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Background: There is a growing body of research to suggest that women with gestational diabetes are less likely to initiate and continue breastfeeding than those who have not had however findings are mixed. There is limited research in the UK assessing the frequency of breastfeeding in women with gestational diabetes, none reporting the association of breastfeeding with incidence of type 2 diabetes and existing research has not adequately adjusted for potential confounders. This study aims to assess frequency of breastfeeding among women with gestational diabetes compared to those without, and to explore how breastfeeding influences risk of future type 2 diabetes in women with gestational diabetes while adjusting for known confounders. Methods: Historical cohort study using routinely collected health care data from Fife and Tayside Health Boards, Scotland, UK including all women diagnosed with gestational diabetes between 1993 and 2015 and a matched comparator cohort (n = 4,968). Women with gestational diabetes were followed up until a diagnosis of type 2 diabetes, the end of the study, or date of death. Multinomial logistic regression was used to estimate odds ratios for breastfeeding for the whole sample and the association between breastfeeding and development of type 2 diabetes in women with gestational diabetes was assessed by Cox regression. Results: Women with a diagnosis of gestational diabetes, who were younger, overweight/obese or living in the most deprived areas were significantly less likely to exclusively breastfeed for a duration of longer than eight weeks. Risk of developing type 2 diabetes among women with gestational diabetes was significantly higher for those who exclusively breastfed less than 8 weeks, lived in the most deprived areas or had a family history of diabetes. Conclusions: This study confirms the important role of a short duration of exclusive breastfeeding in protecting women with gestational diabetes against type 2 diabetes but highlights the challenges to breastfeeding in this group. Interventions are needed to support breastfeeding among women with gestational diabetes that are acceptable to younger, overweight/obese women living in deprived areas. [ABSTRACT FROM AUTHOR]

This account explores the role of action learning during and after an educational programme. We focus on the final stage of a master's programme and the insider research that is a key feature in many UK universities. Researching within one's own organization should lead to individual and organizational learning. However, there is relatively little published on how, indeed if, this learning occurs. Our account contributes to this gap and in doing so draws attention to the ethical and political challenges which can arise when undertaking research within one's own organization. We present the tale of two sets, one during and one after an educational programme. In doing so, we highlight the tensions involved in integrating learning with problem-solving. We illustrate how learning which seemed initially to be lost was later found through action learning.

The number and range of problems associated with academies and "free" schools is worrying and can be attributed to the lack of ability of central Government to oversee the increasingly fragmented education provision. In this article, the author looks at just a few of those problems which have been reported since she started to log them at the beginning of 2014.

Background: Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. Methods: Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. Results: A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals' roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). Conclusion: This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change. [ABSTRACT FROM AUTHOR]

Purpose: The histological diagnosis after diagnostic thyroidectomy for indeterminate thyroid nodules is often non-malignant and some cancers detected are considered 'indolent'. The safety and effectiveness of conservative management in these patients are unclear. The aim of this study was to determine the safety of conservative management of indeterminate thyroid nodules and to explore association between clinical features and pathology in patients undergoing surgery. Methods: This is a retrospective cohort study of patients presenting to a single centre over a 4-year period (2013–2016) with thyroid nodules that were considered indeterminate (thy3f in the UK RCPath classification) on cytology. Demographic data, ultrasound features, follow-up details (in those undergoing conservative management) and histology details (in those undergoing surgery) were collected. Results: Of 164 patients that had Thy3f cytology, 34 were initially managed conservatively; however, 4 of these eventually had surgery (due to patient preference). No patient on conservative management had significant disease progression on ultrasound at a median (interquartile range) of 27 (16–40) months. Of the 134 patients that underwent surgery, 26 had thyroid malignancy. The BTA 'U' classification, gender and age (> 55) were not associated with malignancy in these nodules, but larger nodules (> 40 mm) were more likely to be malignant (p = 0.042). Conclusions: Conservative management of indeterminate (Thy3f or Bethesda stage IV) thyroid nodules is safe in the short term and may be indicated in selected cases after appropriate discussion of risks and benefits of surgery. [ABSTRACT FROM AUTHOR]

Background Early and accurate treatment of infections due to carbapenem-resistant organisms is facilitated by rapid diagnostics, but rare resistance mechanisms can compromise detection. One year after a Guiana Extended-Spectrum (GES)-5 carbapenemase–positive Klebsiella oxytoca infection was identified by whole-genome sequencing (WGS; later found to be part of a cluster of 3 cases), a cluster of 11 patients with GES-5–positive K. oxytoca was identified over 18 weeks in the same hospital. Methods Bacteria were identified by matrix-assisted laser desorption/ionization–time of flight mass spectrometry, antimicrobial susceptibility testing followed European Committee on Antimicrobial Susceptibility Testing guidelines. Ertapenem-resistant isolates were referred to Public Health England for characterization using polymerase chain reaction (PCR) detection of GES, pulsed-field gel electrophoresis (PFGE), and WGS for the second cluster. Results The identification of the first GES-5 K. oxytoca isolate was delayed, being identified by WGS. Implementation of a GES-gene PCR informed the occurrence of the second cluster in real time. In contrast to PFGE, WGS phylogenetic analysis refuted an epidemiological link between the 2 clusters; it also suggested a cascade of patient-to-patient transmission in the later cluster. A novel GES-5–encoding plasmid was present in K. oxytoca , Escherichia coli , and Enterobacter cloacae isolates from unlinked patients within the same hospital group and in human and wastewater isolates from 3 hospitals elsewhere in the United Kingdom. Conclusions Genomic sequencing revolutionized the epidemiological understanding of the clusters; it also underlined the risk of covert plasmid propagation in healthcare settings and revealed the national distribution of the resistance-encoding plasmid. Sequencing results also informed and led to the ongoing use of enhanced diagnostic tests for detecting carbapenemases locally and nationally. [ABSTRACT FROM AUTHOR]

Connection of the new Queensferry Crossing in Scotland (UK) into the existing highway networks each side of the Forth estuary has required design and construction of a large number of technically complex structures. This paper describes the technical challenges involved and how multiple constraints were accommodated in design and construction. In particular, Ferrytoll viaduct is a highly skewed bridge with trapezoidal steel box girders and an innovative substructure solution. This structure was a rationalisation of a larger viaduct that had been detailed in the specimen design, a change which yielded significant benefits to cost, programme, landscape and environment. Other network structures include a range of steel composite structures, pretensioned beam structures, retaining walls and modifications to retained existing structures. [ABSTRACT FROM AUTHOR]

This preliminary research study examined the impact of Strengths Gym, a character strengths-based positive psychological intervention program, on adolescent life satisfaction. Using a quasi-experimental treatment-control condition design, the study compared student outcomes for life satisfaction, positive and negative affect, and self-esteem for 319 adolescent students aged 12-14 (M = 12.98): 218 adolescent students who participated in character strengths-based exercises in the school curriculum, and 101 adolescent students who did not participate in character strengths-based exercises in the school curriculum. Results revealed that adolescents who participated in character strengths-based exercises experienced significantly increased life satisfaction compared to adolescents who did not participate in character strengths-based exercises. Overall, results provide encouraging preliminary support for the application of character strengths-based exercises in the school curriculum as a means of increasing life satisfaction and well-being among youths. [ABSTRACT FROM AUTHOR]

The paper uses stakeholder analysis to examine issues of effectiveness and equity in the performance appraisal of NHS Consultants and academic staff in UK Universities. While the primary focus is on Consultants, the cases discussed show how many dilemmas in consultant appraisal are generic to the performance management of public sector professionals who enjoy significant autonomy and discretion in their work roles. Concepts of accountability and organisational justice are related to the philosophy and practice of performance management to produce a stakeholder systems model of consultant appraisal. The model enables performance appraisal systems to be considered in a holistic way; and confirms the benefit of stakeholder involvement at design, operation, evaluation and reporting stages. Conclusions from the paper address research agendas in performance management as well as the concerns of those involved in consultant appraisal. [ABSTRACT FROM AUTHOR]

Reflects on several issues concerning the role of learning as a core concept within human resource development (HRD) in Great Britain. Emerging outcomes of an action research project that explores how students and academics can become critically reflective HRD practitioners; Planned future research; Applicability of the research to the HRD profession.

More than 60 coal samples, predominantly from the principal coalfields of England and Wales (25) and Scotland (30), were analysed for lead by AAS and for stable lead isotopes by ICP-MS. While the average lead content of Scottish coal, 23.9 mg kg^-1, was more than double thatof coal from England and Wales, 11.0 mg kg^-1, the corresponding mean ^206Pb/^207Pb ratios (1 1 s.d.) were nearly identical, at 1.18110.011 and 1.18410.006, respectively. In the light of the lead isotopic signatures of British coals and of both indigenous (^206Pb/^207Pb ~ 1.17) and imported Australian (^206Pb/^207Pb ~ 1.04) lead ores, an approach based on estimated lead emissions from these sources and the deconvolution of the historical lead and ^206Pb/^207Pb records preservedin lake sediments, peat bogs and archival herbage material indicatesthat coal combustion became an increasingly significant contributor to atmospheric lead deposition in the UK during the period 1830-1930,especially after the onset of England's decline as a major location of lead mining and smelting in the late-19th Century. Since 1930 and the introduction of leaded petrol, the atmospheric ^206Pb/^207Pb ratio in the UK has been strongly influenced by car-exhaust emissions of comparatively ^206Pb-depleted lead of predominantly Australian origin, counter-balanced to some extent by coal-combustion emissions of lead, although these have fallen dramatically since the mid-1950s. Nevertheless, with the introduction and substantial uptake of unleaded petrol in the UK during the last decade, even the declining releases from coal, along with contributions from other sources, are continuing to affect the atmospheric lead content and ^206Pb/^207Pb ratio. [ABSTRACT FROM AUTHOR]

Red mud is a by-product of alumina production. Little is known about the long-term fate of red mud constituents in fresh waters or of the processes regulating recovery of fresh waters following pollution control. In 1983, red mud leachate was diverted away from Kinghorn Loch, UK, after many years of polluting this shallow and monomictic lake. We hypothesised that the redox-sensitive constituents of red mud leachate, phosphorus (P), arsenic (As) and vanadium (V), would persist in the Kinghorn Loch for many years following pollution control as a result of cycling between the lake bed sediment and the overlying water column. To test this hypothesis, we conducted a 12-month field campaign in Kinghorn Loch between May 2012 and April 2013 to quantify the seasonal cycling of P, As, and V in relation to environmental conditions (e.g., dissolved oxygen (DO) concentration, pH, redox chemistry and temperature) in the lake surface and bottom waters. To confirm the mechanisms for P, As and V release, a sediment core incubation experiment was conducted using lake sediment sampled in July 2012, in which DO concentrations were manipulated to create either oxic or anoxic conditions similar to the bed conditions found in the lake. The effects on P, As, and V concentrations and species in the water column were measured daily over an eight-day incubation period. Phosphate (PO 4 -P) and dissolved As concentrations were significantly higher in the bottom waters (75.9 ± 30.2 μg L −1 and 23.5 ± 1.83 μg L −1 , respectively) than in the surface waters (12.9 ± 1.50 μg L −1 and 14.1 ± 2.20 μg L −1 , respectively) in Kinghorn Loch. Sediment release of As and P under anoxic conditions was confirmed by the incubation experiment and by the significant negative correlations between DO and P and As concentrations in the bottom waters of the lake. In contrast, the highest dissolved V concentrations occurred in the bottom waters of Kinghorn Loch under oxic conditions (15.0 ± 3.35 μg L −1 ), with the release from the bed sediment apparently being controlled by a combination of competitive ion concentrations, pH and redox conditions. [ABSTRACT FROM AUTHOR]