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Food supply chains hold significant embodied carbon emissions that need to be mitigated and neutralized. This study aimed to explore the historical Greenhouse Gas (GHG) emissions associated with household food consumption at a local scale i.e. across the eight English regions and the four nations that comprise the United Kingdom (UK). UK EatWell guidelines were used to explore the potential change in emissions and food costs in a scenario of transitions to healthier diets across the study areas. These emissions were calculated based on food consumption data before the advent of the Covid-pandemic i.e. between the years 2001 and 2018. Spatial data analysis was used to explore if the study areas had any significant correlations with respect to the emissions during the study period. The results displayed a potential reduction in GHG emissions for all study areas in the explored scenario. Further impacts include a reduction in household food costs across a majority of the areas during the study period. However, a consistent trend of significant correlations among the study areas was absent. This study concludes that local or regional policymaking should take precedence over national regulations to achieve healthier diets that are both carbon-neutral and affordable for the households. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHRs) could identify long-term health effects of nicotine vaping. We characterised the extent to which vaping is recorded in primary care EHRs in the UK, on a population level. Methods: We performed descriptive analysis of Clinical Practice Research Datalink (CPRD), primary care electronic health records of 25% of the UK population (~ 16 million patients). Patients aged ≥ 18 years whose vaping status was recorded using medical codes between 2006 and 2022 were identified. We reported the frequency of vaping codes; their distribution by patient age, gender, and ethnicity; trends in vaping recording over time (including interrupted time series analyses); and transitions in patient smoking status. Results: Seven medical codes indicated current or former vaping, from 150,114 patients. When their vaping status was first recorded, mean patient age was 50.2 years (standard deviation: 15.0), 52.4% were female, and 82.1% were White. Of those recorded as currently vaping, almost all (98.9%) had records of their prior smoking status: 55.0% had been smoking, 38.3% had stopped smoking, 5.6% had never smoked. Of those who were smoking prior to being recorded as vaping, more than a year after the vaping record, over a third (34.2%) were still smoking, under a quarter (23.7%) quit smoking, 1.7% received a 'never smoked' status, and there was no smoking status for 40.4%. The 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak was significantly associated with a declining trend in new records of current vaping between September 2019 and March 2020; and an immediate significant increase in new records of former vaping, followed by a declining trend. Conclusions: Few patients are being asked about vaping. Most who vape had smoked, and many quit smoking after starting vaping. To enable electronic health records to provide stronger evidence on health effects, we recommend improved completeness, accuracy and consistency. [ABSTRACT FROM AUTHOR]

Early work on change in higher education by Guba and Clarke (1966) suggested that in achieving systematic change in institutions of higher education "there is a difference between what is needed and what is done". The authors, which are the leaders of particular project at the Institute of Education (IoE), University of Worcester, knew the nature of the change that they wanted to bring about but the pathway to enable this change was not clear. Their objective was to achieve a common and shared vision of "inclusive education", to include equality and diversity among all staff across five newly amalgamated but separate academic units or centres constituting the IoE. Through documenting and carefully analysing the process they undertook, they intend to provide deeper insight into and understanding of the nature of change, what helps to create effective change in universities, and whether such change is sustainable. They also explore whether the intended change was achieved and whether any unexpected outcomes, positive or negative, resulted. The authors' purpose throughout this case study is to reflect upon the process and its outcomes and to consider any future steps which are still required, identifying barriers and gateways to success along the way. (Contains 5 figures.)

Compound estuarine flooding is driven by extreme sea-levels and river discharge occurring concurrently, or in close succession, and threatens low-lying coastal regions worldwide. We hypothesise that these drivers of flooding rarely occur independently and co-operate at sub-daily timescales. This research aimed to identify regions and individual estuaries within Britain susceptible to storm-driven compound events, using 27 tide gauges linked to 126 river gauges covering a 30-year record. Five methods were evaluated, based on daily mean, daily maximum, and instantaneous 15-min discharge data to identify extremes in the river records, with corresponding skew surges identified within a 'storm window' based on average hydrograph duration. The durations, relative timings, and overlap of these extreme events were also calculated. Dependence between extreme skew surge and river discharge in Britain displayed a clear east–west split, with gauges on the west coast showing stronger correlations up to 0.33. Interpreting dependence based on correlation alone can be misleading and should be considered alongside number of historic extreme events. The analyses identified 46 gauges, notably the Rivers Lune and Orchy, where there has been the greatest chance and most occurrences of river-sea extremes coinciding, and where these events readily overlapped one another. Our results were sensitive to the analysis method used. Most notably, daily mean discharge underestimated peaks in the record and did not accurately capture likelihood of compound events in 68% of estuaries. This has implications for future flood risk in Britain, whereby studies should capture sub-daily timescale and concurrent sea-fluvial climatology to support long-term flood management plans. [ABSTRACT FROM AUTHOR]

The workplace is considered an effective setting for health and wellbeing interventions, including programmes focusing on nutrition, and provides opportunities to tailor programmes to meet the specific needs of industry and employees. This study explored nutrition practices amongst construction workers and managers to inform the design of a nutrition intervention. Five focus groups were conducted on three construction sites: two with managers (n = 11) and three with workers (n = 27). Construction workers and managers identified several unhealthy nutrition-related behaviours, including high consumption of convenient and fast foods, excessive coffee, alcohol, energy drinks and low fruit and vegetable intake. These behaviours were often attributed to high workloads, long working hours and physically demanding jobs. Snacking and skipping meals were repeatedly reported, attributed to short breaks and poor accessibility to food outlets. The nutritional quality of meals differed between individuals (homemade vs fast food), depending on the type of sites (temporary vs permanent) and site location. Nutrition knowledge, establishing routines, meal planning and preparation were recognized as important in sustaining healthy nutrition habits. However, meal preparation depended on the facilities available, which differed between managers and workers, highlighting the complex relationship between the workplace context and eating behaviours. Construction workers were interested in learning about nutrition and improving their eating habits through nutrition intervention. However, they highlighted that better cooking and storage facilities on site, together with fewer job demands and longer break times, would enhance the sustainability of the intervention and their ability to make healthier food choices. [ABSTRACT FROM AUTHOR]

The incidence of hepatitis E continues to increase and in immunocompromised patients can lead to chronic infection. Management of hepatitis E has evolved over time, with the first step being a reduction of immunosuppression followed by treatment with ribavirin. The European Association for the Study of Liver guidelines support treatment with ribavirin although the optimum dose and regime is unknown. This series reviews eight chronically infected cases treated between 2018 and 2021 in two UK centres (Ipswich Hospital and Addenbrooke's Hospital). Treatment response was defined primarily as sustained virological response at 12 weeks (SVR12) following the cessation of treatment and secondly as sustained virological response at 24 weeks (SVR24). The median dose of ribavirin given daily was 600 mg. The management of five of the eight cases was in line with the guidelines, and treatment was stopped after 12 weeks. Two of these five patients achieved SVR (40%). The remaining three cases were given a 24‐week course based on clinical judgement, and all achieved SVR (100%). The three patients who relapsed received a second 24‐week course of treatment and achieved SVR. Therefore, with a 24‐week course, a 100% treatment success rate was attained. In chronic hepatitis E, a 24‐week course of ribavirin would achieve optimum clearance rates with a single course of treatment. Ensuring the highest dose of ribavirin as possible (aiming to reach 800 mg daily) and attempts to reduce immunosuppressive therapy safely may also be relevant to achieving SVR. [ABSTRACT FROM AUTHOR]

Background: Substance use and psychiatric illness, particularly psychotic disorders, contribute to violence in emergency healthcare settings. However, there is limited research regarding the relationship between specific substances, psychotic symptoms and violent behaviour in such settings. We investigated the interaction between recent cannabinoid and stimulant use, and acute psychotic symptoms, in relation to violent behaviour in a British emergency healthcare setting. Methods: We used electronic medical records from detentions of 1089 individuals under Section 136 of the UK Mental Health Act (1983 amended 2007), an emergency police power used to detain people for 24–36 h for psychiatric assessment. The relationship between recent cannabinoids and/or stimulant use, psychotic symptoms, and violent behaviour, was estimated using logistic regression. Findings: There was evidence of recent alcohol or drug use in 64.5% of detentions. Violent incidents occurred in 12.6% of detentions. Psychotic symptoms increased the odds of violence by 4.0 [95% confidence intervals (CI) 2.2–7.4; p < 0.0001]. Cannabinoid use combined with psychotic symptoms increased the odds of violence further [odds ratios (OR) 7.1, 95% CI 3.7–13.6; p < 0.0001]. Recent use of cannabinoids with stimulants but without psychotic symptoms was also associated with increased odds of violence (OR 3.3, 95% CI 1.4–7.9; p < 0.0001). Interpretation: In the emergency setting, patients who have recently used cannabinoids and exhibit psychotic symptoms are at higher risk of violent behaviour. Those who have used both stimulants and cannabinoids without psychotic symptoms may also be at increased risk. De-escalation protocols in emergency healthcare settings should account explicitly for substance use. [ABSTRACT FROM AUTHOR]

Objective: Quantitative data on visual outcomes after trans-sphenoidal surgery is lacking in the literature. This study aims to address this by quantitatively assessing visual field outcomes after endoscopic trans-sphenoidal pituitary adenectomy using the capabilities of modern semi-automated kinetic perimetry. Methods: Visual field area (deg2) calculated on perimetry performed before and after surgery was statistically analysed. Functional improvement was assessed against UK driving standards. Results: Sixty-four patients (128 eyes) were analysed (May 2016–Nov 2019). I4e and I3e isopter area significantly increased after surgery (p < 0.0001). Of eyes with pre-operative deficits: 80.7% improved and 7.9% worsened; the median amount of improvement was 60% (IQR 6–246%). Median increase in I4e isopter was 2213deg2 (IQR 595–4271deg2) and in I3e isopter 1034 deg2 (IQR 180–2001 deg2). Thirteen out of fifteen (87%) patients with III4e data regained driving eligibility after surgery. Age and extent of resection (EOR) did not correlate with visual improvement. Better pre-operative visual field area correlated with a better post-operative area (p < 0.0001). However, the rate of improvement in the visual field area increased with poorer pre-operative vision (p < 0.0001). Conclusions: A median visual field improvement of 60% may be expected in over 80% of patients. Functionally, a significant proportion of patients can expect to regain driving eligibility. EOR did not impact on visual recovery. When the primary goal of surgery is alleviating visual impairment, optic apparatus decompression without the aim for gross total resection appears a valid strategy. Patients with the worst pre-operative visual field often experience the greatest improvement, and therefore, poor pre-operative vision alone should not preclude surgical intervention. [ABSTRACT FROM AUTHOR]

The focus of this scoping review was to identify the extent, range, and nature of studies that have been published regarding community integration programs and interventions that support people during the transition home from hospital following spinal cord injury. Four electronic databases and one search engine were searched for articles published between 2010 and 2020. Grey literature and manual searches were also done. Of the 16 articles included, 8 were published in peer-reviewed journals. Two of these did not include an evaluation. Study designs included but were not limited to pilot studies (n = 2); mixed methods evaluations (n = 2); single-site randomized controlled trials (n = 3); and, non-randomized single-arm study design (n = 1). The articles were from the United States (n = 12), Canada (n = 2), Australia (n = 1), and the United Kingdom (n = 1). The majority of interventions focused on addressing health-related educational needs, followed by community mobility. Goal setting and promoting self-efficacy were identified as important components, and the importance of involvement of people with lived experience was also highlighted. There was a lack of focus on management of relationships, including addressing sexuality needs. This review highlights the need for further empirical evaluation of implemented programs and interventions in this area, particularly in countries other than the USA, to inform service development. Successful community integration is an important outcome of spinal cord injuries rehabilitation. The majority of published programs focus on health-related educational needs, followed by community mobility. It is recommended that goal setting and promoting self-efficacy are included in programs. It is recommended that people with lived experience of spinal cord injuries are involved in interventions. It is recommended that programs include a focus on management of relationships, including addressing sexuality needs. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To improve your knowledge of public health and the determinants of health • To understand how practice learning can assist nursing students to engage with public health • To familiarise yourself with the factors that contribute to an effective public health placement for nursing students At the point of qualification, nursing students need to be prepared to work in local population health and be aware of the wider determinants of health. The Nursing and Midwifery Council standards of proficiency for registered nurses require them to understand and engage with public health, specifically health promotion and illness prevention. In 2019, representatives from Barnet Clinical Commissioning Group and Middlesex University London, alongside the Royal College of Nursing's public health lead, developed a public health nursing student placement. To date, two child health nursing students in their final year have completed a placement with the public health team. This article examines their experience of the placement, as well as detailing an evaluation of the project. [ABSTRACT FROM AUTHOR]

Background: Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. Methods: Data from patients who underwent endoscopic TSS for a NFPMA (2009–2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. Results: Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). Conclusion: Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth. [ABSTRACT FROM AUTHOR]

Background: Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and future schemes, including challenges to full engagement encountered by stakeholders, which lie beyond the scope of traditional evaluations. Critical Systems Thinking (CST) allows for holistic analysis of fields where multiple stakeholders hold diverse interests and unequal power.Methods: We use CST to (a) critically examine a developing rural social prescribing scheme from multiple stakeholder perspectives and (b) present a relational model for local social prescribing schemes. Our fieldwork included 24 in-depth interviews, regular planning meetings with key stakeholders, and discussions with those involved with national and international SP landscaping. A modified grounded theory approach was used for the analysis, and to consider the core elements of social prescribing sustainability.Results: Our study confirms that local social prescribing schemes must operate with numerous stakeholder interests in mind, seeking to address real life social complexity and offer integrated solutions to multifaceted issues. Three main areas are discussed: holistic vision and boundary judgments; barriers and facilitators; relational issues and "emotional buy in". Problems for staff include selecting suitable clients, feedback and technological issues and funding and evaluation pressures. Barriers for clients include health, transport and expense issues, also lack of prior information and GP involvement. Emotional "buy-in" emerged as essential for all stakeholders, but hard to sustain. Based on our findings we propose a positive relational model comprising shared vision, confidence and commitment; motivation and encouragement, support and wellbeing focus, collaborative relationships, communication and feedback, access to information /resources, learning in and from action, with emotional "buy-in" at its heart.Conclusion: Those implementing social prescribing in different localities inevitably face hard choices about what and whom to include. Research on the sustainability of social prescribing remains limited, studies are required to ascertain which "holistic" models of social prescribing work best for which communities, who are the main beneficiaries of these approaches and how "buy-in" is best sustained. [ABSTRACT FROM AUTHOR]

Presents guidelines for making individual cassette recordings for student homework from tape masters accompanying foreign language texts. Strategies for using and supplementing curricular material are also discussed. (LMO)

Describes a project to assess the impact of teacher unemployment in the United Kingdom and the United States on teachers' attitudes toward the political system and on perceptions of the political self. Findings indicate that status deprivation results in awareness of political forces and tends to make unemployed individuals somewhat more conservative. (Author/DB)

Abstract Waterborne and shellfish-borne enteric viruses associated with wastewater-polluted coastal waters (e.g. Norovirus, Hepatitis A/E viruses, Adenovirus) represent a major threat to human health. Improved understanding of the locations and periods of heightened risks can help target mitigation measures and improve public health. We developed a river-estuary-coast model to simulate virus dispersal, driven by point source discharges and river flows in combination with tidal forcing. Viral inputs were based on measured wastewater adenovirus concentrations and the model was implemented with or without viral die-off. We applied the model to the Conwy river (North Wales, UK), through the estuary, to the Irish Sea coast where bathing waters and shellfisheries are known to be prone to viral contamination. Using a suite of scenarios, we showed that river flow was the primary control of viral export to the coast. Since the Conwy catchment is short and steep, and the estuary is small and river-dominated, short-duration high intensity 'flash floods' were shown to transport viruses through the estuary and out to sea, despite dilution or die-off effects. Duplicating flow events (i.e., storm clustering) did not double the virus export since the virus re-entered the estuary on the flood tide. The tidal magnitude and timing of high water relative to peak river flow were also important drivers regulating viral dispersal. A worst-case event simulation (i.e., combining high river flows with high viral loading and high spring tide) resulted in increased concentrations of virus at nearby coasts, although the spatial spread was similar to the previous scenarios. Our results suggest that impact models for predicting and mitigating episodes of poor microbiological water quality may require careful representation of the intensity and timings of river flow when evaluating pathogen exposure risk. Highlights • Enteric viruses can travel from catchment to estuary while active, within hours. • Coastal recreational waters and shellfisheries have heightened exposure to viruses. • The level of coast exposure is high during ebb tide and high river flow conditions. • Our results represent small catchment-estuary systems, which are common in the UK. • Models for mitigating coastal health risk require sub-daily river flow data. [ABSTRACT FROM AUTHOR]

We propose a suite of actions for strengthening water governance in contexts with complex, multi-tiered arrangements. In doing so, we focus on the collective water policies and approaches of the United Kingdom (UK), including those of devolved governments, which confront a host of serious water-related challenges—from massive flooding of urban areas and agricultural lands, to pressure on aquifers from rising water demand and drought. Further complexity in addressing these challenges has emerged in the wake of the June 2016 vote to leave the European Union (EU), so-called ‘Brexit’, and the ensuing ‘separation process’ with uncertainties for institutional and governance arrangements to follow. We make ten proposals for improving and reinvigorating water policy in complex, multi-layered situations, and comment specifically on their application in the UK setting. These are: put in place a system-wide water policy; fully embrace community-led nested river basin planning and management; fully fund river basin planning and management; re-focus the policy framing; use best-available data and information; create conversational spaces and become a more water-literate society; mobilise people; support and sustain core community networks; underpin river basin plans with regulatory provisions and effective monitoring and enforcement; and address systemic institutional amnesia. Individually and collectively, we contend that these actions will have a marked effect on transforming the planning and management of water resources. A system-wide water policy that maintains and builds on the substantive biophysical and socio-economic benefits delivered through implementation of the EU Water Framework Directive, together with the more recent Floods Directive, will galvanise stewardship of water in the UK. We urge more active engagement with and empowerment of the multiplicity of system ‘actors’, and highlight the role of non-government actors in a post-Brexit world as conduits for reaching out to and connecting directly with a wide range of water-related actors, especially across the EU. While attention to-date has focused on a plethora of specifically water-related projects, initiatives, plans and regulations, what is really needed is a systemic, long-term view of water resource management. [ABSTRACT FROM AUTHOR]

Activity demand models for delivery of the Healthy Child Programme (HCP) through the school nursing workforce are limited. This paper describes the application of a potentially new activity demand model for school nursing. The model identifies what the demand for school nursing is in Staffordshire, using estimated delivery times of universal and targeted components from the HCP, numbers of children and local information around targeted activity, eg, numbers of looked after children. The model suggests that the school nursing service would spend around 60% of time on individual face to face activity, 30% on public health leadership, management and evaluation and the 10% on travel in Staffordshire. It also suggests a shortfall in workforce capacity. The model can be used to underpin commissioning decisions and service redesign and changes in practice would be required to meet the full requirements of the HCP. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors that make it more or less likely that healthcare practitioners (HCPs) will perform certain patient safety behaviors is important in developing effective intervention strategies. A questionnaire to identify determinants of HCP patient safety behaviors does not currently exist. This study reports the development and initial validation of the Influences on Patient Safety Behaviors Questionnaire (IPSBQ) based on the Theoretical Domains Framework. Methods: Two hundred and thirty-three HCPs from three acute National Health Service Hospital Trusts in the United Kingdom completed the 34-item measure focusing on one specific patient safety behavior (using pH as the first line method for checking the position of a nasogastric tube). Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Results: The final questionnaire consisted of 11 factors and 23 items, and CFA produced a reasonable fit: Χ2 (175) = 345.7, p < 0.001; CMIN/DF = 1.98; GFI = 0.90 and RMSEA = 0.06, as well as adequate levels of discriminant validity, and internal consistency (r = 0.21 to 0.64). Conclusions: A reliable and valid theoretically underpinned measure of determinants of HCP patient safety behavior has been developed. The criterion validity of the measure is still unknown and further work is necessary to confirm the reliability and validity of this measure for other patient safety behaviors. [ABSTRACT FROM AUTHOR]

The article presents information on the United Kingdom Employment Retention and Advancement (U.K. ERA) demonstration, which was the largest social experiment conducted in Great Britain. The program, that took place between October 2003 to October 2007, tested the effectiveness of an innovative method used for improving the labor market prospects of low-wage workers and people who were unemployed for a long period in Great Britain.

Abstract: Britain''s national rail system was ‘privatised’ as a result of the 1993 Railways Act, with most of the organisational and ownership changes implemented by 1997. This paper examines the long term impacts of these changes. A key issue when examining long term changes is that of the counterfactual – what would have happened if the changes had not occurred? A simple econometric model of the demand for passenger rail services was developed and used in conjunction with extrapolative methods for key variables such as fares and train km to determine demand-side counterfactuals. Extrapolative methods were also used to determine counterfactual infrastructure and train operation costs. Although our results are sensitive to the assumptions we have made concerning the counterfactual they suggest a number of impacts. Since privatisation, rail demand has grown strongly but our analysis indicates that transitional disruptions suppressed demand by around 9% over a prolonged period (1992/3 to 2005/6), whilst the Hatfield accident reduced demand by about 5%, albeit over a shorter period (2000/1 to 2006/7). A welfare analysis suggests that although consumers seem to have gained as a result of privatisation, for most years this has been offset by increases in costs. An exception is provided by the two years immediately before the Hatfield accident. Overall the loss in welfare since the reforms were introduced far exceeds the net receipts from the sale of rail businesses. Thus although the reforms have had advantages in terms of lower fares and better service levels than otherwise would have been the case, this appears to have been offset by increased infrastructure and train operations costs. The source of these high costs remains an area of speculation but appear to be related to aspects of both market and regulatory failure. [Copyright &y& Elsevier]

For over 200 years the East India Company was the world's largest corporation. Set up as a merchant trading house in 1600, it became a permanent joint stock company in 1657, the forerunner of the modern multinational. The tension between investment and speculation was reflected in a share price which rose and fell with its fortunes. In the beginning bullion was brought from Britain to pay for Indian goods, which were then shipped to Britain. But in 1766, not long after Clive's victory at the battle of Plassey, the Company acquired the diwani, the right to collect the taxes, in Bengal. A situation of “unrequited trade” was thus established. Suddenly the profits from tax collecting more than covered the cost of trade goods. The dividend, jumped from six per cent in 1766 to 12 per cent in 1769. The shares soared. Then the Company's position in South India was threatened and the share price collapsed. The Company had overwhelming debts, but was judged “too big to fail”. It had to be bailed out by the British government, which in return secured the right to nominate representatives to the Bengal Council. Corruption and accountability became increasingly important themes. By the time Warren Hastings was Governor-General the company was purchasing vast quantities of tea from China. What could be sold to China in return? Answer: Indian opium. This trade notoriously led to war with China. But by the end of the Second Opium War, the Indian Mutiny had put paid to the Company's rule over India, though the Company continued a financial existence until 1874. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the performance of ASSIGN against the Framingham equations for predicting 10 year risk of cardiovascular disease in a UK cohort of patients from general practice and to make the evaluation comparable to an independent evaluation of QRISK on the same cohort. Design Prospective open cohort study. Setting 288 practices from England and Wales contributing to The Health Improvement Network (THIN) database. Participants Patients registered with 288 UK practices for some period between January 1995 and March 2006. The number of records available was 1 787 169. Main outcome measures First diagnosis of myocardial infarction, coronary heart disease, stroke and transient ischaemic attacks recorded. Methods We implemented the Anderson Framingham Coronary Heart Disease and Stroke models, ASSIGN, and a more recent Framingham Cox proportional-hazards model and analysed their calibration and discrimination. Results Calibration showed that all models tested overestimated risk particularly for men. ASSIGN showed better discrimination with higher AUROC (0.756/0.792 for men/women), D statistic (1.35/1.58 for men/ women), and R2 (30.47%/37.39% for men/women). The performance of ASSIGN was comparable to that of QRISK on the same cohort. Models agreed on 93e97% of categorical (high/lower) risk assessments and when they disagreed, ASSIGN was often closer to the estimated Kaplan-Meier incidence. ASSIGN also provided a steeper gradient of deprivation and discriminated between those with and without recorded family history of CVD. The estimated incidence was twice/three times as high for women/men with a recorded family history of CVD. Conclusions For systematic CVD risk assessment all models could usefully be applied, but ASSIGN improved on the gradient of deprivation and accounted for recorded family history whereas the Framingham equations did not. However, all models display relatively low specificity and sensitivity. An additional conclusion is that the recording of family history of CVD in primary care databases needs to improve given its importance in risk assessment. [ABSTRACT FROM AUTHOR]

Reduced organ perfusion during cardiopulmonary bypass (CPB) is responsible for morbidity associated with cardiac surgery. Non-pulsatile flow and hypothermia during CPB have been shown to cause reduced perfusion. During CPB, cardiac output is directly proportional to the pump flow rate. Therefore, we hypothesised that increasing pump flow during hypothermic CPB would improve organ perfusion and reduce the inflammatory response in the post-operative period. Methods: Ethics committee approval was obtained. Twelve consecutive patients with good or moderate left ventricular function undergoing elective or inpatient coronary artery bypass grafting were included in the study after obtaining informed consent. Patients were randomised to receive either normal flow or higher pump flow (20% more than the usual flow during hypothermia). Hepatic blood flow, cytokines such as interleukins 1β, 6, 8, 10 and 12, tumour necrosis factor-a and complements C3a, C4a and C5a were measured during the pen-operative period. Data were analysed using SPSS (ver. 15). Categorical data were compared using the chi-square test and trends in cytokines were compared using a repeated measures AN OVA test. Results: Both the groups were similar in pre- and pen-operative variables. Hepatic blood flow almost doubled in the high-pump-flow group following an increase in the flow rate during hypothermia(p=0.026). The release of serum complement IL-6 and 8 appeared to be reduced in the high-flow group; however, the difference did not reach statistical significance. Conclusions: Higher pump flows during hypothermic CPB increase hepatic blood flow. There was a trend towards attenuation of post-operative inflammatory response; however, larger studies will be needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Aliment Pharmacol Ther 2010; 32: 573–581 Background The only therapy for coeliac disease (CD) is a long-term gluten-free diet (GFD). Little is known about the detailed composition of such a diet. Aim To clarify the nutritional composition of a GFD and to compare it with a non-GFD diet in representative non-CD populations. Methods A total of 139 consecutive patients with CD were invited to fill in a prospective validated 5-day food diary, of whom data from 93 were analysed. Results were compared with data from the National Diet and Nutrition Survey of Adults and the UK Women’s Cohort Study (UKWCS). Results Individuals consuming a strict GFD generally had similar intakes of energy and nutrients to those of comparison populations, but a higher proportion of carbohydrate intake was obtained from nonmilk extrinsic sugars and intakes of nonstarch polysaccharides were low. Compared with the UKWCS sample, female patients adhering to a GFD had lower intakes of magnesium, iron, zinc, manganese, selenium and folate. In male patients, intakes of magnesium and selenium were particularly low. Conclusions This study reinforces the need for clinicians to recognize that avoidance of gluten cannot be the sole focus of a gluten-free diet. Maintenance of adequate intakes of essential nutrients and in particular complex carbohydrates must also be the goal for patients. [ABSTRACT FROM AUTHOR]

This paper seeks to address the significance of world music through the category of cosmopolitanism, and of what I term good-enough cosmopolitanism. It does so by way of an encounter with two major mediators of world music based in the UK, Charlie Gillett and Robin Denselow. The intention is to explore ways in which to think about the broader cultural significance of this music, including its continuities with earlier forms of popular music. And its argument is that music provides possibilities to think about cosmopolitan issues in rather distinctive ways—in ways that are different from the lines of thought currently being developed in contemporary mainstream sociology. I am thinking of cosmopolitanism, not in terms of an ideological or identitarian position, but, rather, in terms of a stance or disposition towards the world involving an enlarging imagination and modality of thought. I am interested, then, in the cultural-political potential inherent in the music agenda. [ABSTRACT FROM AUTHOR]

Background: Coeliac disease is a relatively common condition which is usually managed by placing patients on a gluten free diet. Follow up biopsies to confirm histological recovery are controversial with a considerable variation in practice observed. [ABSTRACT FROM PUBLISHER]

The article presents information on various issues related to the British Army. A belt plate of the Royal British Artillery has been illustrated. The book "The Regiments Depart," by William Kimber, covers the history of the British Army from 1945 to 1970. A noon-day gun in Halifax, Nova Scotia is being fired daily except during Christmas Day.

Objective. This article uses data from the National Child Development Survey on a cohort of individuals born in Great Britain during the first week of March 1958 to investigate whether educational attainment and labor force behavior 33 years later are affected by childhood behavioral problems that are exhibited at both age 7 and age 16. Method. Regression methods are used to test hypotheses concerning these effects. Results. Our results indicate that maladjusted children suffer economically when they reach adulthood. Maladjusted children perform worse on aptitude tests and have lower educational attainment. Maladjusted children also are less likely to be employed at age 33 and to have lower wages when employed. Part of the reduced employment and wages is the result of lower education, but part is also due to other factors. Conclusion. Future research should investigate whether adult labor market outcomes vary with the type of behavioral problems exhibited at younger ages. [ABSTRACT FROM AUTHOR]

Examines factors underlying citizenship tests and education in Great Britain. Development of citizenship education; Study of culture and history; Integration of ethnic minorities.

This article is concerned with the culture of Turkish Cypriots in Britain, and at the same time with the problems of finding an adequate theoretical language to theorise those experiences. First, it seeks to bring out the particularity of Turkish-Cypriot culture, located as it is between British, Cypriot and Turkish reference points. We argue that this is a culture that is distinctively, and often uncomfortably, placed between national and transnational conditions of existence. The article looks particularly at the experiences of Turkish-Cypriot women, seeking to explore their sense of cultural positioning as they live their lives in London. In its more theoretical sections, the article seeks to work against the national discursive frame of community and identity that is generally used to describe Turkish-Cypriot culture, suggesting instead an alternative approach that shifts from identity to experience and thinking about experiences. [ABSTRACT FROM AUTHOR]

This paper uses data from the age 33 wave of the British National Child Development Survey (NCDS) to analyze the effects of a parental disruption (divorce or death of a father) on the labour market performance of children when they reach adulthood. The NCDS is a longitudinal study of all children born during the first week of March 1958 in England, Scotland, and Wales. Controlling for a rich set of pre-disruption characteristics, the results indicate that a parental disruption leads to moderately less employment among males and considerably lower wage rates among females at age 33. If pre-disruption characteristics are not controlled for, larger effects are estimated for both males and females. Parental disruption also seems to cause substantial reductions in educational attainment for both males and females. [ABSTRACT FROM AUTHOR]

Discusses various studies concerning the city in Great Britain, featured in the 2001 issue of the periodical 'City.' Complexity of cultural life; Problems in the national culture; Analysis of communication and city planning; Reflection on the draft economic development and regeneration strategy.

Focuses on the use of groupwork as a teaching and learning device in the public administration education in Great Britain. Limitation on the volume of materials; Acquisition of necessary skills and knowledge; Formations of seminars and tutorials.

A recent review article in the British Journal of Politics and International Relations made a number of criticisms about the supposed lack of innovation and theoretical rigour found in current British politics textbooks. Jones and Robins constructively engage the points made in the article and argue that the criticisms made are only partly valid. They conclude that, within the obvious confines of a basic text, there is more on offer to students than there has ever been and that the success of these textbooks provides publishers with the means to cross-subsidise minority interest scholarship. [ABSTRACT FROM AUTHOR]

According to the European Commission, construction is an important industry providing the EU with 18 million jobs and contributing to 9% of the EU’s GDP in 2020. Construction workers struggle with healthy food choices due to lack of knowledge, long working hours, remote site locations, poor food facilities on site, and temporary accommodation. Yet, nutrition interventions in construction are rare, with no UK studies. This is an exploratory study designed to investigate workers’ perceptions of a workplace intervention to facilitate healthy nutrition choices. Engaging participants in the intervention design showed positive results on behaviour change. Five internally homogenous focus groups were conducted on three different construction sites (in three companies); two with managers (n = 11) and three with workers (including subcontractors) (n = 27). Sites differed in size (14; 50-100; and 300 workers); two were temporary. Framework Analysis was used to analyse data. The main themes uncovered in the focus groups were; 1) the need for workers to learn about food to sustain good energy levels, as deemed crucial for their job 2) the desire to get an understanding about portion sizes, food labels, impacts of food on mood and practical ideas of healthy snacks and meal planning and 3) the importance of intervention accessibility for everybody on site (including subcontractors), convenient scheduling and location, and managers support to encourage participation. A participatory approach was used to explore workers’ suggestions on the content and delivery of the nutrition intervention. Education and practicality of recommendations were of the essence to workers, who suggested that individual characteristics, the nature of construction jobs (e.g. busy schedules, transient jobs), and resources available (e.g. storage) need to be considered when designing the intervention. Inclusivity, accessibility and managerial support were regarded as valuable in the intervention delivery. Key messages: · This research produced recommendations to encourage the development and implementation of inclusive nutrition interventions in construction, to improve the health and wellbeing of workers. · This research invites public health consultants and senior leaders in construction to invest in supporting healthy behaviours of workers, with a consideration of job and workplace characteristics. [ABSTRACT FROM AUTHOR]

This article aims to assess the British press's reporting and analysis of the Gulf conflict in 1987, the year in which the conflict intensified. The article will confine itself to the daily press because of its concern with news and comment, rather than weekly publications which tend to be more featurish or academic, or which simply summarize the dailies. It will deal only with the serious press. The general public tends to be less interested in foreign affairs, while intellectuals and decision-makers read the quality newspapers. In concentrating on this perspective, I have taken four of the British daily newspapers: the Financial Times, the Times, the Independent, and the Guardian. [ABSTRACT FROM AUTHOR]

As football related disorders remain stubbornly impervious to 'solutions', so the study of football hooliganism has become almost a minor branch of the social sciences. This paper looks critically at the main academic approaches to the problem in the UK and Europe. The shortcomings of much of this work are revealed, both theoretically and in terms of the evidence employed about the nature of hooliganism. The meager amount of data about hooliganism contained in the plethora of Government reports that have so far been commissioned is striking. This may well be the reason why 'official' remedies so often prove inadequate. One way of gaining an understanding of this phenomenon is by making contact with, talking to, and observing at first hand the behaviour of those people most centrally involved, the hooligans themselves. This paper concludes with a series of portraits of 'the boys', some of it based on their own published writing. This will illustrate different forms of hooligan involvements. It will also provide an understanding of its origins as well as the true scale and scope of hooligan activity, about which many myths prevail. Something of the changes as well as the continuities on the football scene over the past 25 years will be indicated. Finally we will attempt to locate the whole phenomenon in its true place within British youth culture. [ABSTRACT FROM AUTHOR]

Examines some of the issues which affect the teaching of politics in Great Britain. Role of the Politics Association Resource Center; Factors which determine which textbooks are used for studying and teaching; Examination of the Politics syllabus at the sixth-form and undergraduate levels.

Discusses British Broadcasting Corporation's (BBC) commitment to the cause of regional broadcasting. Policy documents and statements affirming the commitment; BBC's legacy of regionalism and the challenges it faces; New agenda for regionalism as a result of 1980s and 1990s socio-economic transformations; Presentation of BBC Television Regions 1991-92 report; Significance of BBC to the regionalist agenda.

The article offers a look at the growth of the independent production sector in Great Britain. Independent production appeals to a new ethos in broadcasting and independents are seen as the carriers of diversity and innovation in programmes and in programme-making methods. It mentions that with the introduction of Channel Four, a significant number of small, independent production companies established themselves outside London, England. It reveals that there has been a broad consensus that such production has been a source of both cultural innovation and industrial flexibility in the television industry.

The article examines the processes through which cultural identities are produced and consumed, at both macro and micro levels. This discussion argues that a cultural identity must be defined, not by its positive content, but always by its relation to, and differentiation from, other cultural identities. The construction of cultural identities is discussed. The cultural identity of Great Britain is, in fact, formulated around the cultural identity of its dominant English part. The England being reconstructed based on race is being reconstructed around a tradition which is unproblematically white, a tradition which tends toward a morbid celebration of England and Englishness from which blacks are systematically excluded.

The article discusses politics in the British television broadcasting industry. The author states that from the communications revolution of the 1980s, anomalous political alliances were born. He argues that between these political alliances of commerce and entrepreneurship on one hand, and cultural paternalism on the other, there is no meaningful choice. He adds that the way toward a democratic media and cultural policy is not clear and it is unfortunate, he claims, that the debate has become polarized over these alliances. The objective of the debates, he believes, should be aimed at making media accountable and responsive to social, instead of commercial needs.

The article emphasizes the importance of mass media in the success of military campaigns. The authors note that the failure of the Falklands campaign of the British Ministry of Defence (MOD) could be attributed to its censorship rules. A television executive criticized the MOD for its failure to understand the importance of information war in the Falklands crisis, which prevented the media from disseminating information that could elicit public support on war issues. It is argued that the Falkland project could have been successful if the public relations policy of the military was balanced with its secrecy policy.

The authors explore the concept of selling the blueprints for an information Utopia that has dominated in business of the legions of politicians, futurologists, advertising agencies and public relations experts in Great Britain. They note that regional inequality in the country is likely to be amplified by an information revolution. They also assert that access to information technologies in Britain is regionally differentiated and that spatial inequalities are associated with class and income.

Focuses on medical issues in Great Britain. Query on the access of computer files as a legal right; Need for change in recommendations on pertussis immunization; Function of an ophthalmic accident and emergency department.

Assesses how the major trade unions in Great Britain are responding in their attitudes and policies to technological innovation. Likely impact of microelectronics on employment and work patterns; Changes in occupational structure; Developments in trade union composition; Variations between union memberships in different spheres.

The monitoring of metals in ambient air has been undertaken for over 40 years on a national basis in the UK. During this period, the UK pollution landscape has continued to evolve in terms of emission sources, and the measurement framework for metals in ambient air, the UK Heavy Metals Monitoring Network, has also been subject to significant configuration changes. Therefore, this work provides a timely review of more recent concentration trends in the context of current emission profiles. Overall, throughout this time period, there has been a significant downward trend in the emissions and consequently, the measured concentrations of most metals in UK ambient air. Ambient concentrations were generally found to be well correlated with emission estimates. Analysis of the sensitivity of measured concentrations to emissions suggests that concentrations have fallen faster than the reduction in emission estimates would have predicted at typical median urban background sites. [ABSTRACT FROM AUTHOR]