people with PHIV included, 669 (53%) were female, median age at ART initiation was 8.3 years, and the median nadir CD4 z score was −4.0. Mean CD4 count was higher in young people with PHIV who started ART before age 10 years and had a nadir CD4 z score ≥−4; these young people with PHIV had a decline in CD4 count after age 10 that was comparable to that of the general population. Mean CD4 count was lower in young people with PHIV who had started ART before age 10 and had a nadir CD4 z score <−4; for this group, the decline in CD4 count after age 10 was steeper over time. Conclusions In children, in addition to starting ART at an early age, optimizing ART to maintain a higher CD4 z score during childhood may be important to maximizing immune reconstitution later in life. [ABSTRACT FROM AUTHOR]

Purpose: Increased school autonomy and accountability have been a common denominator of national reforms in otherwise heterogeneous governance systems in Europe and the USA. The paper argues that because schools serving disadvantaged communities (SSDCs) often have lower average performance, they are more often sanctioned or under closer scrutiny, but might also receive more additional resources. The purpose of this paper is to therefore analyze whether SSDCs have more or less autonomy than schools with a more advantageous context in four countries with heterogeneous autonomy and accountability policies. Design/methodology/approach: The paper is based on the data from the Programme for International Student Assessment 2012 school and student questionnaires from Finland, Germany, the UK, and the USA. The choice of countries is based on different governance models described by Glatter "et al." (2003). The data are used to identify SSDCs and analyze the reported autonomy in resource allocation and curriculum and assessment. Using regression analyses, patterns are analyzed for each country individually. They are then juxtaposed and compared. Differences are related back to the governance models of the respective countries. Findings: The results indicate an association between the communities the schools are serving and the autonomy either in the allocation of resources, or the curriculum and assessment. SSDCs appeared to have a little more autonomy than schools with a more advantageous context in Finland, Germany, and the UK, but less autonomy in the USA. The comparison suggests that in the USA, autonomy is rather a reward for schools that have the least amount of need, whereas in the other three countries it could be a result of strategies to improve schools in need. The paper discusses possible explanations in the policies and support structures for SSDCs. Originality/value: The effects of increased school autonomy and accountability on student achievement have been discussed at length. How different accountability policies affect the autonomy of schools with the highest needs has so far not been studied. The study can be understood as a first step to unravel this association. Following steps should include in-depth investigations of the mechanisms underlying increased or diminished autonomy for SSDCs, and the consequences for school improvement in these schools.

The coronavirus disease (COVID-19) pandemic continues to present unique challenges to governments and organisations around the world, but one sector has incorporated COVID-19 into its core mission with relative ease: advertisers have acknowledged the pandemic while continuing to draw on notions of 'normality' to activate our desire to consume. As the UK's series of lockdowns have come to an end, we look back over more than a year of unusual advertising and consider how the pandemic has changed approaches to marketing and the shape of consumer culture in ways connected to ideas about what constitutes 'normal' life. Discussions of the relationship between the pandemic and consumerism have included critiques of the prioritising of profit over people, and conceptualisations of Coronavirus as a brand itself, but the politics of notions of 'normality' promoted by consumer culture demand closer consideration. This article complements existing studies and debates by examining the tensions, contradictions and morally neutral positions revealed by the advertising response to the coronavirus disease pandemic. Through an analysis of UK advertising campaigns launched during and with reference to the pandemic, this work explores key themes and strategies, including their connection to power dynamics concerning race, gender, class and capitalism. We suggest advertising during crises may offer the opportunity to critique larger dynamics and trends of consumerism, including narrow notions of the defining features of 'everyday' life. [ABSTRACT FROM AUTHOR]

Objective: Research has just begun to identify American college students who study abroad as a group at-risk for sexual violence victimization. The purpose of the current study was to examine the context of these incidents. Participants: We utilized a large longitudinal sample of 2,428 United States college students studying abroad for between 4 and 21 weeks in 12 different foreign countries. Methods: We estimated descriptive statistics and logistic regression models to assess prevalence and correlates of sexual victimization abroad, as well as effect size comparisons to quantify changes in drinking abroad. Results: Over one-fifth of students experienced sexual violence while abroad, including sexual assault and verbal coercion. Women, younger students, those who experienced sexual violence prior, and heavier drinkers had the greatest odds of sexual violence victimization abroad. Conclusions: Findings point to the need for evidence-based programming to reduce sexual violence risk among American college students studying in foreign countries. [ABSTRACT FROM AUTHOR]

Harrington (2022) provides a novel theory that explains how a private information exchange involving gross list prices can lead to higher transaction prices. On this basis, he considers that private list price exchanges between competitors should be presumed to harm competition. The theory, which has received much attention in the context of the EU trucks cartel case, was recently referred to by the UK Competition Appeal Tribunal as a "unilateral effects" theory, given that it involves no coordination once list prices have been exchanged. Unlike conventional collusion, the theory does not rely on a monitoring and retaliation mechanism. Given its novelty and relevance for recent competition cases, we consider it useful to explore its potential limitations. We show that both the scope for and magnitude of harm are sensitive to key modelling parameters such as the number of firms, the degree of product substitutability, and the level of marginal cost—sometimes in opposite directions. We also show that there may be no scope for the anticompetitive effect when firms are capacity constrained. Finally, we discuss several additional qualitative aspects that may undermine the theory of harm: the adaptability of internal pricing processes over time, the lack of verifiability of exchanged list price information (especially when the exchange is private), and possible procompetitive or competitively neutral reasons for the conduct. We conclude that, although Harrington provides an insightful addition to the wider literature on the competitive effects of information exchanges, the effects of list price exchanges are not sufficiently unambiguous to justify a general presumption of competitive harm. [ABSTRACT FROM AUTHOR]

Background: The paper compares and contrasts the policy context of teacher training for vocational educators (VETT) in Scotland and England and locates this in its European setting. It explores the wider socio-economic context, one that emphasises lifelong learning, competitiveness and social justice. Purpose: In particular, it addresses the UK Coalition government's orientation to vocational teacher education and the way in which this impacts upon VETT in the two home nations. Sources of evidence: It draws on a small-scale illuminative case study of teacher educators in England and Scotland. Main argument: It explores the limits and possibilities for the development of radical and critical practices embedded in VETT policy and practice. (Contains 5 notes.)

University-community partnerships offer synergistic spaces for communities to address difficulties and universities to meet their missions. Geographers are well positioned to participate in these partnerships, owing to the discipline's integrative nature, spatial perspectives and analytic approaches, and its attention to social and environmental issues at many scales. This paper endeavours to assist geographers interested in these partnerships by illustrating three case studies of geography-community partnerships. We reflect critically on the mutual benefits from, and barriers to, these partnerships. On the basis of case studies and literature review, the paper recommends ways to enhance university-community partnerships to help dismantle the ivory tower. (Contains 1 figure and 6 notes.)

Doctoral completion and times-to-completion are issues of growing concern in the university community. Research on student completion difficulties has focused on student characteristics and student-supervisor relations. This article addresses the administration of graduate programs--more specifically, graduate deans' knowledge of and attitudes toward doctoral completion rates and times-to-completion. A survey was carried out involving graduate deans from Canada, the United States, and the United Kingdom. Data showed most deans were unable to report doctoral completion percentages and completion times. Still, they rated completion at their universities as relatively good. Their lack of information may hinder attempts to improve trends in doctoral completion. Improved surveillance of students' progress in doctoral programs may aid deans in evaluating the impact of program requirements and economic factors on doctoral completion and graduate studies in general.

Presents extracts from critical responses to the 1996 White Paper entitled "Excellence in Schools" which pointed out educational deficiencies, racism, and overall poorer education for minorities and ethnic groups within the U.K. educational system. Comments focus on such topics as educational and teacher standards and accountability and helping students achieve. (GR)

Purpose: Genetic variants identified through population-based genome-wide studies are generally of high frequency, exerting their action in the central part of the refractive error spectrum. However, the power to identify associations with variants of lower minor allele frequency is greatly reduced, requiring considerable sample sizes. Here we aim to assess the impact of rare variants on genetic variation of refractive errors in a very large general population cohort. Methods: Genetic association analyses of non-cyclopaedic autorefraction calculated as mean spherical equivalent (SPHE) used whole-exome sequence genotypic information from 50,893 unrelated participants in the UK Biobank of European ancestry. Gene-based analyses tested for association with SPHE using an optimised SNP-set kernel association test (SKAT-O) restricted to rare variants (minor allele frequency < 1%) within protein-coding regions of the genome. All models were adjusted for age, sex and common lead variants within the same locus reported by previous genome-wide association studies. Potentially causal markers driving association at significant loci were elucidated using sensitivity analyses by sequentially dropping the most associated variants from gene-based analyses. Results: We found strong statistical evidence for association of SPHE with the SIX6 (p-value = 2.15 x 10−10, or Bonferroni-Corrected p = 4.41x10-06) and the CRX gene (p-value = 6.65 x 10−08, or Bonferroni-Corrected p = 0.001). The SIX6 gene codes for a transcription factor believed to be critical to the eye, retina and optic disc development and morphology, while CRX regulates photoreceptor specification and expression of over 700 genes in the retina. These novel associations suggest an important role of genes involved in eye morphogenesis in refractive error. Conclusion: The results of our study support previous research highlighting the importance of rare variants to the genetic risk of refractive error. We explain some of the origins of the genetic signals seen in GWAS but also report for the first time a completely novel association with the CRX gene. [ABSTRACT FROM AUTHOR]

Current antiretroviral therapy (ART) guidelines recommend treating all children with HIV-1 infection. This has changed from the broader use of ART to treat children to improve morbidity and minimise mortality. However, prior to current recommendations, not everyone with HIV-1 received timely treatment. What happens to the paediatric immune system when HIV-1 replication is not appropriately supressed remains unclear. 11 samples from adolescents with HIV-1 on ART and uninfected controls in the UK, aged 12-25 years, were examined; overall, adolescents with CD4+ counts > 500/ml and a viral load < 50 copies/ml were compared with adolescents with CD4+ counts < 500/ml and a viral load > 50 copies/ml at time of sampling. Measurements of thymic output were combined with high throughput next generation sequencing and bioinformatics to systematically organize CD4+ and CD8+ T cell receptor (TCR) repertoires. TCR repertoire diversity, clonal expansions, TCR sequence sharing, and formation of TCR clusters in HIV-1 infected adolescents with successful HIV-1 suppression were compared to adolescents with ineffective HIV-1 suppression. Thymic output and CD4+ T cell numbers were decreased in HIV-1 infected adolescents with poor HIV-1 suppression. A strong homeostatic TCR response, driven by the decreased CD4+ T cell compartment and reduced thymic output was observed in the virally uncontrolled HIV-1-infected adolescents. Formation of abundant robust TCR clusters and structurally related TCRs were found in the adolescents with effective HIV-1 suppression. Numerous CD4+ T cell numbers in the virally controlled adolescents emphasize the importance of high thymic output and formation of robust TCR clusters in the maintenance of HIV-1 suppression. While the profound capacity for immune recovery in children may allow better opportunity to deal with immunological stress, when ART is taken appropriately, this study demonstrates new insights into the unique paediatric immune system and the immunological changes when HIV-1 replication is ongoing. [ABSTRACT FROM AUTHOR]

The transition from hedonic to compulsive use in Substance Use Disorders (SUD) is a critical point in SUD progression and hence relevant for assessment and treatment. To measure the habitual patterns of substance consumption, the Craving Automated Scales (CAS) for alcohol (CAS-A), substances (CAS-S) and cigarette smoking (CAS-CS) were developed and introduced to different countries. In this study, we aimed to investigate the structural stability of CAS across substances and cultures. This study analyzed the CAS-scores of a sample of 370 participants in Germany, China and the UK, including 262 opioid-users, 65 smokers and 43 alcohol-users. We performed stability analyses to check the stability (i. e. factorial invariance) of factor solutions. Based on confirmed stability of the general factor (gfactor) solution and the calculations rule obtained in the previous validation of CAS-alcohol (CAS-A), the factor structures of CAS-A, CAS-S and CAS-CS were compared. The gfactor solutions based on calculations rule shows good stability, with the mean stability coefficients of 0.990 and 0.977 for CAS-S and CAS-CS respectively. The gfactor patterns were similar for CAS-A, CAS-S and CAS-CS, as well as across samples (Germany, China and the UK), with most factor-loadings larger than 0.7. Based on these findings, CAS-S and CAS-CS were also associated with established clinical measures of SUD. Our findings suggest the two-gfactor solution based on a proposed calculation rule has a high stability across substances and cultures. This could be in line with common neurobiological mechanisms underlying habitual substance use. Moreover, comparing CAS with established clinical tools suggests that CAS might assess the automated behavior in substance consumption in a more sophisticated way. • The two-gfactor solution of the Craving Automated Scale has a good stability. • The Craving Automated Scale can be used across substances. • The Craving Automated Scale is associated with established SUD measures. [ABSTRACT FROM AUTHOR]

Objectives Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. Methods Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies. [ABSTRACT FROM AUTHOR]

This study aimed to assess (i) COVID‐19 transmission prior to and following spectator events and (ii) methodological approaches to capturing event‐related transmission during the spectator return. Local authority population transmission rates were used to identify higher transmission areas, which were excluded from participant attendance following registration. Using observational online and SMS questionnaires, self‐reported COVID‐19 diagnoses (positive tests) and racing‐related NHS Test and Trace contacts within 14 days of spectating were reported for two British Horseracing events and three Point to Point (PTP) grassroots races. There were 1,477 registrations for the British Horseracing events, and 1,678 registrations for PTP races. Responses were received from 464 attendees of British Horseracing events (31.4% response rate). Two attendees reported a COVID‐19 diagnosis, and no attendees reported NHS Test and Trace contact. From PTP races, 862 attendees (51.3%) consented to receive the SMS survey, and responses were received from 495 attendees (57.4% response rate). Five attendees reported positive COVID‐19 diagnoses, and two attendees reported being contacted by NHS Test and Trace, of which one was following a non‐racing potential COVID‐19 exposure. There was limited evidence of COVID‐19 transmission at outdoor elite and grassroots level horseracing events during autumn 2020. A higher response rate was received with SMS surveys; however, there was a reluctancy to "opt in" to SMS methodology. This study describes different methodological approaches to monitoring COVID‐19 transmission risk at events, which may have relevance for other sporting and event contexts during the current pandemic, and sustained attendances during periods with circulating transmissible diseases. [ABSTRACT FROM AUTHOR]

Risk perception refers to how individuals interpret their susceptibility to threats, and has been hypothesised as an important predictor of intentions and behaviour in many theories of health behaviour change. However, its components, optimal measurement, and effects are not yet fully understood. The TRIRISK model, developed in the US, conceptualises risk perception as deliberative, affective and experiential components. In this study, we aimed to assess the replicability of the TRIRISK model in a UK sample by confirmatory factor analysis (CFA), explore the inherent factor structure of risk perception in the UK sample by exploratory factor analysis (EFA), and assess the associations of EFA-based factors with intentions to change behaviour and subsequent behaviour change. Data were derived from an online randomised controlled trial assessing cancer risk perception using the TRIRISK instrument and intention and lifestyle measures before and after communication of cancer risk. In the CFA analysis, the TRIRISK model of risk perception did not provide a good fit for the UK data. A revised model developed using EFA consisted of two separate "numerical" and "self-reflective" factors of deliberative risk perception, and a third factor combining affective with a subset of experiential items. This model provided a better fit to the data when cross-validated. Using multivariable regression analysis, we found that the self-reflective and affective-experiential factors of the model identified in this study were reliable predictors of intentions to prevent cancer. There were no associations of any of the risk perception factors with behaviour change. This study confirms that risk perception is clearly a multidimensional construct, having identified self-reflective risk perception as a new distinct component with predictive validity for intention. Furthermore, we highlight the practical implications of our findings for the design of interventions incorporating risk perception aimed at behaviour change in the context of cancer prevention. [ABSTRACT FROM AUTHOR]

The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH. [ABSTRACT FROM AUTHOR]

Summary: This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015. The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these guidelines may also be of use in other areas of the world. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and during transfer. There are new sections specifically discussing capnography, sedation and regional anaesthesia. In addition, the indications for processed electroencephalogram and neuromuscular monitoring have been updated. [ABSTRACT FROM AUTHOR]

Across the political spectrum of different historical periods, welfare deterrence has shaped social security and immigration policy in both Australia and the United Kingdom. Deterrence discourages access to state welfare through the production and mobilization of negative affect to deter specific groups from claiming state support, and by crafting public affect (of fear and disgust) about these target populations in order to garner consent for punitive policies. In this paper, we argue that deterrence works as a human technology where the crafting of negative affect operates as a technology of statecraft. Through critical juxtaposition and multiple genealogies of deterrence, this paper meshes time and space, and colony/colonizer and metropole, to show the historical and contemporary connectivity of the affective nature of deterrence. We identify five main operations that produce the 'feel' of deterrence: stigmatization by design, destitution by design, deterrent architecture, the control of movement, and the centrality of labour; as well as tracing the political economy of deterrence. [ABSTRACT FROM AUTHOR]

Background: Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians' endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians' beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care. Methods: We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians' beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically. Results: Clinicians' beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians' prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device's capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results. Conclusions: Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests' capabilities and integration into clinical practice. Implementation strategies should bolster users' necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests' purpose and benefits, identifying and addressing clinicians' misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available. [ABSTRACT FROM AUTHOR]

Pharmacogenetics (PGx) studies the influence of genetic variation on drug response. Clinically actionable associations inform guidelines created by the Clinical Pharmacogenetics Implementation Consortium (CPIC), but the broad impact of genetic variation on entire populations is not well understood. We analyzed PGx allele and phenotype frequencies for 487,409 participants in the UK Biobank, the largest PGx study to date. For 14 CPIC pharmacogenes known to influence human drug response, we find that 99.5% of individuals may have an atypical response to at least 1 drug; on average they may have an atypical response to 10.3 drugs. Nearly 24% of participants have been prescribed a drug for which they are predicted to have an atypical response. Non‐European populations carry a greater frequency of variants that are predicted to be functionally deleterious; many of these are not captured by current PGx allele definitions. Strategies for detecting and interpreting rare variation will be critical for enabling broad application of pharmacogenetics. [ABSTRACT FROM AUTHOR]

As the UK reopened after the first wave of the COVID-19 epidemic, crucial questions emerged around the role for ongoing interventions, including test-trace-isolate (TTI) strategies and mandatory masks. Here we assess the importance of masks in secondary schools by evaluating their impact over September 1–October 23, 2020. We show that, assuming TTI levels from August 2020 and no fundamental changes in the virus's transmissibility, adoption of masks in secondary schools would have reduced the predicted size of a second wave, but preventing it would have required 68% or 46% of those with symptoms to seek testing (assuming masks' effective coverage 15% or 30% respectively). With masks in community settings but not secondary schools, the required testing rates increase to 76% and 57%. [ABSTRACT FROM AUTHOR]

Aims: To test the feasibility and acceptability of a customized six-session cognitive behavioral therapy (CBT) group intervention for adults with recurrent trigeminal neuralgia (TN). Methods: Fifteen participants with TN were recruited from a specialist facial pain unit in London, United Kingdom. The effects of the group intervention were evaluated using validated self-report measures, which the participants completed before and after the intervention and at 1-month and 9-month follow-ups. A semi-structured interview was also used at the 1-year follow-up to gather qualitative feedback of the group intervention. Results: Participants reported an increase in confidence in managing everyday tasks in the presence of TN symptoms, a reduction in negative beliefs about pain, and an increase in engagement in meaningful activity. All patients completed the group intervention (100% retention rate). Qualitative feedback highlighted that the group CBT intervention was helpful, and no participants reported a worsening of mood or experience as a result of the intervention. Conclusion: The trends for improvement in several domains, plus the positive experiences of the participants, suggest that a CBT management program is acceptable and feasible for this population and should be further developed and implemented on a larger scale to determine its clinical efficacy. [ABSTRACT FROM AUTHOR]

Over 30,000 adult cardiac operations are carried out in the UK annually. A small number of these patients need to return to theatre in the first few days after the initial surgery, but the exact proportion is unknown. The majority of these resternotomies are for bleeding or cardiac tamponade. The Association of Cardiothoracic Anaesthesia and Critical Care carried out a 1-year national audit of resternotomy in 2018. Twenty-three of the 35 centres that were eligible participated. The overall resternotomy rate (95%CI) within the period of admission for the initial operation in these centres was 3.6% (3.37-3.85). The rate varied between centres from 0.69% to 7.6%. Of the 849 patients who required resternotomy, 127 subsequently died, giving a mortality rate (95%CI) of 15.0% (12.7-17.5). In patients who underwent resternotomy, the median (IQR [range]) length of stay on ICU was 5 (2-10 [0-335]) days, and time to tracheal extubation was 20 (12-48 [0-2880]) hours. A total of 89.3% of patients who underwent resternotomy were transfused red cells, with a median (IQR [range]) of 4 (2-7 [1-1144]) units of red blood cells. The rate (95%CI) of needing renal replacement therapy was 23.4% (20.6-26.5). This UK-wide audit has demonstrated that resternotomy after cardiac surgery is associated with prolonged intensive care stay, high rates of blood transfusion, renal replacement therapy and very high mortality. Further research into this area is required to try to improve patient care and outcomes in patients who require resternotomy in the first 24 h after cardiac surgery. [ABSTRACT FROM AUTHOR]

We describe the approach taken to develop the United Kingdom's first community Earth system model, UKESM1. This is a joint effort involving the Met Office and the Natural Environment Research Council (NERC), representing the U.K. academic community. We document our model development procedure and the subsequent U.K. submission to CMIP6, based on a traceable hierarchy of coupled physical and Earth system models. UKESM1 builds on the well‐established, world‐leading HadGEM models of the physical climate system and incorporates cutting‐edge new representations of aerosols, atmospheric chemistry, terrestrial carbon, and nitrogen cycles and an advanced model of ocean biogeochemistry. A high‐level metric of overall performance shows that both models, HadGEM3‐GC3.1 and UKESM1, perform better than most other CMIP6 models so far submitted for a broad range of variables. We point to much more extensive evaluation performed in other papers in this special issue. The merits of not using any forced climate change simulations within our model development process are discussed. First results from HadGEM3‐GC3.1 and UKESM1 include the emergent climate sensitivity (5.5 and 5.4 K, respectively) which is high relative to the current range of CMIP5 models. The role of cloud microphysics and cloud‐aerosol interactions in driving the climate sensitivity, and the systematic approach taken to understand this role, is highlighted in other papers in this special issue. We place our findings within the broader modeling landscape indicating how our understanding of key processes driving higher sensitivity in the two U.K. models seems to align with results from a number of other CMIP6 models. Plain Language Summary: The United Kingdom has taken a community approach to model development and delivery of simulations to the sixth phase of the Coupled Model Intercomparison Project (CMIP6). The papers in this special issue characterize and evaluate the U.K. models and highlight emerging properties of the models, such as the climate sensitivity. Understanding of the reasons for an increase in sensitivity in these new models is highlighted here, and similarities to our findings from other modeling centers are discussed. Key Points: The United Kingdom has developed its first community Earth system model and delivered a traceable hierarchy of models to CMIP6We applied a process‐based evaluation strategy in model development but chose not to use historic trends or measures of climate responseThe U.K. models exhibit higher climate sensitivity than seen in CMIP5 arising in part from more positive cloud feedbacks [ABSTRACT FROM AUTHOR]

Drug strategies in Great Britain emphasize the notion of recovery, with the concept being central in England, Wales and Scotland. There are however tensions, with recovery being defined differently across jurisdictions. In this study we address this dilemma by critically interrogating how the term recovery is represented, how these presentations are shaped and what effects are subsequently had. We applied an adapted version of Bacchi's What's the Problem Represented to Be? (WPR) policy analysis approach to the 2017 UK Drug Strategy, the 2008–2018 Welsh Drug Strategy and the 2008 Scottish Drug Strategy notions of service user responsibility; (b) recovery as 'a problem of product quality', shaped by the implicit notion of service provider responsibility and the disease model of addiction; (c) recovery as 'a problem of service collaboration and teamwork', underpinned by the bio-psycho-social model of addiction. We conclude that the problematisations found in GB's current drug policies have the ability to shape the drug policy-making process which may limit mainstream knowledge of recovery, and thereby unintentionally contribute to a narrow understanding of how to effectively support the service user community in their recovery from problematic drug use. [ABSTRACT FROM AUTHOR]

The hot summer was largely a consequence of the atmospheric circulation anomalies and elevated sea-surface temperature in the proximity of the United Kingdom, but these alone are insufficient to fully explain the magnitude of the observed temperature anomalies for the season overall. The most recent set of probabilistic projections from the UK Climate projections (UKCP18) give a wider but overlapping range of 10-25% for the current climate and a likelihood greater than 50% of summers exceeding 2018 temperatures by the mid-twenty-first century. The summer North Atlantic Oscillation (SNAO) represents the principal pattern of year-to-year variability in the summer climate of the north Atlantic and influences summer rainfall and air temperature across northern Europe through its association with the North Atlantic storm track (Folland I et al i ., [6]). We expect UK temperatures to be dependent on atmospheric circulation, with warmer summer temperatures, for example, when southerly winds blow across the United Kingdom. [Extracted from the article]

There are currently an estimated 2.8–3.8 million people in the UK who fulfil the UK Ministry of Defence definition of a military veteran (a minimum of one day's military service). Despite these numbers, there is little research on who the public views as a veteran and how this differs across society. Rachael Gribble, Simon Wessely, Susan Klein, David A Alexander, Christopher Dandeker and Nicola T Fear examine public conceptualisations of the term 'veteran' compared with definitions from the Ministry of Defence and those of ex-service personnel themselves. Factors associated with commonly endorsed definitions are identified. [ABSTRACT FROM AUTHOR]

Waste tanks at the nuclear facility located at Sellafield, UK, represent a nuclear source which could release radionuclides to the atmosphere. A model chain which combines atmospheric transport, deposition as well as riverine transport to sea has been developed to predict the riverine activity concentrations of 137Cs. The source term was estimated to be 9 × 104 TBq of 137Cs, or 1% of the assumed total 137Cs inventory of the HAL (Highly Active Liquid) storage tanks. Air dispersion modelling predicted 137Cs deposition reaching 127 kBq m−2 at the Vikedal catchment in Western Norway. Thus, the riverine transport model predicted that the activity concentration of 137Cs in water at the river outlet could reach 9000 Bq m−3 in the aqueous phase and 1000 Bq kg−1 in solid phase at peak level. The lake and river reaches showed different transport patterns due to the buffering effects caused by dilution and slowing down of water velocity. [ABSTRACT FROM AUTHOR]

Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs. [ABSTRACT FROM AUTHOR]

There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non-consensual transfusion as a physical violation. Consent to treatment is at the heart of this guideline. Refusal of treatment by an adult with capacity is lawful. The reasons why a patient might refuse transfusion and the implications are examined. The processes and products that are deemed acceptable or unacceptable to Jehovah's Witnesses are described. When a team is faced with a patient who refuses transfusion, a thorough review of the clinical situation is advocated and all options for treatment should be explored. After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help. [ABSTRACT FROM AUTHOR]

Background: In previous studies, the association between Compulsive Sexual Behavior Disorder (CSBD) and childhood sexual abuse (CSA) has been discussed (Slavin et al., 2020). However, the mechanism that CSA leads to CSBD has not been clarified in detail. Some studies have described that CSA related to self-objectification (e.g., Talmon & Ginzburg, 2016). Furthermore, it has been suggested that self-objectification increases sexual risk behaviors (e.g., Ingram et al., 2023). In short, self-objectification may mediate the association between CSBD and CSA. This study aimed to examine a model of the effects of CSA, self-objectification, and self-compassion on CSBD. Methods: 935 participants via online were included in the analysis (Korean: n = 329, Japan: n = 377, the UK: n = 229). The scales were the CSBD-19, Self-Compassion scale, Childhood Trauma Questionnaire, and Objectified Body Consciousness scale. Results: Moderated mediation model indicated that the mediation effect of self-objectification measured by body surveillance, and moderation effect of self-compassion were not significant. Additional exploratory analyzes showed that body shame significantly mediated between CSA and CSBD in three countries, and self-compassion mediated in only the UK and Korea. Conclusion: The result indicates that individuals with CSA experiences may develop CSBD through Body shame in three countries. Therefore, it is necessary to focus on body shame when reducing the risk of CSBD. Self-compassion intervention may be applicable to support CSBD with CSA in the UK and Korea. However, in Japan, it was shown that it is necessary to further examine the function of self-compassion. [ABSTRACT FROM AUTHOR]

Abstract: Clark's claims about the scale of English agricultural output from the 1200s to the 1860s flout historical and geographical reality. His income‐based estimates start with the daily real wages of adult males and assume that days worked per year were constant. Those advanced in British economic growth make no such assumption and instead are built up from the output side. They correlate better with population trends and are consistent with an economy slowly growing and becoming richer. Clark's denial that such growth occurred, his assertion that substantially more land must have been under arable cultivation, his belief that conditions of full employment invariably prevailed in the countryside at harvest time, his concern that the wage bill would have exceeded the value of output in British economic growth, his refusal to consider the possibility that the working year was of variable length, and his assertion that output per acre must have been equalized across arable and pasture are all shown to be figments of his ‘Malthus delusion’. [ABSTRACT FROM AUTHOR]

Increasing attention has focused on the role of joint commissioning in health and social care policy and practice in England. This paper provides an empirical examination of the three discourses of joint commissioning developed from an interpretative analysis of documents by Dickinson et al. (2013; BMC Health Services Research, 13) and applied to data from our study exploring the role of knowledge in commissioning in England. Based on interviews with 92 participants undertaken between 2011 and 2013, our analysis confirms that the three discourses of prevention or empowerment or efficiency are used by professionals from across health and social care organisations to frame their experiences of joint commissioning. However, contrary to Dickinson et al., we also demonstrate that commissioners and other stakeholders combine and trade off these different discourses in unexpected ways. Moreover, at sites where the service user experience was central to the commissioning process (joint commissioning as empowerment), a greater sense of agreement about commissioning decisions appeared to have been established even when the other discourses were also in play. [ABSTRACT FROM AUTHOR]

Objectives We sought to compare all-cause mortality of people living with HIV and accessing care in Canada and the UK. Methods Individuals from the Canadian Observational Cohort ( CANOC) collaboration and UK Collaborative HIV Cohort ( UK CHIC) study who were aged ≥ 18 years, had initiated antiretroviral therapy ( ART) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow-up as a competing risk. Results A total of 19 960 participants were included in the analysis ( CANOC, 4137; UK CHIC, 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range ( IQR): 33, 46 years) vs. 36 years ( IQR: 31, 43 years) for UK CHIC participants], to be male (86 vs. 73%, respectively), and to report men who have sex with men ( MSM) sexual transmission risk (72 vs. 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person-years ( PY) of follow-up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval ( CI): 7.1, 8.3 per 1000 PY]. The crude mortality rates were 8.6 (95% CI: 7.4, 10.0) and 7.5 (95% CI: 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow-up as a competing risk (adjusted hazard ratio 0.86; 95% CI: 0.72-1.03). Conclusions Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission. [ABSTRACT FROM AUTHOR]

The conventionally antithetical stereotypes of the United Kingdom and United States health care systems needs to be modified in the case of the elderly. Relative to the rest of the population, the over-65s in the United States are more satisfied with their medical care than their UK counterparts. There is also much common ground: shared worries about the quality of elderly care and similar attitudes towards assisted death. Comparison is further complicated by within country variations: comparative studies should take account of the fact that even seemingly polar models may have pools of similarity. [ABSTRACT FROM AUTHOR]

Background Specific phobia (SP) is the most common anxiety disorder among children with Williams syndrome (WS); prevalence rates derived from Diagnostic and Statistical Manual of Mental Disorders-based diagnostic interviews range from 37% to 56%. We evaluated the effects of gender, age, intellectual abilities and/or behaviour regulation difficulties on the likelihood that a child with WS would be diagnosed with SP. Methods A total of 194 6-17 year-olds with WS were evaluated. To best characterise the relations between the predictors and the probability of a SP diagnosis, we explored not only possible linear effects but also curvilinear effects. Results No gender differences were detected. As age increased, the likelihood of receiving a SP diagnosis decreased. As IQ increased, the probability of receiving a SP diagnosis also decreased. Behaviour regulation difficulties were the strongest predictor of a positive diagnosis. A quadratic relation was detected: The probability of receiving a SP diagnosis gradually rose as behaviour regulation difficulties increased. However, once behaviour regulation difficulties approached the clinical range, the probability of receiving a SP diagnosis asymptoted at a high level. Conclusion Children with behaviour regulation difficulties in or just below the clinical range were at the greatest risk of developing SP. These findings highlight the value of large samples and the importance of evaluating for nonlinear effects to provide accurate model specification when characterising relations among a dependent variable and possible predictors. [ABSTRACT FROM AUTHOR]

Many studies have examined the determinants of ministerial selection. However, the effect of electoral incentives on government post allocation has so far not been studied in the literature. Drawing on data from the United Kingdom over the period 1992–2015, this article investigates the relationship between the selection of ministers and the electoral interests of the actors in this selection process – party leaders and members of parliament (MPs). The findings demonstrate that the greater the electoral safety of constituencies, the more likely are MPs to have a higher office. The results reveal a broader conception of party strategy in government formation than previously documented. The paper thus suggests that electorates can affect the allocation of ministerial positions in the UK. [ABSTRACT FROM AUTHOR]

Safe vascular access is integral to anaesthetic and critical care practice, but procedures are a frequent source of patient adverse events. Ensuring safe and effective approaches to vascular catheter insertion should be a priority for all practitioners. New technology such as ultrasound and other imaging has increased the number of tools available. This guidance was created using review of current practice and literature, as well as expert opinion. The result is a consensus document which provides practical advice on the safe insertion and removal of vascular access devices. [ABSTRACT FROM AUTHOR]

The intellectual career of William Stukeley (1687–1765) has received much attention. However, one manuscript by Stukeley has never been discussed. In 1757 he composed a short treatise, ‘On the Philosophy of Pleasure’, in which he argued an unusual case, namely, that a man and woman ought to feel entitled to consummate their philosophic friendship with kissing. The manuscript illuminates an interesting episode in Stukeley’s private life, but it also has a broader significance. Firstly, it incorporates many of the themes developed elsewhere by Stukeley, showing how contemporary historical and scientific understanding could be synthesised with a mystical account, of ancient derivation, of the physical and social universe. Secondly, the manuscript sheds light on the changing relations of men and women. Social and cultural developments among the literate in eighteenth-century Britain were facilitating heterosocial interaction, outside the framework of courtship and marriage, in ways that enhanced both the possibilities for heterosocial friendship and the risks attached to it. In his manuscript, Stukeley sought to expand the physical expression of amicable affection between a woman and man: he was looking for ways to move beyond the constraints of Platonic love without falling into libertinism. His position accords with the idea that the pursuit of happiness in the eighteenth century had a sexual dimension. However, while Stukeley sought greater latitude in erotic expression, his effort illustrates the challenge of doing so without undermining the contemporary norms of social order. [ABSTRACT FROM AUTHOR]

It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. [ABSTRACT FROM AUTHOR]

This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end-tidal carbon dioxide monitoring have been updated. [ABSTRACT FROM AUTHOR]

The article deals with the changes in the British National Health Service. Since the establishment of the National Health Service, successive governments have exerted efforts to reconcile the objectives, minimizing its budget while maximizing its productive. Minimizing the agency's budget reflects the fact that health care should compete with other services for public resources and is further constrained by the desire of all governments to win elections by keeping taxes as low as possible. On the other hand, maximizing the productivity of the National Health Service reflects the fact that a combination of demographic changes and technological advances has increased the agency's output.