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Countless workers handle bodily effluvia and body envelope violations every working day, and consequentially face deeply unpleasant levels of disgust. Understanding if and how they adapt can help inform policies to improve worker satisfaction and reduce staff turnover. So far, limited evidence exist that self-reported disgust is reduced (or lower to begin with) among those employed in high-disgust environments. However, it is unclear if this is due to demand effects or translates into real behavioural changes. Here, we tested healthcare assistants (N = 32) employed in UK care homes and a control sample (N = 50). We replicated reduced self-reported pathogen disgust sensitivity in healthcare workers compared to controls. We also found it negatively correlated with career duration, suggesting long-term habituation. Furthermore, we found that healthcare assistants showed no behavioural disgust avoidance on a web-based preferential looking task (equivalent to eye tracking). Surprisingly, this extended to disgust elicitors found outside care homes, suggesting generalisation of disgust habituation. While we found no difference between bodily effluvia (core disgust) and body envelope violations (gore disgust), generalisation did not extend to other domains: self-reported sexual and moral disgust sensitivity were not different between healthcare assistants and the control group, nor was there a correlation with career duration. In sum, our work confirms that people in high-frequency disgust employment are less sensitive to pathogen disgust. Crucially, we provide preliminary evidence that this is due to a process of long-term habituation with generalisation to disgust-elicitors within the pathogen domain, but not beyond it. [ABSTRACT FROM AUTHOR]

Summary: There is increasing disconnect between children and nature in the UK. Given that childhood nature experiences are important for the development of nature connection, well-being benefits and aspects of children's development, mapping the existing biodiversity that children are exposed to on a daily basis in schools and their grounds is vital to identifying areas of low biodiversity and to developing strategies to increase exposure to nature. Despite children spending a large portion of time at schools, there has not yet been an in-depth, in situ assessment of the biodiversity present in school grounds. Using a sample of 14 English schools, including state-funded and non-state-funded schools, we used remote images to quantify green-space area within a 3–km buffer around (buffer greenness) and within (school greenness) each school, including the school's grounds surrounding the buildings, and in situ images to quantify vegetation visible to children within each school's grounds (visible vegetation). We also surveyed trees, ground plants, ground invertebrates and birds within school grounds. School greenness correlated positively with visible vegetation, but buffer greenness was not related to either school greenness or visible vegetation. Buffer greenness correlated positively with plant richness, and school greenness correlated positively with tree abundance and richness. Visible vegetation correlated positively with tree abundance and richness, maximum tree diameter at breast height, plant richness and invertebrate abundance. Non-state-funded schools had higher visible vegetation than state-funded schools. Our sample indicates that schools can support considerable biodiversity and that this is broadly consistent across state-funded and non-state-funded schools. We suggest that increasing the amount of vegetation, through planting of trees, shrubs and borders, may be the most effective method of increasing school biodiversity, as visible vegetation had effects on the greatest number of taxa. [ABSTRACT FROM AUTHOR]

Objective Flares of autoimmune rheumatic diseases (AIRDs) following COVID-19 vaccination are a particular concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs, using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys. Methods The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details for patients with AIRDs. Flares following vaccination were identified as patient-reported (a), increased immunosuppression (b), clinical exacerbations (c) and worsening of PROMIS scores (d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs. Results Of 15 165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5% and 26.7% by definitions a–d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K  = 0.403, P  = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P  = 0.013), mental health disorders (MHDs) (P  < 0.001) and autoimmune disease multimorbidity (AIDm) (P  < 0.001). In regression analysis, the presence of AIDm [odds ratio (OR) = 1.4; 95% CI: 1.1, 1.7; P  = 0.003), or a MHD (OR = 1.7; 95% CI: 1.1, 2.6; P  = 0.007), or being a Moderna vaccine recipient (OR = 1.5; 95% CI: 1.09, 2.2; P  = 0.014) were predictors of flares. Use of MMF (OR = 0.5; 95% CI: 0.3, 0.8; P  = 0.009) and glucocorticoids (OR = 0.6; 95% CI: 0.5, 0.8; P  = 0.003) were protective. A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR = 1.3; 95% CI: 1.1, 1.5; P  < 0.001). Conclusion Flares occur in nearly 1 in 10 individuals with AIRDs after COVID vaccination; people with comorbidities (especially AIDm), MHDs and those receiving the Moderna vaccine are particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group. [ABSTRACT FROM AUTHOR]

Host genetic factors significantly influence susceptibility to SARS-CoV-2 infection and COVID-19 severity. Among these genetic factors are single-nucleotide variants (SNVs). IFNAR2 and IFNAR1 genes have been associated with severe COVID-19 in populations from the United Kingdom, Africa, and Latin America. IFNAR1 and IFNAR2 are subunits forming the type I interferon receptor (IFNAR). SNVs in the IFNAR genes impact protein function, affecting antiviral response and disease phenotypes. This systematic review aimed to describe IFNAR1 and IFNAR2 variants associated with COVID-19 susceptibility and severity. Accordingly, the current review focused on IFNAR1 and IFNAR2 studies published between January 2021 and February 2023, utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. The electronic search was conducted in PubMed databases using Boolean operators and inclusion and exclusion criteria. Of the 170 literature pieces, 11 studies were included. We include case reports of rare SNVs, defined by minor allele frequency (MAF) < 1%, and genome-wide associated studies (GWAS). Variants in IFNAR1 and IFNAR2 could potentially be new targets for therapies that limit the infection and the resulting inflammation by SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Objectives : Observational studies suggested an inverse association between physical activity and periodontitis. However, observational studies might be subject to unobserved confounding and reverse causation bias. We conducted an instrumental variable study to strengthen the evidence on the relationship between physical activity and periodontitis. Materials and methods: We used genetic variants associated with self-reported and accelerometer-assessed physical activity in 377,234 and 91,084 UK Biobank participants, respectively, as instruments. For these instruments, genetic associations with periodontitis were obtained from 17,353 cases and 28,210 controls in the GeneLifestyle Interactions in Dental Endpoints consortium. Results: We found no evidence for effects of self-reported moderate-to-vigorous physical activity, self-reported vigorous physical activity, accelerometry "average accelerations," and "fraction of accelerations > 425 milli-gravities" on periodontitis. For example, the odds ratio for self-reported moderate-to-vigorous physical activity was 1.07 (95% credible interval: 0.87; 1.34) in Causal Analysis using Summary Effect Estimates. We conducted sensitivity analyses to rule out weak instrument bias and correlated horizontal pleiotropy. Conclusions: The study does not support an effect of physical activity on the risk of periodontitis. Clinical relevance: This study provides little evidence that recommending physical activity would help prevent periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Interleukin 6 (IL-6) is considered to play a role in the dysbiotic host response in the development of periodontitis. While the inhibition of the IL-6 receptor using monoclonal antibodies is a well-established therapy for some diseases, so far, its potential benefit in patients with periodontitis has not been examined. We tested the association of genetically proxied downregulation of IL-6 signaling with periodontitis to explore whether downregulation of IL-6 signaling could represent a viable treatment target for periodontitis, Materials and methods: As proxies for IL-6 signaling downregulation, we selected 52 genetic variants in close vicinity of the gene encoding IL-6 receptor that were associated with lower circulating C-reactive protein (CRP) levels in a genome-wide association study (GWAS) of 575 531 participants of European ancestry from the UK Biobank and the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. Associations with periodontitis were tested with inverse-variance weighted Mendelian randomization in a study of 17 353 cases and 28 210 controls of European descent in the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) consortium. In addition, the effect of CRP reduction independent of the IL-6 pathway was assessed. Results: Genetically proxied downregulation of IL-6 signaling was associated with lower odds of periodontitis (odds ratio (OR) = 0.81 per 1-unit decrement in log-CRP levels; 95% confidence interval (CI): [0.66;0.99]; P = 0.0497). Genetically proxied reduction of CRP independent of the IL-6 pathway had a similar effect (OR = 0.81; 95% CI: [0.68; 0.98]; P = 0.0296). Conclusion: In conclusion, genetically proxied downregulation of IL-6 signaling was associated with lower odds of periodontitis and CRP might be a causal target for the effect of IL-6 on the risk of periodontitis. [ABSTRACT FROM AUTHOR]

Purpose: Myopia prevalence has increased in the UK at age 10‐16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4–5 years of age. Methods: Retrospective anonymised data from computerised vision screening at age 4–5 years were analysed from serial cross‐sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter‐by‐letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. Results: Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2–8.0), 8.5 (8.1–8.9), 7.5 (7.1–7.9), 7.8 (7.4–8.2), 8.7 (8.1–9.2), 8.5 (7.9–9.0) and 9.3 (8.8–9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. Conclusions: For children 4–5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population. [ABSTRACT FROM AUTHOR]

Dental Nursing speaks with Laura Edgar about the latest in dental decontamination. [ABSTRACT FROM AUTHOR]

Since June 2020, the SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) study has conducted routine PCR testing in UK healthcare workers and sequenced PCRpositive samples. SIREN detected increases in infections and reinfections and detected Omicron subvariant waves emergence contemporaneous with national surveillance. SIREN's sentinel surveillance methods can be used for variant surveillance. [ABSTRACT FROM AUTHOR]

Aims: Individuals with supranormal left ventricular ejection fraction (snLVEF; LVEF >70%) have increased mortality. However, the genetic and phenotypic profile of snLVEF remains unknown. This study aimed to determine the relationship of both snLVEF genetic risk and phenotype with survival and underdiagnosed heart failure (HF). Methods and results: A snLVEF genetic risk score (GRS) was applied and cases of snLVEF were identified in 486 754 individuals across two population‐based cohorts (BioMe Biobank and UK Biobank). The snLVEF GRS and phenotype were evaluated for association with survival, as well as HF diagnosis, markers, symptoms, and medications. Of 486 754 participants, the median age was 58 years, 20 069 (4.1%) died, and 10 088 (2.1%) had diagnosed HF. Both snLVEF GRS (hazard ratio [HR] 1.1 for top 10% vs. bottom 10% GRS; p = 0.002) and phenotype (HR 1.4; p = 0.003) were associated with increased all‐cause mortality. Both snLVEF GRS and phenotype were associated with reduced HF diagnosis (odds ratio [OR] 0.97 and OR 0.63, respectively; both p ≤0.002). However, the snLVEF GRS and phenotype were both associated with elevated brain natriuretic peptide (BNP) levels (146 and 185 pg/ml increase, respectively; p <0.001), including 268 out of 455 (59%) individuals with snLVEF phenotype who had BNP >100 pg/ml. Among 476 666 participants without HF diagnoses, snLVEF GRS and phenotype were associated with increased HF symptoms (e.g. exertional dyspnoea OR 1.4 and OR 1.3; p <0.003) and HF medications (e.g. loop diuretic OR 1.2 and OR 1.03; p <0.02). Associations were consistent in hypertensive individuals without cardiac comorbidities. Conclusions: Genetic predisposition to and presence of snLVEF are associated with decreased survival and underdiagnosed HF. [ABSTRACT FROM AUTHOR]

Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events. To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort. 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse. Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73–5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26–2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62–1.27). Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long‐term oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) and the impact of diagnostic ureteroscopy (URS) on survival outcomes. Materials and Methods: A retrospective analysis of all consecutive patients undergoing RNU for suspected UTUC at a UK tertiary referral centre from a prospectively maintained database was conducted. The primary outcome measures were 5‐ and 10‐year cancer‐specific survival (CSS). The secondary outcomes were: overall survival (OS), recurrence‐free survival (RFS), impact of prior diagnostic URS on OS, CSS and intravesical RFS (intravesical‐RFS), and predictors of intravesical recurrence. Statistical analysis was performed in R using the 'survminer' and 'survival' packages. The Kaplan–Meier method was used to calculate survival functions and these were expressed in graphical form. Uni‐/multivariate survival analyses were performed using the Cox proportional hazard regression model. Statistical significance in this study was set at P < 0.05. Results: A total of 422 patients underwent RNU with confirmed UTUC. The median (interquartile range) follow‐up of patients with confirmed UTUC was 9.2 (5.6–12.7) years. The 5‐ and 10‐year CSS rates were 70.5% (95% confidence interval [CI] 65.9–74.9) and 67.1% (95% CI 62.4–71.6), respectively. OS (HR 1.04 [95% CI 0.78–1.38]; P = 0.46) and CSS (HR 0.96 [95% CI 0.68–1.34]; P = 0.81) were similar in the diagnostic URS and the direct RNU cohorts. intravesical RFS was superior for the direct RNU cohort (HR 1.94 [95% CI 1.19–3.17]; P = 0.008). In multivariate analysis, prior URS, T2 stage, proximal ureter tumour and bladder cancer history were predictors of metachronous bladder recurrence. Conclusion: This single‐centre retrospective cohort study reports the long‐term oncological outcomes of RNU with a median follow‐up of 9.2 years, serving as a reference standard in counselling patients undergoing RNU. Stage and grade of the RNU specimen were the only two studied factors that appeared to adversely impact long‐term CSS and OS. Our results suggest that the risk of intravesical recurrence is increased nearly twofold in patients who have undergone diagnostic URS prior to RNU. Prior URS, however, does not appear to adversely impact long‐term CSS and OS. The authors suggest that a risk‐stratified approach be adopted, wherein diagnostic URS is offered only in equivocal cases. [ABSTRACT FROM AUTHOR]

Background and purpose: The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. Methods: This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March–16th May 2018 (pre-COVID-19 pandemic); and 16th March–16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System–29 (PROMIS-29 version 2.0) at 30 days after stroke. Results: We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001). Conclusion: Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health. [ABSTRACT FROM AUTHOR]

Peatlands have often been neglected in Earth system models (ESMs). Where they are included, they are usually represented via a separate, prescribed grid cell fraction that is given the physical characteristics of a peat (highly organic) soil. However, in reality soils vary on a spectrum between purely mineral soil (no organic material) and purely organic soil, typically with an organic layer of variable thickness overlying mineral soil below. They are also dynamic, with organic layer thickness and its properties changing over time. Neither the spectrum of soil types nor their dynamic nature can be captured by current ESMs. Here we present a new version of an ESM land surface scheme (Joint UK Land Environment Simulator, JULES) where soil organic matter accumulation – and thus peatland formation, degradation and stability – is integrated in the vertically resolved soil carbon scheme. We also introduce the capacity to track soil carbon age as a function of depth in JULES and compare this to measured peat age–depth profiles. The new scheme is tested and evaluated at northern and temperate sites. This scheme simulates dynamic feedbacks between the soil organic material and its thermal and hydraulic characteristics. We show that draining the peatlands can lead to significant carbon loss, soil compaction and changes in peat properties. However, negative feedbacks can lead to the potential for peatlands to rewet themselves following drainage. These ecohydrological feedbacks can also lead to peatlands maintaining themselves in climates where peat formation would not otherwise initiate in the model, i.e. displaying some degree of resilience. The new model produces similar results to the original model for mineral soils and realistic profiles of soil organic carbon for peatlands. We evaluate the model against typical peat profiles based on 216 northern and temperate sites from a global dataset of peat cores. The root-mean-squared error (RMSE) in the soil carbon profile is reduced by 35 %–80 % in the best-performing JULES-Peat simulations compared with the standard JULES configuration. The RMSE in these JULES-Peat simulations is 7.7–16.7 kg C m -3 depending on climate zone, which is considerably smaller than the soil carbon itself (around 30–60 kg C m -3). The RMSE at mineral soil sites is also reduced in JULES-Peat compared with the original JULES configuration (reduced by ∼ 30 %–50 %). Thus, JULES-Peat can be used as a complete scheme that simulates both organic and mineral soils. It does not require any additional input data and introduces minimal additional variables to the model. This provides a new approach for improving the simulation of organic and peatland soils and associated carbon-cycle feedbacks in ESMs. [ABSTRACT FROM AUTHOR]

Establishing IT governance arrangements is a deeply political process, where relationships of power play a crucial role. While the importance of power relationships is widely acknowledged in IS literature, specific mechanisms whereby the consequences of power relationships affect IT governance arrangements are still under‐researched. This study investigates the way power relationships are inscribed in the governance of digital identity systems in Denmark and the United Kingdom, where public and private actors are involved. Drawing on the theoretical lens of circuits of power, we contribute to research on the role of power in IT governance by identifying two distinct mechanisms of power inscription into IT governance: power cultivation and power limitation. [ABSTRACT FROM AUTHOR]

The Eocene Harwich Formation, underlying the Greater London (UK) area, presents many construction problems for design and location of tunnels, pipelines and other engineering infrastructure projects. Variable deposits make up the sequence of the Harwich Formation. These include cemented fault zones, hard grounds, loose gravel and sand that, when unexpectedly encountered, can cause construction delays and increase costs. Here, we interpret borehole cores and logs, and in situ observations coupled with borehole-derived samples, and calculate particle-size distributions to develop a general facies model that accounts for the lithological distribution within the Harwich Formation. This provides an improved geological framework for proposed subsurface construction that can reduce inherent engineering uncertainties, not only in the London region but potentially also in other similar geological environments. [ABSTRACT FROM AUTHOR]

Background: Variability in low-density lipoprotein cholesterol (LDL-C) response to statins is underappreciated. We characterised patients by their statin response (SR), baseline risk of cardiovascular disease (CVD) and 10-year CVD outcomes. Methods and results: A multivariable model was developed using 183,213 United Kingdom (UK) patients without CVD to predict probability of sub-optimal SR, defined by guidelines as <40% reduction in LDL-C. We externally validated the model in a Hong Kong (HK) cohort (n = 170,904). Patients were stratified into four groups by predicted SR and 10-year CVD risk score: [SR1] optimal SR & low risk; [SR2] sub-optimal SR & low risk; [SR3] optimal SR & high risk; [SR4] sub-optimal SR & high risk; and 10-year hazard ratios (HR) determined for first major adverse cardiovascular event (MACE). Our SR model included 12 characteristics, with an area under the curve of 0.70 (95% confidence interval [CI] 0.70–0.71; UK) and 0.68 (95% CI 0.67–0.68; HK). HRs for MACE in predicted sub-optimal SR with low CVD risk groups (SR2 to SR1) were 1.39 (95% CI 1.35–1.43, p<0.001; UK) and 1.14 (95% CI 1.11–1.17, p<0.001; HK). In both cohorts, patients with predicted sub-optimal SR with high CVD risk (SR4 to SR3) had elevated risk of MACE (UK HR 1.36, 95% CI 1.32–1.40, p<0.001: HK HR 1.25, 95% CI 1.21–1.28, p<0.001). Conclusions: Patients with sub-optimal response to statins experienced significantly more MACE, regardless of baseline CVD risk. To enhance cholesterol management for primary prevention, statin response should be considered alongside risk assessment. [ABSTRACT FROM AUTHOR]

Legislation plays a key role in regulating beekeeping practices and biosecurity measures, but different countries present conflicting legislative frameworks in terms of allowing antibiotic use. Currently the EU and the UK only permit antibiotics under the cascade principle, but while the UK considers the application in cases of European Foulbrood, the EU strongly discourages antibiotic use. In the US, antibiotics are registered for honeybees and their treatments are regularly authorised. This study relied on an international survey to assess the current use of antibiotics and general awareness among beekeepers, within the three legislative contexts. The results showed a similar use of antibiotics in all three geographical areas, regardless of the legislative context. General use and awareness indicated that the EU and US would likely benefit from national inspectors. Furthermore, even though beekeepers were somewhat aware of the various risks associated with improper antibiotic use, they would likely benefit from targeted training on the matter. [ABSTRACT FROM AUTHOR]

Peatlands have often been neglected in Earth System Models (ESMs). Where they are included, they are usually represented via a separate, prescribed grid cell fraction that is given the physical characteristics of a peat (highly organic) soil. However, in reality soils vary on a spectrum between purely mineral soil (no organic material), and purely organic soil, typically with an organic layer of variable thickness overlying mineral soil below. They are also dynamic, with organic layer thickness and its properties changing over time. Neither the spectrum of soil types nor their dynamic nature can be captured by current ESMs. Here we present a new version of an ESM land surface scheme (Joint UK Land Environment Simulator, JULES) where soil organic matter accumulation - and thus peatland formation, degradation and stability - is integrated in the vertically-resolved soil carbon scheme. We also introduce the capacity to track soil carbon age as a function of depth in JULES, and compare this to measured peat age-depth profiles. This scheme simulates dynamic feedbacks between the soil organic material and its thermal and hydraulic characteristics. We show that draining the peatlands can lead to significant carbon loss along with soil compaction and changes in peat properties. However, negative feedbacks can lead to the potential for peatlands to rewet themselves following drainage. These ecohydrological feedbacks can also lead to peatlands maintaining themselves in climates where peat formation would not otherwise initiate in the model, i.e. displaying some degree of resilience. The new model produces similar results to the original model for mineral soils, and realistic profiles of soil organic carbon for peatlands. In particular the best performing configurations had root mean squared error (RMSE) in carbon density for peat sites of 7.7-16.7 kgC m−3 depending on climate zone, when compared against typical peat profiles based on 216 sites from a global dataset of peat cores. This error is considerably smaller than the soil carbon itself (around 30-60 kgC m−3) and reduced by 35-80 % compared with standard JULES. The RMSE at mineral soil sites is also smaller in JULES-Peat than JULES itself (reduced by ~30-50 %). Thus JULES-Peat can be used as a complete scheme that simulates both organic and mineral soils. It does not require any additional input data and introduces minimal additional variables to the model. This provides a new approach for improving the simulation of organic and peatland soils, and associated carbon-cycle feedbacks in ESMs, which other land surface models could follow. [ABSTRACT FROM AUTHOR]

Radicalisation and extremist violence are of increasing concern internationally. The unconventional, decentralised, and transnational nature of modern terrorism involves an active process of radicalisation requiring national security responses to reflect findings from recent empirical research. This study aims to identify factors that relate to extremist attitudes and potential vulnerability to radicalisation in order to inform preventative action. A cross-sectional survey was conducted of a representative population sample of men and women aged 18–45 of Muslim heritage recruited by quota sampling in two English cities. Logistic regressions were performed on a seven-item dichotomised measure based on our previously developed scale of 'sympathy for terrorist acts'. Scores representing 'non-condemnation of these acts' were deemed to represent risk for radicalisation. Thirteen respondents had a positive score on the sympathy for terrorism measure (2.4%), 39 scored zero (6.41%) and the remainder (91.4%) had a negative score representing condemnation of terrorist acts. There was a significant association between sympathy for terrorism and belonging to the local or global Muslim community, anxiety, and support for the use of defensive violence. Gender, religious identity, country of birth, belief in Sharia law, the importance of religion in life, and mosque attendance were all not associated with sympathy for terrorism. The results contribute to an understanding of the radicalisation process and have potential value in developing preventative public health interventions. [ABSTRACT FROM AUTHOR]

Background: Experiences of potentially morally injurious events (PMIEs) have been found to negatively impact the mental health of US personnel/veterans, yet little is known about the effect of PMIEs on the mental health of the UK Armed Forces (AF). This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of UK AF veterans. Method: Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an online questionnaire to 204 UK veterans. Subjects were classified as having experienced a morally injurious event (n = 66), a non-morally injurious traumatic event (n = 57), a 'mixed' event (n = 31), or no event (n = 50). Results: Potentially morally injurious experiences were associated with adverse mental health outcomes, including likely anxiety disorders and suicidal ideation, compared to those who reported no event exposure. The likelihood of meeting criteria for probable PTSD was greatest in those who had experienced a non-morally injurious trauma. No statistically significant association between alcohol misuse and experiencing a PMIE or traumatic event was observed. Conclusions: The results provide preliminary evidence that potentially morally injurious experiences are associated with adverse mental health outcomes in UK AF veterans. Further work is needed to better understand the interplay between morally injurious events and threat-based trauma in order to design effective pathways for prevention and intervention for people exposed to highly challenging events. [ABSTRACT FROM AUTHOR]

COVID‐19 research from China suggests health care workers are at risk of distress, have specific concerns, and need support. It remains unknown whether findings are applicable to UK health care staff and whether psychological support based on generic approaches is effective. We administered an online survey at a leading neuroscience hospital in the UK to examine how individual staff characteristics contribute to distress, concerns, and interventions most valued during the COVID‐19 pandemic. We found a high incidence of distress, particularly in females and staff with previous mental health history. Concerns fell into three factors: 'risk of infection', 'work challenges', and 'social change', and were affected by professional role and contact with COVID‐19 patients. These three factors predicted distress. Psychological support and clear updates were deemed most useful, with specific needs affected by age, professional role, and contact with COVID‐19 patients. This is the first documentation of a high incidence of psychological distress predicted by three types of concerns in health care workers of a neuroscience hospital. Distress, concerns, and interventions most valued were all affected by individual staff characteristics. These findings highlight the importance of providing stratified, one to one support interventions, tailored to professional group, and background, rather than more generic approaches. Practitioner points: The COVID‐19 pandemic has resulted in a high incidence of psychological distress in UK health care staff.Distress, concerns, and interventions most valued are influenced by individual staff characteristics.Stratified, one‐to‐one support interventions, tailored to professional group, and background, rather than more generic approaches for stress reduction and resilience, are crucial. [ABSTRACT FROM AUTHOR]

This study explored the experiences of clinicians in providing treatment in cases of military-related moral injury (MI). Qualitative interviews were carried out with 15 clinicians. Clinicians found patients experienced particular maladaptive appraisals following MI, which were considered different from the responses experienced after threat-based trauma. To address MI-related distress, clinicians utilized a range of treatment approaches. Several difficulties in providing care to patients following MI were described, including the impact of providing treatment on the clinicians own mental health. This study provides detailed insight into the approaches currently used to identify and treat UK Veterans with MI-related psychological problems. These findings highlight the need to evaluate the effectiveness of the treatments currently provided for MI-related psychological problems and suggest developing best practice guidance may improve clinician confidence in delivering care to those adversely impacted by MI. [ABSTRACT FROM AUTHOR]

Understanding which factors influence the ability of individuals to respond to changing temperatures is fundamental to species conservation under climate change.We investigated how a community of butterflies responded to fine‐scale changes in air temperature, and whether species‐specific responses were predicted by ecological or morphological traits.Using data collected across a UK reserve network, we investigated the ability of 29 butterfly species to buffer thoracic temperature against changes in air temperature. First, we tested whether differences were attributable to taxonomic family, morphology or habitat association. We then investigated the relative importance of two buffering mechanisms: behavioural thermoregulation versus fine‐scale microclimate selection. Finally, we tested whether species' responses to changing temperatures predicted their population trends from a UK‐wide dataset.We found significant interspecific variation in buffering ability, which varied between families and increased with wing length. We also found interspecific differences in the relative importance of the two buffering mechanisms, with species relying on microclimate selection suffering larger population declines over the last 40 years than those that could alter their temperature behaviourally.Our results highlight the importance of understanding how different species respond to fine‐scale temperature variation, and the value of taking microclimate into account in conservation management to ensure favourable conditions are maintained for temperature‐sensitive species. [ABSTRACT FROM AUTHOR]

Social media and the data it produces lend itself to being visualised as a network. Individual Twitter users can be represented as nodes and retweeted by another Twitter user, thereby forming a relationship, an edge, between users. However, an unbounded network is a sprawling mass of nodes and edges. Boundary settings are typically applied, for example, a time period, a hashtag, a keyword search or a network substructure of a phenomenon of interest. Thus, the particular visualisation created is dependent upon the boundaries applied, enabling productive visual consumption, but concealing its social shaping. To explore this question of boundary setting and its associated issues, we draw on an example from the Twitter discussions about the UK Minister for Health, Jeremy Hunt, and the media debate surrounding the contractual hours of junior doctors during 2015–2016. We discuss the role and impact differing stakeholders have in setting these boundaries. We seek to provide a set of 'questioning lenses' in which we ask why these boundary settings were selected, what effect they have, and what are the potential implications of these boundary setting techniques on the visualisation consumer. [ABSTRACT FROM AUTHOR]

This paper presents findings on the household availability of digital media devices and the uses made of this technology by young people aged 12 to 18 living within the Greater Melbourne area of Australia. Drawing upon questionnaire data from a purposive sample of 860 students frequency analysis of this data indicates three dominant factors shape a young person's media experience: gender, siblings present within the home, and parents' highest level of education1. Moreover, when examining the types of software programs and the social network services used by young people age emerges as an additional layer to understanding these practices. In order to help contextualise these digital engagements, a comparative analysis with youth in the UK and the USA is undertaken to explore the ongoing validity of previous research claiming Australian youth as being some of the most digitally connected youth in the world. [ABSTRACT FROM AUTHOR]

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Background: UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms. Methods: A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids. Results: The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted significantly longer in the veteran sample than in emergency responders. These included seven of the most common symptoms, together with two others: muscle pain and restlessness. The persistence of these symptoms in the veteran group suggests a post-traumatic illness linked to lengthy overseas service in combat units. Conclusions: The nature and duration of symptoms exhibited by veterans may be associated with their experience of heightened risks. Exposure to severe or prolonged trauma seems to be associated with chronic multi-symptom illness, symptoms of post-traumatic stress and somatic expressions of pain that may delay or complicate the recovery process. [ABSTRACT FROM AUTHOR]

Introduction: Non‐invasive ventilation (NIV) is recommended for treatment of acute hypercapnic respiratory failure (AHRF) in acute exacerbations of COPD. National UK audit data suggests that mortality rates are rising in COPD patients treated with NIV. Objective: To investigate temporal trends in in‐hospital mortality in COPD patients undergoing a first episode of ward‐based NIV for AHRF. Methods: Retrospective study of hospitalised COPD patients treated with a first episode of ward‐based NIV at a large UK teaching hospital between 2004 and 2017. Patients were split into two cohorts based on year of admission, 2004‐2010 (Cohort 1) and 2013‐2017 (Cohort 2), to facilitate comparison of patient characteristics. Results: In total, 547 unique patients were studied. There was no difference in in‐hospital mortality rate between the time periods studied (17.6% vs 20.5%, P = .378). In Cohort 2 there were more females, a higher rate of co‐morbid bronchiectasis and pneumonia on admission and more severe acidosis, hypercapnia and hypoxia. More patients in Cohort 2 had NIV as the ceiling of treatment. Patients in Cohort 2 experienced a longer time from AHRF diagnosis to application of NIV, higher maximum inspiratory positive airway pressure, lower maximum oxygen and shorter duration of NIV. Finally, patients in Cohort 2 experienced a shorter hospital length of stay (LOS), with no differences observed in rate of transfer to critical care or intubation. Conclusion: In‐hospital mortality remained stable and LOS decreased over time, despite greater comorbidity and more severe AHRF in COPD patients treated for the first time with ward‐based NIV. [ABSTRACT FROM AUTHOR]

The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences. [ABSTRACT FROM AUTHOR]

Summary: Good's syndrome (thymoma and hypogammaglobulinaemia) is a rare secondary immunodeficiency disease, previously reported in the published literature as mainly individual cases or small case series. We use the national UK‐Primary Immune Deficiency (UKPID) registry to identify a large cohort of patients in the UK with this PID to review its clinical course, natural history and prognosis. Clinical information, laboratory data, treatment and outcome were collated and analysed. Seventy‐eight patients with a median age of 64 years, 59% of whom were female, were reviewed. Median age of presentation was 54 years. Absolute B cell numbers and serum immunoglobulins were very low in all patients and all received immunoglobulin replacement therapy. All patients had undergone thymectomy and nine (12%) had thymic carcinoma (four locally invasive and five had disseminated disease) requiring adjuvant radiotherapy and/or chemotherapy. CD4 T cells were significantly lower in these patients with malignant thymoma. Seventy‐four (95%) presented with infections, 35 (45%) had bronchiectasis, seven (9%) chronic sinusitis, but only eight (10%) had serious invasive fungal or viral infections. Patients with AB‐type thymomas were more likely to have bronchiectasis. Twenty (26%) suffered from autoimmune diseases (pure red cell aplasia, hypothyroidism, arthritis, myasthenia gravis, systemic lupus erythematosus, Sjögren's syndrome). There was no association between thymoma type and autoimmunity. Seven (9%) patients had died. Good's syndrome is associated with significant morbidity relating to infectious and autoimmune complications. Prospective studies are required to understand why some patients with thymoma develop persistent hypogammaglobulinaemia. Good's syndrome (thymoma and hypogammaglobulinemia is a rare secondary immunodeficiency. This is one of the largest series of patients with this condition collating information on the clinical features, laboratory parameters, complications and mortality of this disease. Prospective translational studies are required to better understand the pathogenesis of this disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate variation in optometric referral decision‐making and the influence of experience and continuing education and training (CET). Methods: To gain insight into unwarranted variation in referral activity in the United Kingdom (UK): (1) triage data were audited to investigate source of referral, provisional diagnosis, and outcome; (2) an online system was developed to present two sets of 10 vignettes, designed to avoid prompting answers. Participating optometrists completed 10 pre‐CET vignettes, recording their tests and management decisions. The main group of participants chose whatever CET they wished over a 6‐month period and then completed another 10 post‐CET vignettes. A second group of newly‐qualified optometrists completed the vignettes before and after a CET course intervention, followed by a third group of pre‐registered optometrists with an intervention of 6‐months experience of their pre‐registration year. Results: The audit identified 1951 optometric referrals and 158 optometrists (211 referrals were from general medical practitioners), with 122 of the 158 optometrists making fewer than ten referrals. Two newly‐qualified optometrists generated 12.5% of the total referrals in the audit (N = 2162). Many suspect glaucoma referrals were based on a single suspect measurement resulting in a high discharge rate after community review, as did referrals for certain fundus‐related appearances for which no treatment was indicated. The intervention of gaining CET points appeared to have no significant impact (p = 0.37) on referral decision‐making, although this part of the study was underpowered. Self‐selection bias was confirmed in the main group. When the main group and newly‐qualified practitioners were compared, the number of referrals was negatively associated with time since qualification (p = 0.005). When all 20 referral decisions were compared, all optometrists referring more than 10 vignette patients came from a group of newly‐qualified practitioners up to 2 years post‐qualification. Pre‐registered optometrists generally referred more appropriately than newly‐qualified. Upon qualification, there was a significant increase in the number of sight tests undertaken per day (p = <0.0005). Conclusions: Gaining CET points alone is unlikely to significantly improve referral decision‐making. Mentoring and targeted CET for the newly‐qualified up to 2 years post‐qualification should be considered. Ophthalmology replies to the referring newly‐qualified optometrist are vital for moderating future referrals and developing clinical confidence. [ABSTRACT FROM AUTHOR]

Summary: This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well‐established registry. [ABSTRACT FROM AUTHOR]

The association of post-traumatic stress disorder (PTSD) symptom clusters with combat and other operational experiences among United Kingdom Armed Forces (UK AF) personnel who deployed to Afghanistan in 2009 were examined. Previous studies suggest that the risk of developing PTSD rises as combat exposure levels increase. To date, no UK research has investigated how specific classes of combat and operational experiences relate to PTSD symptom clusters. The current study was a secondary analysis of data derived from a two-arm cluster, randomized-controlled trial of a postdeployment operational stress-reduction intervention in deployed UK AF personnel. 2510 UK AF personnel provided combat exposure data and completed the PTSD checklist (civilian version) immediately post-deployment while 1635 of the original cohort completed further followed-up measures four to six months later. A 14-item combat experience scale was explored using principle component analysis, which yielded three main categories of experience: (1) violent combat, (2) proximity to wounding or death and (3) encountering explosive devices. The association of combat experience classes to PTSD 5-factor “dysphoric arousal” model (re-experiencing, avoidance, numbing, dysphoric-arousal and anxious-arousal symptoms) was assessed. Greater exposure to violent combat was predictive of re-experiencing and numbing symptoms, while proximity to wounding or death experiences were predictive of re-experiencing and anxious-arousal symptoms. Explosive device exposure was predictive of anxious-arousal symptoms. The present study suggests that categories of combat experience differentially impact on PTSD symptom clusters and may have relevance for clinicians treating military personnel following deployment. [ABSTRACT FROM AUTHOR]

Background. Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine. Methods. We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions. Results. There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P < .0001 for all correlations). The correlations were stronger in the prevaccine period than in the postvaccine period. After vaccine introduction, the mean rotavirus IQS decreased by 40% (95% confidence interval [CI], 25%-55%) in the United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction. Conclusions. Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction. [ABSTRACT FROM AUTHOR]

This paper draws on empirical research with NEET populations (16–24-year-olds not in education, employment or training) in the U.K. in order to engage with issues around identification, data and metrics produced through datalogical systems. Our aim is to bridge contemporary discourses around data, digital bureaucracy and datalogical systems with empirical material drawn from a long-term ethnographic project with NEET groups in Leeds, U.K. in order to highlight the way datalogical systems ideologically and politically shape people’s lives. We argue that NEET is a long-standing data category that does work and has resonance within wider datalogical systems. Secondly, that these systems are decision-making and far from benign. They have real impact on people’s lives – not just in a straightforwardly, but in obscure, complex and uneven ways which makes the potential for disruption or intervention increasingly problematic. Finally, these datalogical systems also implicate and are generated by us, even as we seek to critique them. [ABSTRACT FROM PUBLISHER]

Background: Immunologists are increasingly being asked to assess patients with non-classical and secondary antibody deficiency to determine their potential need for immunoglobulin replacement therapy (IGRT). Immunoglobulin is a limited, expensive resource and no clear guidance exists for this broad patient group. The purpose of this survey is to establish what factors influence the decision to commence IGRT in adult patients, when diagnostic criteria for primary antibody deficiency are not fulfilled.Methods: Under the auspices of the United Kingdom Primary Immunodeficiency Network (UKPIN), a study group was established which circulated an online questionnaire to the consultant body across the UK and Ireland. Results provided a snapshot of the current clinical practice of 71% of consultant immunologists, from 30 centers.Results: In order of importance, factors which influence the decision to commence IGRT include number of hospital admissions with infection, serum IgG level, bronchiectasis, radiologically proven pneumonia, number of positive sputum cultures, number of antibiotic courses, and results of immunization studies. The commonest test vaccine used was Pneumovax 23 with measurement of serotype-specific responses at 4 weeks, with a threshold of 0.35 μg/ml in 2/3 of serotypes measured. Eighty-six percent of patients are treated with a trial of prophylactic antibiotics prior to consideration of IGRT. Efficacy of IGRT trial is assessed at between 6 and 12 months.Conclusions: There was consistency in clinical practice using a combination of clinical history, evidence of infections, and vaccination testing for diagnosis. However, there was some variation in the implementation of this practice, particularly in vaccine choice and assessment of response to vaccination. [ABSTRACT FROM AUTHOR]

This article draws on research with young NEETs (not in education, employment or training) in Leeds in order to contest the assumption that technological qualities informing new media devices (here mobile phones) simply or transparently translate into social or ontological categories. We draw on a long-term ethnographic study of NEET individuals to argue that one of the underpinning principles of mobile phones – that they pertain to mobility and that mobility is positive and agential – is called into question. Our aim is not only to unpack a number of concepts and assumptions underpinning the mobile phone but also to suggest that these concepts unhelpfully (and even detrimentally) locate mobile phones in relation to the technological possibilities on offer without taking into account what is simultaneously made impossible and immobile, and for whom. Finally, when we set the digital experiences of NEETs alongside the discourses around mobile phones, we find that mobility is restricted – not enabling, and that it is forged in, and articulated as part of an everyday life that is dominated by the social and economic horizons set by the groups status as NEET. [ABSTRACT FROM AUTHOR]

This article details a systemic analysis of the controls in place and possible interventions available to further reduce the risk of a foot and mouth disease (FMD) outbreak in the United Kingdom. Using a research-based network analysis tool, we identify vulnerabilities within the multibarrier control system and their corresponding critical control points (CCPs). CCPs represent opportunities for active intervention that produce the greatest improvement to United Kingdom's resilience to future FMD outbreaks. Using an adapted 'features, events, and processes' (FEPs) methodology and network analysis, our results suggest that movements of animals and goods associated with legal activities significantly influence the system's behavior due to their higher frequency and ability to combine and create scenarios of exposure similar in origin to the U.K. FMD outbreaks of 1967/8 and 2001. The systemic risk assessment highlights areas outside of disease control that are relevant to disease spread. Further, it proves to be a powerful tool for demonstrating the need for implementing disease controls that have not previously been part of the system. [ABSTRACT FROM AUTHOR]

Background: Increasing pressure in the United Kingdom (UK) urgent care system has led to Emergency Departments (EDs) failing to meet the national requirement that 95% of patients are admitted, discharged or transferred within 4-h of arrival. Despite the target being the same for all acute hospitals, individual Trusts organise their services in different ways. The impact of this variation on patient journey time and waiting is unknown. Our study aimed to apply the Lean technique of Value Stream Mapping (VSM) to investigate care processes and delays in patient journeys at four contrasting hospitals.Methods: VSM timing data were collected for patients accessing acute care at four hospitals in South West England. Data were categorised according to waits and activities, which were compared across sites to identify variations in practice from the patient viewpoint. We included Public and Patient Involvement (PPI) to fully interpret our findings; observations and initial findings were considered in a PPI workshop.Results: One hundred eight patients were recruited, comprising 25,432 min of patient time containing 4098 episodes of care or waiting. The median patient journey was 223 min (3 h, 43 min); just within the 4-h target. Although total patient journey times were similar between sites, the stage where the greatest proportion of waiting occurred varied. Reasons for waiting were dominated by waits for beds, investigations or results to be available. From our sample we observed that EDs without a discharge/clinical decision area exhibited a greater proportion of waiting time following an admission or discharge decision. PPI interpretation indicated that patients who experience waits at the beginning of their journey feel more anxious because they are 'not in the system yet'.Conclusions: The novel application of VSM analysis across different hospitals, coupled with PPI interpretation, provides important insight into the impact of care provision on patient experience. Measures that could reduce patient waiting include automatic notification of test results, and the option of discharge/clinical decision areas for patients awaiting results or departure. To enhance patient experience, good communication with patients and relatives about reasons for waits is essential. [ABSTRACT FROM AUTHOR]

The number of people living into older age (>65 years) is rising rapidly. Older people are more likely to fall and this has adverse consequences for their quality of life and that of their families. Falls also pose a substantial financial burden on healthcare systems. Extensive research from systematic reviews and meta-analyses has established effective approaches for reducing falls among older people, although uncertainties and controversy remain. The evidence suggests that exercise based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community. This review integrates current knowledge on assessment and management strategies to prevent falls in older people living in the community. It summarizes known risk factors for falls in this population and presents assessment strategies that can be used to assess the risk of falls. It discusses the management of risks and interventions to reduce falls among older people in the community, as well as future directions and promising approaches. [ABSTRACT FROM AUTHOR]

United Kingdom (UK) Universities strive to increase international student numbers and claim to be internationalising the student experience. In parallel student-centred approaches appear to be the norm across learning, teaching and assessment strategies. However, a tension exists in delivering both of these claims concurrently in that domestic and inbound international students often have different experiences, expectations, needs and perceptions regarding pedagogy, support and curriculum. While programme delivery centres on the UK educational mode, universities tend to accommodate orientation for all students centrally, as a largely homogenous group. This paper explores the experiences of inbound Erasmus exchange students from several European Union (EU) countries to determine if student-centred approaches are adequate to meet their needs. It also examines possible gaps in the tutor-student pedagogic experience, expectations and perceptions. With reference to gap analysis, a case study of a module in a post-1992 University is explored. Observation, focus groups, policy analysis and quantitative analysis of student results are used to make sense of the intercultural pedagogic experiences of the students and potential implications for curriculum design and delivery. Findings indicate that the processes and procedures put in place to support Erasmus students in navigating UK pedagogic styles, assessment and curriculum are insufficient to truly support the student journey in a way that student centeredness would imply. Key areas of discord revolve around curriculum structure, assessment style, expectations and pedagogic approach. In essence, the cognitive and intangible processes and aspects of the student journey are problematic with evidence to suggest that poor cross-institutional communication and generic orientation compound the challenges. The research is particularly significant in that it highlights the need to provide a more reflective and reflexive approach to working with Erasmus students, requiring a shift away from a mechanistic focus on systems, structures and cultural awareness towards cultural intelligence. [ABSTRACT FROM AUTHOR]

Ensuring patient access to genomic information in the face of increasing demand requires clinicians to develop innovative ways of working. This paper presents the first empirical prospective observational cohort study of UK multi-disciplinary genetic service delivery. It describes and explores collaborative working practices including the utilisation and role of clinical geneticists and non-medical genetic counsellors. Six hundred and fifty new patients referred to a regional genetics service were tracked through 850 clinical contacts until discharge. Referral decisions regarding allocation of lead health professional assigned to the case were monitored, including the use of initial clinical contact guidelines. Significant differences were found in the cases led by genetic counsellors and those led by clinical geneticists. Around a sixth, 16.8% (109/650) of referrals were dealt with by a letter back to the referrer or re-directed to another service provider and 14.8% (80/541) of the remaining patients chose not to schedule an appointment. Of the remaining 461 patients, genetic counsellors were allocated as lead health professional for 46.2% (213/461). A further 61 patients did not attend. Of those who did, 86.3% (345/400) were discharged after one or two appointments. Genetic counsellors contributed to 95% (784/825) of total patient contacts. They provided 93.7% (395/432) of initial contacts and 26.8% (106/395) of patients were discharged at that point. The information from this study informed a planned service re-design. More research is needed to assess the effectiveness and efficiency of different models of collaborative multi-disciplinary working within genetics services. [ABSTRACT FROM AUTHOR]

C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organization. [ABSTRACT FROM AUTHOR]