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Migrants' remittances have often been understood to operate as a form of insurance for families, communities and countries of origin, increasing in times of downturn and disaster. But what happens when the same crisis hits both destination and origin countries simultaneously? During the Covid-19 pandemic, despite early expectations of a dramatic contraction, official recorded remittances were characterized as remarkably a 'resilient' financial flow. This article investigates the people and processes behind remittances through the crisis. Drawing on micro-level mixed-methods primary research in the UK, we investigate indications of community-level resilience in migrants' remittance practices, highlighting that perceptions of rising needs abroad added fuel to people's desire to remit, while diverse economic capacities also mediated remittance sending. Both a strong sense of meaning and connection, and the stresses of managing multiple needs at home and abroad, were apparent in diaspora accounts of sending remittances. While money ultimately continued to flow, through this as through many other crises, the discourse of remittance resilience risks eclipsing the major challenges navigated by migrant communities. The relevance to research and policy in the context of the contemporary cost-of-living crisis is explored. [ABSTRACT FROM AUTHOR]

Background: Intravenous immunoglobulin (IVIg) for Clostridioides difficile infection (CDI) no longer features in treatment guidelines. However, IVIg is still used by some clinicians for severe or recurrent CDI (rCDI) cases. The main objective of this study was to investigate the efficacy of IVIg and to identify possible predictors of disease resolution post IVIg administration for patients with CDI. Methods: This retrospective observational cohort study of patients ≥2 years old hospitalised with severe, relapsing, or rCDI treated with IVIg therapy was performed in a large UK tertiary hospital between April 2018 and March 2023. Scanned electronic notes from patient admissions and clinical reporting systems were used to collect relevant data. Results: In total, 20/978 patients diagnosed with CDI over the 5-year study were treated with IVIg. Twelve (60%) had hospital-onset CDI. Eleven of the twenty patients (55%) responded to treatment, with a mean of 8.6 (SD 10.7) days to disease resolution. Sixteen (80%) patients were treated for severe CDI and four (20%) for rCDI (n = 3) and relapsing CDI (n = 1). There were no statistically significant differences in possible independent predictors of disease resolution post IVIg administration between groups. There was an average of 6.2 (4.9) days to IVIg administration after diagnosis with no difference between responders and non-responders (p = 0.88) and no further significant difference in additional indicators. Four (36%) of the responders were immunosuppressed compared to just one (11%) of the non-responders (p = 0.15). Six of the responders (two with recurrent and four with severe CDI) improved rapidly within 2 days, and three of these were immunosuppressed. Conclusion: We observed disease resolution post IVIg therapy in over 50% of patients with refractory CDI. Our data also support a potential enhanced effect of IVIg in immunosuppressed individuals. Thus, the role of IVIg for CDI treatment, particularly in the immunosuppressed, warrants future case–control studies coupled to mechanistic investigations to improve care for this ongoing significant healthcare-associated infection. [ABSTRACT FROM AUTHOR]

The article discusses outlook for clinical lipidology in the United Kingdom. Topics explored include the introduction of hospital outpatient lipid clinics that offer diagnostic, genetic testing, and therapeutic services, the development of several novel forms of lipid-lowering compounds, and the operations of medical associations that cater to lipidologists in the region such as HEART UK and the British Atherosclerosis Society (BAS).

While well-established attachment measures have been developed for infancy, early childhood, and adulthood, a "measurement gap" has been identified in middle childhood, where behavioral or representational measures are not yet sufficiently robust. This article documents the development of a new measure--the Child Attachment Interview (CAI)--which seeks to bridge this gap. The CAI is a semistructured interview, in which children are invited to describe their relationships with their primary caregivers. The coding system is informed by the Adult Attachment Interview and the Strange Situation Procedure, and produces 4 attachment categories along with a continuous measure of attachment security based on ratings of attachment-related dimensions. The main psychometric properties are presented, including interrater reliability, test-retest reliability, and concurrent and discriminant validities, both for normally developing children and for those referred for mental health treatment. The CAI correlates as expected with other attachment measures and predicts independently collected ratings of social functioning. The findings suggest that the CAI is a reliable, valid, and promising measure of child-parent attachment in middle childhood. Directions for improvements to the coding system are discussed. (Contains 2 footnotes, 11 tables, and 1 figure.)

Background: We investigated the association of several air pollution measures with postmenopausal breast cancer (BCa) risk. Methods: This study included 155,235 postmenopausal women (of which 6146 with BCa) from UK Biobank. Cancer diagnoses were ascertained through the linkage to the UK National Health Service Central Registers. Annual exposure averages were available from 2005, 2006, 2007, and 2010 for NO2, from 2007 and 2010 for PM10, and from 2010 for PM2.5, NOX, PM2.5–10 and PM2.5 absorbance. Information on BCa risk factors was collected at baseline. Cox proportional hazards regression was used to evaluate the associations of year-specific and cumulative average exposures with BCa risk, overall and with 2-year exposure lag, while adjusting for BCa risk factors. Results: PM10 in 2007 and cumulative average PM10 were positively associated with BCa risk (2007 PM10: Hazard ratio [HR] per 10 µg/m3 = 1.18, 95% CI 1.08, 1.29; cumulative average PM10: HR per 10 µg/m3 = 1.99, 95% CI 1.75, 2.27). Compared to women with low exposure, women with higher 2007 PM10 and cumulative average PM10 had greater BCa risk (4th vs. 1st quartile HR = 1.15, 95% CI 1.07, 1.24, p-trend = 0.001 and HR = 1.35, 95% CI 1.25, 1.44, p-trend < 0.0001, respectively). No significant associations were found for any other exposure measures. In the analysis with 2-year exposure lag, both 2007 PM 10 and cumulative average PM10 were positively associated with BCa risk (4th vs. 1st quartile HR = 1.19, 95% CI 1.10, 1.28 and HR = 1.29, 95% CI 1.19, 1.39, respectively). Conclusion: Our findings suggest a positive association of 2007 PM10 and cumulative average PM10 with postmenopausal BCa risk. [ABSTRACT FROM AUTHOR]

The authors reflect on the key role played by rheumatologists in the treatment and management of interstitial lung disease (ILD), including progressive fibrosing ILD. Also cited are the relationship of ILD with rheumatic diseases like rheumatic arthritis (RA), idiopathic inflammatory myopathies and systemic sclerosis (SSc), and the multidisciplinary team (MDT) approach for the diagnosis and treatment of ILD as per the Respiratory Society and National Health Service (NHS) England.

With the advent of high throughput genetic data, there have been attempts to estimate heritability from genome-wide SNP data on a cohort of distantly related individuals using linear mixed model (LMM). Fitting such an LMM in a large scale cohort study, however, is tremendously challenging due to its high dimensional linear algebraic operations. In this paper, we propose a new method named PredLMM approximating the aforementioned LMM motivated by the concepts of genetic coalescence and Gaussian predictive process. PredLMM has substantially better computational complexity than most of the existing LMM based methods and thus, provides a fast alternative for estimating heritability in large scale cohort studies. Theoretically, we show that under a model of genetic coalescence, the limiting form of our approximation is the celebrated predictive process approximation of large Gaussian process likelihoods that has well-established accuracy standards. We illustrate our approach with extensive simulation studies and use it to estimate the heritability of multiple quantitative traits from the UK Biobank cohort. Author summary: In recent years, there is an increased interest of estimating heritability from genome-wide SNP data in large scale cohort studies. Here, we propose the PredLMM, a computationally rapid and memory-efficient linear mixed model for heritability estimation. The proposed approach can estimate SNP heritability on Biobank-scale datasets in a fraction of time compared to the existing mixed model based approaches. Along with the extensive simulations illustrating the precision and robustness of the PredLMM, we have also estimated heritability of several anthropometric traits from the UK Biobank cohort. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is an extremely prevalent virus linked to multiple cancers, but most notably cervical cancer. The cervical screening programme in the UK has developed significantly since it was first introduced in 1964. This, together with the introduction of HPV vaccination, has made a huge difference to the early diagnosis and mortality for cervical cancer patients. Uptake of screening is paramount and this article addresses the barriers to this, and how these might be overcome. Other ethical issues around the topic of HPV, vaccination and screening include discrimination around sexual behaviour and orientation, education, vaccination availability and vertical transmission. This is an area of medicine that continues to develop and evolve as we understand more about HPV and how to tackle it. [ABSTRACT FROM AUTHOR]

Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment. Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged home the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively. Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk. [ABSTRACT FROM AUTHOR]

The expansion of the British Empire facilitated movement for both colonizers and colonized across the world. This study focuses on Indian traveling ayahs (female servants and nannies) who traveled between India and Britain, but often underwent periods of destitution in Britain before returning to India. Using case studies of destitute ayahs, this essay investigates how the British state, British persons and British institutions responded to the destitution of imperial subjects from overseas in Britain during the nineteenth and early twentieth centuries. The study examines the social, legal and economic power dynamics underlying these responses, revealing a combination of confrontation and collaboration between migrant colonized subjects and those engaging with them in responding to contradictory imperial polices. The article highlights the agency of a neglected group of women who, in asserting their contribution to the Empire and their rights as imperial subjects, refused to accept a second-class form of Britishness. • Traveling ayahs' experiences in Britain. • History of the British Empire at home in Britain. • Dynamic socio-political responses to presence of colonized subjects in Britain. • Fissures, dissents, collaborations within imperial spaces. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) has created unprecedented challenges on the healthcare system. The aim of this multi-centre study was to measure the impact of COVID-19 on IR services in the UK.Material and Methods: Retrospective cross-sectional study of IR practice in six UK centres during the COVID-19 pandemic was carried out. All therapeutic IR procedures were identified using the respective hospital radiology information systems and COVID-19 status found on the hospital patient record systems. The total number of therapeutic IR procedures was recorded over two time periods, 25/03/2019-21/04/2019 (control group) and 30/03/2020-26/04/2020 (COVID-19 group). The data points collected were: procedure type, aerosol-generating nature, acute or elective case, modality used, in- or out-of-hours case and whether the procedure was done at the bedside (portable).Results: A 31% decrease in overall number of IR procedures was observed during COVID-19 compared to the control group (1363 cases vs 942 cases); however, the acute work decreased by only 0.5%. An increase in out-of-hours work by 10% was observed. COVID-19 was suspected or laboratory proved in 9.9% of cases (n = 93), and 15% of total cases (n = 141) were classed as aerosol-generating procedures. A 66% rise in cholecystostomy was noted during COVID-19. Image-guided ablation, IVC filters, aortic stent grafting and visceral vascular stenting had the greatest % decreases in practice during COVID-19, with 91.7%, 83.3%, 80.8% and 80.2% decreases, respectively.Conclusion: During the global pandemic, IR has continued to provide emergency and elective treatment highlighting the adaptability of IR in supporting other specialties. [ABSTRACT FROM AUTHOR]

When a caesarean section is performed on a singleton pregnancy when there is no clinical indication, this is deemed a maternal request caesarean section (CSMR). The procedure contributes to the ever rising rates of caesarean sections in the UK, as well as the rates associated risks and subsequent financial burden to the NHS. The ethics of exposing these otherwise healthy women to the risks of surgery and the increasing financial strain on our healthcare system becomes complicated with the importance of assessing and managing the patients' psychological well-being and the demand to promote patient choice and autonomy. This article considers the main reasons behind why we encounter CSMRs, while exploring the ethical dilemmas we as obstetricians face. We will also look at ways to manage these women, with suggestions of support and evidence to provide in order for them to make an informed decision. [ABSTRACT FROM AUTHOR]

Objectives: Mindfulness research in education has focused on its potential to support student well‐being. There is a paucity of research on the interaction between mindfulness and academic performance (AP). This qualitative study builds on results of the largest randomised control trial of mindfulness in education to date which suggested mindfulness can have mixed effects on academic performance. A more in‐depth understanding of the relationship between mindfulness and academic performance is therefore needed to ascertain if, how and for which students mindfulness facilitates academic performance. The objective of the study was to capture students' perceptions of the impact of mindfulness on their academic performance. Methods: Thematic analysis was applied to data obtained by six in‐depth interviews from three higher and three lower performing undergraduate participants in the mindfulness intervention arm of the Mindful Student Study randomised control trial. Results: Three themes emerged, whereby five students described mindfulness having a positive impact on their academic performance. One student felt mindfulness had an initial negative impact on academic performance. All students felt mindfulness enhanced self‐awareness and self‐regulation of their thinking, feelings and behaviours, and our analysis suggests students perceived these processes underpinned the effect of mindfulness on academic performance. Conclusion: Differences in students' psychological distress and study habits may determine the differing initial impact of mindfulness on academic performance. [ABSTRACT FROM AUTHOR]

Aims: Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. Methods: Using this mixed population sample of adolescents, we took a 'bottom‐up' approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales. Results: Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines. Conclusion: We have used a bottom‐up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis. What's new?: Adolescents with Type 1 diabetes frequently experience diabetic ketoacidosis. However, how much treating this condition costs in this age group remains unknown in the UK.We used the 2014 national survey data set to conduct a novel, 'bottom‐up' approach to cost analysis.Our data suggest that the average cost of an episode of diabetic ketoacidosis in an adolescent in the UK in 2014 was £1387.Use of the British Society of Paediatric Endocrinology and Diabetes guidelines was associated with a significant £762 reduction in costs. [ABSTRACT FROM AUTHOR]

The evolving nature of atypical work arrangements is studied. A particular focus is placed on one such form of work relation: zero-hours contracts (ZHCs). The paper uses existing secondary data and new survey data collected for the specific purpose of studying alternative work arrangements to describe the nature of ZHC work in the UK labour market. The interaction with labour market policy is explored, in the context of the 2016 introduction of the UK's National Living Wage. ZHC work is shown to be an important feature of today's work arrangements, and the wage cost shock induced by the new, higher minimum wage resulted in an increased use of ZHCs in the UK social care sector, and in low wage sectors more generally. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection.Methods: We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection.Results: At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective.Conclusions: Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective. [ABSTRACT FROM AUTHOR]

Background: Men and women are increasingly likely to stay sexually active into later life, but research shows that sexual activity and satisfaction decrease with increasing age. Ill health and medical treatments may affect sexual activity but there is little research on why some older people with a health problem affecting their sexual activity are satisfied with their sex life, and others are not. Methods: A mixed method study integrating data and analyses from the third British National Survey of Sexual Attitudes and Lifestyles (n = 3343 aged 55–74 years) and from follow-up in-depth interviews with 23 survey participants who reported having a health condition or taking medication affecting their sex life. Results: Overall, 26.9% of men and 17.1% of women aged 55–74 reported having a health condition that affected their sex life. Among this group, women were less likely than men to be sexually active in the previous 6 months (54.3% vs 62.0%) but just as likely to be satisfied with their sex life (41.9% vs 42.1%). In follow-up interviews, participants sometimes struggled to tease out the effects of ill health from those of advancing age. Where effects of ill health were identified, they tended to operate through the inclination and capacity to be sexually active, the practical possibilities for doing so and the limits placed on forms of sexual expression. In close relationships partners worked to establish compensatory mechanisms, but in less close relationships ill health provided an excuse to stop sex or deterred attempts to resolve difficulties. Most fundamentally, ill health may influence whether individuals have a partner with whom to have sex. Conclusion: The data show complex interactions between health, lifestyle and relationship factors that affect sexual activity/satisfaction. When dealing with sexual problems in older people, practitioners need to take account of individual lifestyle, needs and preferences. [ABSTRACT FROM AUTHOR]

Aim Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self-care in students with Type 1 diabetes in all UK universities. Methods Some 1865 current UK university students aged 18-24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. Results In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes-related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19-7.16], illness (OR 3.48, 95% CI 2.06-5.87) and weight management issues (OR 3.19, 95% CI 1.99-5.11) as barriers to self-care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. Conclusion The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider. [ABSTRACT FROM AUTHOR]

Agricultural soils are the primary source of nitrous oxide emissions due to management practices including fertiliser application. While fertiliser rates are one of the main drivers of nitrous oxide emissions, emissions are also dependent on other variables such as climate and soil properties. To understand the spatial and inter-annual variations in emission rate, simulations of N 2 O emissions were made from 2000 to 2010 for UK grass and croplands. In addition, the sensitivity of these emissions to soil and climate inputs was also tested. Emissions of between 0.3 to 3.5 kg N ha −1 yr −1 and 0.7–7 kg N ha −1 yr −1 were simulated across UK croplands and grasslands, respectively. While inter-annual variations can be attributed to climate influences, the primary driver of spatial variations in emissions was soil clay content. However, when the sensitivity of nitrous oxide emissions to soil clay content alone was tested, it was not always the best predictor of emissions, when soil texture is altered outside of the normal range used as inputs to the model from different databases. [ABSTRACT FROM AUTHOR]

Women with experience of being 'looked after' are more likely than their peers to become young mothers. There has been limited research investigating support for their needs. This study, embedded in a randomised trial of Group Family Nurse Partnership ( gFNP), involved interviews with young mothers with care experience, Family Nurses delivering group gFNP, and health and social care professionals. This first qualitative study to explore the views of these varied stakeholders found consensus regarding young mothers' social isolation and lack of trusting relationships but diversity in views about the potential of gFNP to meet their needs. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of painful sex among women in Britain, and to explore associated sexual, relationship and health factors that should be considered in assessment.Design: Multi-stage, clustered and stratified population probability sample survey, using computer-assisted self-interview. Sample frame was the British Postcode Address File.Setting: Participants interviewed at home between 2010 and 2012.Sample: A total of 15 162 adults aged 16-74 years (8869 women). Data reported from 6669 sexually active women.Methods: Age-adjusted logistic regressions to examine associations between painful sex and indicators of sexual, relational, mental and physical health.Main Outcome Measure: Physical pain as a result of sex for ≥3 months in the past year, plus measures of symptom severity.Results: Painful sex was reported by 7.5% (95% CI 6.7-8.3) of sexually active women, of whom one-quarter experienced symptoms very often or always, for ≥6 months, and causing distress. Reporting painful sex was strongly associated with other sexual function problems, notably vaginal dryness (age adjusted odds ratio 7.9; 6.17-10.12), anxiety about sex (6.34; 4.76-8.46) and lacking enjoyment in sex (6.12; 4.81-7.79). It was associated with sexual relationship factors [such as not sharing same level of interest in sex (2.56; 1.97-3.33)], as well as with adverse experiences such as non-volitional sex (2.17; 1.68-2.80). Associations were also found with measures of psychological and physical health, including depressive symptoms (1.68; 1.28-2.21).Conclusion: Painful sex is reported by a sizeable minority of women in Britain. Health professionals should be supported to undertake holistic assessment and treatment which takes account of the sexual, relationship and health context of symptoms.Tweetable Abstract: Painful sex-reported by 7.5% of women in Britain-is linked to poorer sexual, physical, relational and mental health. [ABSTRACT FROM AUTHOR]

Study Question: What is the prevalence of infertility and of help seeking among women and men in Britain?Summary Answer: One in eight women and one in ten men aged 16-74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help.What Is Known Already: Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations.Study Design, Size, Duration: A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16-74 years.Participants/materials, Setting, Methods: Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI).Main Results and the Role Of Chance: The reported prevalence of infertility was 12.5% (CI 95% 11.7-13.3) among women and 10.1% (CI 95% 9.2-11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6-61.0) among women and 53.2% (CI 95% 48.1-58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life.Limitations, Reasons For Caution: These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias.Wider Implications Of the Findings: The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health.Study Funding/competing Interests: Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections (STIs) are common, especially in young women, and pregnant women are inherently at risk. In pregnancy, sexually transmitted infections can have serious consequences for the woman, the fetus and neonate yet may remain asymptomatic throughout. Screening for many STIs is not explicit in UK antenatal guidelines and may be overlooked. Therefore it is essential to consider a woman's risk of STIs regularly throughout pregnancy and know how and when to undertake an appropriate sexual history and relevant testing. Early diagnosis and treatment, partner notification and multi-disciplinary management together with genitourinary physicians and paediatricians are key to securing good outcomes for mother and child. This article reviews the presentation, diagnosis and management of non-HIV STIs in pregnancy, highlighting indications for testing and important differences compared with management of non-pregnant women. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the most appropriate rehabilitation outcome measure for use in a young adult population with acquired brain injury. Methods: A 2-year prospective study of patients admitted to a UK military neuro-rehabilitation unit with acquired brain injury to compare the appropriateness of the Functional Independence Measure/Functional Assessment Measure (FIM+FAM) vs the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) in assessing outcomes. Patients were assessed at admission, discharge and at 4-month follow-up using FIM+FAM and MPAI-4. Results: The FIM+FAM total motor score showed a marked ceiling affect, 42% of patients scored the maximum on admission rising to 80% at discharge. The MPAI-4 did not show significant ceiling effects. The other sub-scales of FIM+FAM and MPAI-4 were generally comparable, no more than 17% achieved ceiling at follow-up. Conclusions: This is the first comparative study of FIM+FAM and MPAI-4 in a young adult military population following acquired brain injury. All patients showed improvements in both outcome measures following intensive inpatient rehabilitation. However, the MPAI-4 did not show ceiling effects in motor scores. This measure was, therefore, found to be more appropriate in the cohort. [ABSTRACT FROM PUBLISHER]

Background: Several prior studies have found an association between statin use and reduced risk of colorectal cancer. We hypothesized that these findings may be due to systematic bias and examined the independent association of colorectal cancer risk with statin use, serum cholesterol, and change in cholesterol concentration.Methods and Findings: 22,163 colorectal cancer cases and 86,538 matched controls between 1995 and 2013 were identified within The Health Improvement Network (THIN) a population-representative database. Conditional logistic regression models estimated colorectal cancer risk with statin use, serum total cholesterol (mmol/L), and change in total cholesterol level. We confirmed a decreased risk of colorectal cancer with statin use (long-term: odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91-0.99; short-term: OR, 0.92; 95% CI, 0.85-0.99). However, to assess whether the observed association may result from indication bias, a subgroup analysis was conducted among patients prescribed a statin. In this subgroup (n = 5,102 cases, n = 19,032 controls), 3.1% of case subjects and 3.1% of controls discontinued therapy. The risk of colorectal cancer was not significantly different among those who continued statin therapy and those who discontinued (OR, 0.98; 95% CI, 0.79-1.22). Increased serum cholesterol was independently associated with decreased risk of colorectal cancer (OR, 0.89 per mmol/L increase; 95% CI, 0.87-0.91); the association was only present if serum cholesterol was measured near the cancer diagnosis (<6 mo: OR, 0.76; 95% CI, 0.47-0.61; >24 mo: OR, 0.98; 95% CI, 0.93-1.03). Decreases in serum total cholesterol >1 mmol/L ≥1 year prior to cancer diagnosis were associated with subsequent colorectal cancer (statin users: OR, 1.25; 95 CI%, 1.03-1.53; nonusers: OR, 2.36; 95 CI%, 1.78-3.12). As an observational study, limitations included incomplete data and residual confounding.Conclusions: Although the risk of colorectal cancer was lower in statin users versus nonusers, no difference was observed among those who continued versus discontinued statin therapy, suggesting the potential for indication bias. The association between decreased serum cholesterol and colorectal cancer risk suggests a cholesterol-lowering effect of undiagnosed malignancy. Clinical judgment should be used when considering causes of cholesterol reduction in patients, including those on statin therapy. [ABSTRACT FROM AUTHOR]

Objectives: To describe the prevalence of medication use to assist sexual performance in Britain and to identify associated factors.Methods: Cross-sectional probability sample, undertaken in 2010-2012, of 15 162 people aged 16-74 years, resident in Britain, of whom, 5617 men and 8095 women reported sexual experience (ever) and 4817 men were sexually-active (reported sex in the last year).Results: Ever use of medication to assist sexual performance (medicated sex) was more commonly reported by men than women (12.9% (95% CI 11.9% to 13.9%) vs 1.9% (95% CI 1.7% to 2.3%)) and associated with older age in men and younger age in women. It was associated with reporting smoking, and use of alcohol and recreational drugs, as well as unsafe sex (≥2 partners and no condom use in the last year) in both men and women. Among men, the proportion reporting medicated sex in the last year was higher among those reporting erectile difficulties (ED) than those not doing so (28.4% (95% CI 24.4% to 32.8%) vs 4.1% (95% CI 3.4% to 4.9%)). In all men, medicated sex was associated with more frequent sexual activity, meeting a partner on the internet, unsafe sex and recent sexually transmitted infections diagnosis; associations that persisted after adjusting for same-sex behaviour and ED. However, there were significant interactions with reporting ED, indicating that among men with ED, medicated sex is not associated with same-sex behaviour and ever use of recreational drugs.Conclusions: A substantial minority of people in Britain report medicated sex, and the association between medicated sex and risky sexual behaviour is not confined to high-risk groups. [ABSTRACT FROM AUTHOR]

The following change has been made to the publication since the original version was printed. [ABSTRACT FROM AUTHOR]

Purpose: Septic patients with hyperlactatemia have increased mortality rates, irrespective of hemodynamic and oxygen-derived variables. The aims of the study are the following: (1) to ascertain whether lactate clearance (LC) (percentage change in lactate over unit time) predicts mortality in septic patients admitted to intensive care directly from the emergency department and (2) to calculate the optimal "cut-off" value for mortality prediction. Methods: Three-year retrospective observational study of consecutive patients with severe sepsis and septic shock admitted to intensive care from the emergency department of a tertiary UK hospital. We calculated 6- hour LC, performed receiver operating characteristic analyses to calculate optimal cut-off values for initial lactate and LC, dichotomized patients according to the LC cut-off, and calculated hazard ratios using a Cox proportional hazards model. Results: One hundred six patients were identified; 78, after exclusions. Lactate clearance was independently associated with 30-day mortality (P b .04); optimal cut-off, 36%. Mortality rates were 61.1% and 10.7% for patientswith 6-hour LC 36% or less and greater than 36%, respectively. Hazard ratio for deathwith LC 36% or less was 7.33 (95% confidence interval, 2.17-24.73; P b .001). Conclusions: Six-hour LC was independently associated with mortality, and the optimal cut-off value was 36%, significantly higher than previously reported. Wewould support further research investigating this higher LC as a distinct resuscitation end point in patients with severe sepsis and septic shock. [ABSTRACT FROM AUTHOR]

Traditional outsourcing literature has claimed gains for the customer in terms of quality and costs. However, such gains are illusory in outsourcing of high-risk, complex tasks. The use of contracts and governance mechanisms for handling complex procurements is essential in obtaining rewards from outsourcing. Powerful incentives and risks are normally used in industrial service contracts to transfer risks to measure compliance with performance measures. The availability contracts for complex engineering services provision are forms of outsourcing contracts thattransfer resourcesfrom government to external service providers on a substantial scale. The change moves the contractor role from creating resources to managing resources. Such role change mandates collaboration with customers and suppliers in supply/value chains. The management task is then perceived in terms of linking and optimising alignments rather than increasing service levels. Incentive design is one mechanism for linking the coordination of resources required in availability contracting to the business model. This article studies the impacts of agreed contract type and incentive mechanism on the customer and service provider profits using agent-based discrete event simulation model under multiple risk sharing scenarios. [ABSTRACT FROM AUTHOR]

Based on research conducted with men arriving from eastern Europe in London after the expansion of the EU in 2004, this article examines how migrants’ narratives of the city construct a counter-discourse to a ‘global’ London. It is argued that the use of ‘visual narratives’– a combination of participant-directed photography and semi-structured interviews as a methodology—allows for the exploration of embodied and material aspects of everyday lives in the city, which destabilise traditional urban pictorial approaches to the city. Such narratives of participants’ embodied movements through London relocate the observer as the everyday mobile-subject; they highlight the connections between urban and transnational mobilities; and they present participants’ constructions of different kinds of affective spaces in the city where they begin to negotiate home, belonging and return. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The study aim was to determine the outcome, in relation to military service in UK military combat amputees. Patients and methods: Casualties were assessed at mean 2.4 years after injury and graded by a Functional Activity Assessment (FAA) ranging from 1 (fully fit) to 5 (unfit all duties) to score vocational functional outcome. ISS were calculated and the patients were categorised as having unilateral or multiple amputations. The Short Form-36 Health Survey (SF-36) was completed. Results: Of the 52, 8 patients had left the forces by medical discharge, with 44 continuing to serve. 33 of the 44 had returned to work. 50 patients had FAA grades and were at least 7.6 months post-injury. No patients were graded as FAA1, 8 as FAA2, 18 as FAA3, 19 as FAA4 and 5 as FAA5. There was a trend for the FAA score to increase with injury severity, as measured by ISS i.e. vocational functional outcome was worse with more severe injuries, although this did not reach statistical significance (p =0.095). Multiple amputee patients had significantly higher FAA grades (p <0.001) and were all FAA 4 or 5. Of the 33 patients who had returned to work, 8 were FAA2, 12 FAA3 and 12 FAA4. The mean SF-36 scores for Physical Component Summary (PCS) increased significantly from 36.4 to 43.4 (p =0.001) with rehabilitation, while Mental Component Summary (MCS) was 53.0 and remained similar at 53.6 (p =0.987). MCS scores were similar in these patients to the normal population, 50 (SD 10). Conclusions: This study is the first to report the outcomes, with regards to return to work, of the UK military amputees injured in Afghanistan and Iraq Soldiers are surviving more severe and complex injuries than before and the majority are able to return successfully to military work. SF-36 PCS scores improve significantly with rehabilitation, and while MCS scores remain constant, the initial assessments are comparable with a normal population. [Copyright &y& Elsevier]

The temporal variation of ambient SO and the chemical composition of particulate matters (PM and PM) were studied at National Physical Laboratory (NPL), New Delhi (28°38′N, 77°10′E). Spatial variation of SO at seven air quality monitoring stations over Delhi was also studied simultaneously. Wide range of ambient SO was recorded during winter (2.55 to 17.43 ppb) compare to other seasons. SO mixing ratio was recorded significantly high at industrial sites during winter and summer; however, no significant spatial difference in SO mixing ratio was recorded during monsoon. SO/(SO+SO) ratio was recorded high (0.74) during winter and low (0.69) during summer. Monthly variation of PSCF was analyzed using HYSPLIT seven days backward trajectories and daily average SO data. PSCF analysis suggests that, during winter (December, January, February) ambient SO at the study site might have contributed from long distance sources, located towards west and southwest directions; during monsoon (July, August, September) marine contribution was noticed; whereas, during summer (April, May and June) it was from regional sources (located within few 100 km of study site). During winter there was significant contribution from the long distance sources located in western Asia, northwestern Pakistan, Rajasthan and Punjab provinces of India. Coal used in thermal power plants at Panipat (in the northwestern side) and Faridabad (in the southeastern side), local industries, soil erosion and biomass burning may be major contributing factors for SO during summer. The study establishes that the transport sector may not be the major source of ambient SO in Delhi. [ABSTRACT FROM AUTHOR]

Since the 1990s migrants from smaller, legally differentiated and non-citizen immigrant groups have formed the main flows of migration to the UK and yet they have been overlooked in academic and public debates and agendas. While much academic research has been devoted to racism, the new forms of racism which accompany the `new migration' have also received little attention. This article, therefore, demonstrates the continuing importance and changing nature of contemporary racisms as experienced by Ghanaians; a less-established migrant group. The article traces the particular forms of racisms experienced within their working lives as well as their diverse responses to racism: a relatively unexplored dimension of discrimination. The various coping strategies which the workers developed to overcome difficulties are highlighted, at the individual and collective levels, and this reveals the importance of diaspora groups and transnational links. It is argued that focusing on responses to racism is a crucial facet in helping to understand the actual impact of racial discrimination and also avoids portraying minority ethnic groups as the passive recipients of racisms. The article is also an intervention into the current debates about multicultural Britain. It is argued that the current discourse on the failures of mufticulturalism should focus less on minority ethnic groups as the principal problem for integration and engage with the issues of racism, exclusion and material inequalities which penetrate the lives of low-paid migrant workers. [ABSTRACT FROM AUTHOR]

OBJECTIVES To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler’s syndrome). PATIENTS AND METHODS Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. RESULTS Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, ‘box-site’ pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. CONCLUSIONS SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure. [ABSTRACT FROM AUTHOR]

The article reports on the interlocking worlds of the Anglo-Boer war in South Africa/India. It is posed that this war has changed lives and histories in various parts of the world. This war involved the forces of Great Britain and the Boer army. It is mentioned that the British were defeated in three important battles against the Boers. In retaliation, they captured Boer children and women and put them into concentration camps.

Background: Previous linkage and association studies may have implicated the Dystrobrevinbinding protein 1 (DTNBP1) gene locus or a gene in linkage disequilibrium with DTNBP1 on chromosome 6p22.3 in genetic susceptibility to schizophrenia. Methods: We used the case control design to test for of allelic and haplotypic association with schizophrenia in a sample of four hundred and fifty research subjects with schizophrenia and four hundred and fifty ancestrally matched supernormal controls. We genotyped the SNP markers previously found to be significantly associated with schizophrenia in the original study and also other markers found to be positive in subsequent studies. Results: We could find no evidence of allelic, genotypic or haplotypic association with schizophrenia in our UK sample. Conclusion: The results suggest that the DTNBP1 gene contribution to schizophrenia must be rare or absent in our sample. The discrepant allelic association results in previous studies of association between DTNBP1 and schizophrenia could be due population admixture. However, even positive studies of European populations do not show any consistent DTNBP1 alleles or haplotypes associated with schizophrenia. Further research is needed to resolve these issues. The possible confounding of linkage with association in family samples already showing linkage at 6p22.3 might be revealed by testing genes closely linked to DTNBP1 for allelic association and by restricting family based tests of association to only one case per family. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the psychometric properties of the ADDQoL-Teen, an innovative individualised, patient-centred questionnaire measuring perceived impact of diabetes mellitus on quality of life (QoL) of teenagers. Respondents rate all 30 life domains for frequency, and personally applicable domains for 'bother'. Two overview items measure present QoL and diabetes-dependent QoL. ADDQoL-Teen design was based on the ADDQoL (for adults with diabetes). Methods: Interviews and discussion groups were conducted with 23 teenagers aged 13-16 years, during work to design the ADDQoL-Teen. The new questionnaire was then completed by 152 young people, (mean age 16.4 ± 2.4 years), attending diabetes clinics at six UK centres. Results: Five domains detracted from the measure's reliability and factor structure, four of which were analysed separately and one deleted. The 25-domain ADDQoL-Teen had high internal consistency reliability [Cronbach's alpha = 0.91, (N = 133)] and could be summed into an overall Average Weighted Impact score. There were two subscales: a 10-item Impact-Self subscale (measuring impact of diabetes and its treatment on the individual) and a 15-item Impact-Other subscale (measuring impact on interactions with others and the external world). Both subscales had good internal consistency reliability, [Cronbach's alpha coefficients of 0.82 (N = 142) and 0.88 (N = 138) respectively]. Domains reported as most severely (and negatively) impacted by diabetes were (mean weighted impact ± SD): lie in bed (-3.68 ± 3.41), interrupting activities (-3.5 ± 3.23), worry about the future (-3.45 ± 3.28), career (-3.43 ± 3.15) and sweets (-3.24 ± 3.24), (maximum range -9 to +3). Analysis of the overview items showed that although 72.5% considered that their present QoL was good or brilliant, 61.8% felt that having diabetes had a negative impact on QoL, but 35.6% reported no impact and 2.6% reported a positive impact on QoL. Conclusions: The ADDQoL-Teen is a new measure of perceived impact of diabetes and its treatment on QoL of teenagers. It will help healthcare professionals and parents consider QoL issues as well as medical outcomes when caring for young people with diabetes. It may be used in clinical trials and for routine clinical monitoring in a context of continuing evaluation. [ABSTRACT FROM AUTHOR]

A total of 365 potential Open University (OU) students responded to a postal test (via two cloze passages) of their reading skills, and a survey of their reading habits. A best-fit multiple regression model showed that previous educational level and time elapsed since a respondent had last finished a book were the best predictors of cloze scores. A five-factor model explained 37.2% of variance in the data; brief descriptions of respondents associated with each factor are given. Age accounted for 11.6% of the variance, higher than any other factor. Younger respondents were significantly more likely to score low on the more difficult cloze passage, to read books less frequently, and to read tabloid newspapers. [ABSTRACT FROM AUTHOR]

Comments on the issues related to medical care in Great Britain. Occurrence of Down's syndrome in babies; Reduction of nocturnal emergency surgery; Treatment of esophageal cancer.

Focuses on medical-related issues in Great Britain. Criticism on the maternity services in both the medical and lay press; Shortage of cardiologists in the country; Occurrence of Pneumocystis carinii in therapeutically immunosuppressed patients.

Comments on several issues related to medical care in Great Britain. Information on beta-blockers in asthma; Effect of antiepileptic drugs on the hypothalamic-pituitary axis; Factors contributing to mortality in paracetamol-induced hepatic failure.

The article reports on a survey done by researchers to demonstrate the successful implementation of the revised rules of blood services of men having sex with men of Great Britain. It informs that improved blood screening can help to remove the ban on blood donation by such men. It also states that the percentage of such men is less in Great Britain as the national survey indicates.

The article discusses a survey of tertiary-level neonatal intensive care units (NICUs) in Great Britain on current practices of cutaneous antisepsis prior to insertion of central venous and umbilical catheters. The data were obtained from the nurse manager. There was a lack of uniformity across the NICUs with regard to the type or concentration of antiseptic solutions used. Bacterial counts in the skin of infants were reduced with the use of topical chlorhexidine, isopropyl alcohol or povidone iodine.