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Although it has been argued that school libraries are important for supporting the reading engagement of pupils who receive free school meals, to date there has been little analysis of the extent to which use of school library spaces is related to these pupils' reading behaviors. We analyzed data from 6,264 children and young adults in the United Kingdom entitled to free school meals (FSM) who completed the 2019 National Literacy Trust Annual Literacy Survey. Our goals were to understand the extent to which these pupils' engagement with reading and writing were related to access to or use of their school libraries and to understand some of the reasons why they do or do not use school libraries. We found their enjoyment of both reading and writing, their confidence in their own abilities, and the frequency with which they read or wrote for pleasure outside of school was significantly higher for those pupils eligible for FSM who used their school libraries relative to both those who did not use their school libraries and those who had no school library. Consistent with this finding, children eligible for FSM who used their school library engaged with a greater diversity of reading material and writing than those who were not school library users. Pupils who had access to welcoming, well-equipped libraries with books well-matched to students' interests used the libraries for those reasons and because, for many, it was a safe haven. Many non-users either had no school library or perceived the library as poorly equipped, unwelcoming, or uninteresting. We argue that effective school libraries can be a significant resource in supporting engagement with self-motivated literacy practices in children from low-income families.

Objectives: The incidence of type 2 diabetes in UK Black African and Caribbean communities is up to three times higher than in the general population, and engagement with self-management advice is poorer. This study explores the perspective of those living with diabetes to understand how the cultural salience of advice could be improved. Design: Participants were recruited via community venues, faith institutions and primary care. Eight focus groups were conducted with 41 individuals (Black African n = 23, Black Caribbean n = 18). Grounded theory methods were used for analysis. Results: Although motivated to manage the condition, individuals experienced a misalignment between elements of the care provision and cultural norms. Explanatory models of diabetes differed from the biomedical model reducing trust in treatment protocols. A lack of cultural salience reduced the accessibility of advice. Furthermore, elements of self-management advice were seen to conflict directly with some cultural traditions and practices. Individuals had to reconcile the two perspectives in order to proceed with self-management, often prioritising cultural norms and advice from informal sources over healthcare advice. Building personal relationships with the healthcare team improved trust and engagement. Conclusion: Findings suggest the needs in these communities were not being fully met. The healthcare interaction was pivotal in improving trust and engagement and reducing misinformation. However, appropriately informed community support also offers the potential to mitigate misalignment and to improve equity of access.

Open online courses could provide stepping stones for audiences that are underrepresented in higher education (HE). However, there are concerns that these instead proliferate forms of exclusion and do not address known difficulties for widening participation. We explore how organisations that represent the perspectives of particular underserved audiences for HE can act as 'Learner Representative Partners' to support the creation of appropriate courses and to highlight practices that exclude. Six course development processes where a university worked with different partners are analysed using interviews, documentation of resource use, and data on learner behaviour. The analysis utilises previously identified challenges to widening participation and collaborative course creation. Getting partners to directly engage in authoring the course was particularly beneficial but all partners prompted critical thought and greater understanding of the intended audiences. We suggest principles to support such partnerships effectively. These include adapting to a variable capacity of partners to contribute, to encourage reuse or creation of resources by partners, and to facilitate partners to feel confident in expressing their views.

Neoliberal reform of the university sector has resulted in increasing numbers of academics employed on casual or fixed-term contracts. While there is an emergent body of literature on issues of precarity in the academy, relatively little attention has been paid to the roles and responsibilities of those tenured academics who employ and "manage" non-tenured researchers. The work involved in hiring and managing a contract researcher is rarely acknowledged or supported, and managers receive little to no training. In this paper, we draw on Dorothy Smith's feminist sociological approach to analyse interviews with 22 non-tenured researchers to examine how managerial relationships shape the employment experiences of those working precariously. We argue that tenured academics have ethical responsibilities to provide a working environment that is fair, supports the ongoing development and wellbeing of non-tenured staff, and challenges dominant discourses of precarious academics as 'other'.

Purpose: The Village model, most extensively developed in the USA, is an innovative response to ageing populations and older adults who wish to remain living independently within their community. The "Urban Villages" participatory action research study aimed to test the potential of the Village model to work with groups of older adults in two economically deprived, inner-city neighbourhoods in Manchester, UK. Design/methodology/approach: Participatory methods were used to work with residents to, first, adapt the Village model to the Manchester setting, and second, to develop and deliver community projects that supported ageing in place. The study aimed to involve marginalised individuals and groups in the co-design, leadership and implementation of the projects. Ethnographic methods were applied to observe and reflect on the development of "Urban Villages". Interviews and focus groups were organised to gather the views of the residents involved in the community projects. Findings: Residents were supported to develop and test seven projects, all aimed at reducing social isolation and supporting ageing in place. The study provides new insights into challenges related to co-production with older people in deprived neighbourhoods. These challenges are presented under the following headings: individual capacity and expectations; collective capacity including communication and knowledge; and the capacity of place. Originality/value: To date, only a limited amount of literature is available showing how co-production with older adults can be realised when working with marginalised groups and deprived communities. The paper explores the potential of participatory approaches to develop age-friendly initiatives through strengthening the capacity of older adults to age in place. [ABSTRACT FROM AUTHOR]

Background This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. Methods We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. Results Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. Conclusions While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners. [ABSTRACT FROM AUTHOR]

Aims: To describe the process and outputs of a workshop convened to identify key priorities for future research in the area of diabetes and physical activity and provide recommendations to researchers and research funders on how best to address them. Methods: A 1‐day research workshop was conducted, bringing together researchers, people living with diabetes, healthcare professionals, and members of staff from Diabetes UK to identify and prioritise recommendations for future research into physical activity and diabetes. Results: Workshop attendees prioritised four key themes for further research: (i) better understanding of the physiology of exercise in all groups of people: in particular, what patient metabolic characteristics influence or predict the physiological response to physical activity, and the potential role of physical activity in beta cell preservation; (ii) designing physical activity interventions for maximum impact; (iii) promoting sustained physical activity across the life course; (iv) designing physical activity studies for groups with multiple long‐term conditions. Conclusions: This paper outlines recommendations to address the current gaps in knowledge related to diabetes and physical activity and calls on the research community to develop applications in these areas and funders to consider how to stimulate research in these areas. [ABSTRACT FROM AUTHOR]

Background: Lifestyle impacts the health of kidney transplant recipients (KTRs) who are at risk of weight gain, post-transplantation diabetes mellitus and dyslipidaemia. Their capacity to self-care is key to adapting the lifestyle choices that impact their health. Aims: This qualitative study aimed to understand KTRs' lifestyle choices in relation to their post-transplant life and explore the impact of support provided by healthcare professionals (HCPs) and significant others on KTR's self-care. Methods: The project involved 33 participants who were involved in one of five focus groups, or 15 one-to-one semi-structured interviews. The participants were KTRs who had received a transplant over 6 months or more ago, their significant others and healthcare professionals. Participants were all selected from one UK transplant centre. Purposive sampling ensured both a diversity of KTRs and a range of professionals participating, with data analysed using thematic framework analysis. Findings: The authors report on a number of selected themes. These themes draw from a larger, more extensive analysis and conceptual framework concerning health, wellbeing and lifestyle, and they identify how effective health communicative interactions and health literacy plays an integral role in developing KTRs' self-care. Conclusion: Supporting KTR's lifestyle choices post-transplant involves building self-care capacity through effective health communication and health literacy. [ABSTRACT FROM AUTHOR]

Aims: To develop an evidence‐based, culturally tailored, diabetes self‐management education and support programme for Black‐British adults, called Healthy Eating and Active Lifestyles for Diabetes (HEAL‐D), using participatory methods to engage key stakeholders in the intervention design process. Methods: Black‐British adults living with type 2 diabetes, healthcare professionals and community leaders were engaged in an intervention development study. The intervention structure, format, content and delivery were developed through three phases of participatory research: Phase 1, formative research, involved focus groups and interviews; interactive co‐development workshops were conducted in Phase 2; and Phase 3 focused on materials development. Results: In Phase 1, focus groups and interviews identified the importance of nurturing collectivism, a reliance on informal sources of information/advice, barriers to attending appointments associated with competing priorities of work, travel and carer commitments, and a preference for directness and simple, clear advice/messages. A priority for healthcare professionals was the intervention embedding within current primary care structures and aligning with incentivised targets/metrics. Phase 2 (workshops) highlighted key requirements: avoidance of medical settings, appropriately trained and culturally knowledgeable educators, flexible appointments, preference for verbal and visual information and avoidance of technical/medical terminology. In Phase 3 (materials development), culturally sensitive videos, short films and information booklets were developed to convey educational messages, and food photography was used to provide culturally relevant dietary advice. Conclusions: Participatory methods provide a means to understand the needs of specific communities. This approach enables the development of healthcare interventions that are sensitive to the needs of service users and providers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline the "Hybrid" "International" Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, "earn, learn and return" programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS. Design/methodology/approach: A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a "HIEM programme". The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis. Findings: The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis. Research limitations/implications: The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties. Practical implications: The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal. Originality/value: This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this "hybrid" curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This "hybrid" model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10–12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities. What's new?: The prevalence of Type 2 diabetes is alarmingly high among minority ethnic groups in the United Kingdom (UK), approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10–12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years.A wealth of literature exists aiming to understand how genetic, physiological, socio‐economic and lifestyle factors contribute to ethnic inequalities in Type 2 diabetes. Much of this evidence is drawn from the USA; the current review focuses on the UK context, in which there are distinctions in demographic, social and healthcare system factors that contribute to the presentation and outcomes of Type 2 diabetes.This review highlights a number of ways in which ethnicity impacts on the pathophysiology, presentation, complications and management of Type 2 diabetes. Importantly, it draws upon evidence from UK cohorts and recognizes distinctions between UK cohorts and those residing in other regions. The focus on the UK context aims to provide practitioners with a greater understanding of Type 2 diabetes in minority ethnic groups. [ABSTRACT FROM AUTHOR]

UK Sure Start Children's Centres (SSCCs) aim to lessen behavioural disorders yet we lack evidence concerning how this is achieved. This study evaluates one possible mechanism: improved home learning environments (HLEs). Data come from a longitudinal study of 2568 families and children recruited at a mean age of 14 months from 117 SSCCs in England in 2012. Behavioural disorders were measured at 38 months via the Strengths and Difficulties Questionnaire. HLEs were measured at 14 and 38 months via parental interview. Families' use of SSCCs was measured via parental interview at 14, 22, and 38 months. This study suggests that the use of SSCCs is associated with fewer preschool behavioural disorders via intermediate changes to the quality of HLE's. Implications are discussed for social policies and for early years' professionals. [ABSTRACT FROM AUTHOR]

Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21–23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21–23 years were higher among those who regularly skipped breakfast at 11–13 years (BMI 1·41 (95 % CI 0·57, 2·26), P =0·001; cholesterol 0·15 (95 % CI –0·01, 0·31), P =0·063) and at 21–23 years (BMI 1·05 (95 % CI 0·22, 1·89), P =0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P =0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups. [ABSTRACT FROM AUTHOR]

Objective: We explore variations in service performance and quality improvement across healthcare organisations using the concept of improvement capability. We draw upon a theoretically informed framework comprising eight dimensions of improvement capability, firstly to describe and compare quality improvement within healthcare organisations and, secondly to investigate the interactions between organisational performance and improvement capability.Design: A multiple qualitative case study using semi-structured interviews guided by the improvement capability framework.Setting: Five National Health Service maternity services sites across the UK. We focused on maternity services due to high levels of variation in quality and the availability of performance metrics which enabled us to select organisations from across the performance spectrum.Participants: About 52 hospital staff members across the five case studies in positions relevant to the research questions, including midwives, obstetricians and clinical managers/leaders.Main Outcome Measure: A qualitative analysis of narratives of quality improvement and performance in the five case studies, using the improvement capability framework as an analytic device to compare and contrast cases.Results: The improvement capability framework has utility in analysing quality improvement within and across organisations. Qualitative differences in the configurations of improvement capability were identified across all providers but were particularly striking between higher and lower performing organisations.Conclusions: The improvement capability framework is a useful tool for healthcare organisations to assess, manage and develop their own improvement capabilities. We identified an interaction between performance and improvement capability; higher performing organisations appeared to have more developed improvement capabilities, though the meaning of this relationship requires further research. [ABSTRACT FROM AUTHOR]

Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and “youth‐friendly” service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social‐recovery oriented, evidence‐based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth‐oriented. [ABSTRACT FROM AUTHOR]

Abstract: A summary of the latest evidence‐based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes‐related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non‐nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted ‘GRADE’ methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines. [ABSTRACT FROM AUTHOR]

Background: Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. Methods: In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15+0-18+6 weeks' gestation), post intervention (27+0-28+6 weeks) and in late pregnancy (34+0-36+0 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). Results: Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. Conclusions: In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. Trial registration: Current controlled trials; ISRCTN89971375 [ABSTRACT FROM AUTHOR]

Context: Interventions targeting maternal obesity are a healthcare and public health priority. Objective: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. Data Sources: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Study Selection: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. Data Synthesis: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. Conclusion: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice. [ABSTRACT FROM AUTHOR]

ObjectiveAcculturation to the UK diet may contribute to the increased burden of non-communicable diseases in Black British communities. The present study aimed to assess nutritional composition and the contribution that traditional foods make to dietary intake in a group of UK-residing Caribbean and West African adults and to explore differences according to ethnicity and duration of residence.DesignObservational study. Dietary intake was assessed using multiple, standardised triple-pass 24 h recalls and analysed using a nutritional composition database. Associations between sociodemographic variables and duration of residence with dietary intake were assessed using ANCOVA.SettingLondon, UK, October 2011–December 2012.SubjectsUK adults of Caribbean (n 50) or West African (n 83) ancestry, aged 18–75 years.ResultsThe Caribbean participants were older and more likely to be born in the UK. After adjusting for age, sex and ethnicity, those who had been resident in the UK for the longest duration had significantly higher intakes of energy (P<0·001), fat (P=0·002) and Na (P=0·03). The West African participants sourced significantly more energy (P=0·04), fat (P=0·02), saturated fat (P=0·02) and Na (P=0·001) from traditional cultural foods compared with the Caribbean diet, which was more reliant on ‘Westernised’ foods such as sugar-sweetened beverages.ConclusionsThese results are novel in demonstrating dietary acculturation in UK adults of Caribbean and West African ancestry. We have provided detailed data regarding the role of traditional foods, presenting dietary information that may guide in individualising care for patients from these communities and improve the cultural sensitivity of public health strategies. [ABSTRACT FROM PUBLISHER]

This paper presents a review of the family services that were offered by a sample of 121 English Sure Start Children’s Centres in 2011 and 2012. Children’s Centres are community based facilities that aim to improve outcomes for at-risk families and children through the delivery of a range of services largely aimed at families with young children. Services commonly offered include: health advice, childcare and early education, employment advice, informal drop-in facilities, and specialist support on parenting. This paper provides a snapshot of Children’s Centre service provision in 2011 and 2012 and documents the extent of change. A picture of broad stability was observed in the numbers of services that centres reported offering (from a list of 47 services grouped into 11 categories). However, some Children’s Centres also appeared to be changing the focus of the services that they provided. Some centres seemed to be shifting towards providing greater outreach (rather than parent-support) and services which were targeted (rather than universal). [ABSTRACT FROM PUBLISHER]

Aims To investigate the relationship βetween adiposity and plasma free fatty acid levels and the influence of total plasma free fatty acid level on insulin sensitivity and β-cell function. Methods An insulin sensitivity index, acute insulin response to glucose and a disposition index, derived from i.v. glucose tolerance minimal model analysis and total fasting plasma free fatty acid levels were available for 533 participants in the Reading, Imperial, Surrey, Cambridge, Kings study. Bivariate correlations were made Between insulin sensitivity index, acute insulin response to glucose and disposition index and Both adiposity measures (BMI, waist circumference and Body fat mass) and total plasma free fatty acid levels. Multivariate linear regression analysis was performed, controlling for age, sex, ethnicity and adiposity. Results After adjustment, all adiposity measures were inversely associated with insulin sensitivity index (BMI: β = -0.357; waist circumference: β = -0.380; βody fat mass: β = -0.375) and disposition index (BMI: β = -0.215; waist circumference: β = -0.248; βody fat mass: β = -0.221) and positively associated with acute insulin response to glucose [BMI: β = 0.200; waist circumference: β = 0.195; Body fat mass β = 0.209 (P values <0.001)]. Adiposity explained 13, 4 and 5% of the variation in insulin sensitivity index, acute insulin response to glucose and disposition index, respectively. After adjustment, no adiposity measure was associated with free fatty acid level, But total plasma free fatty acid level was inversely associated with insulin sensitivity index (β = -0.133), acute insulin response to glucose (β = -0.148) and disposition index [β = -0.218 (P values <0.01)]. Plasma free fatty acid concentration accounted for 1.5, 2 and 4% of the variation in insulin sensitivity index, acute insulin response to glucose and disposition index, respectively. Conclusions Plasma free fatty acid levels have a modest negative association with insulin sensitivity, β-cell secretion and disposition index But no association with adiposity measures. It is unlikely that plasma free fatty acids are the primary mediators of obesity-related insulin resistance or β-cell dysfunction. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to propose a curriculum for paediatric musculoskeletal (pMSK) medicine to be taught to general practice trainees due to low self-rated confidence in pMSK assessment amongst both primary and secondary care physicians. It notes the use of Dephi methodology to identify learning needs in topics including allergy, genetics and psychiatry. It concludes the essence of the GP curriculum on pMSK medicine to improve the management of children with MSK disorders.

The UK weaning guidelines recommend the introduction of solid food at or around 6 months. The evidence suggests that knowledge of the guidelines is high, although only a small minority of parents wait until 6 months to wean. The aim of this study was to assess understanding of the UK weaning guidelines in a sample of UK parents and investigate the associations of this understanding with weaning timing, and in comparison to other influencing factors. This study conducted an online survey of UK parents. Eligible participants had weaned a child since the introduction of the current guidelines. Of 3607 participants, 86% accurately understood the guidelines. Eighty-seven per cent of health visitors were reported to have advised weaning at or around 6 months. Knowledge of the guidelines was associated with later weaning (independently of demographic factors) ( P < 0.001) but did not ensure compliance: 80% of mothers who weaned before 24 weeks and 65% who weaned before 17 weeks were aware of the guidelines. Younger mothers ( P < 0.001), those receiving benefits ( P < 0.001), those educated only to 16 ( P < 0.001) and minority ethnic groups ( P < 0.001) had lower levels of awareness. Poor understanding of the guidelines was the most reliable predictor of early weaning ( P = 0.021) together with young maternal age ( P = 0.014). Following the baby-led weaning approach was the most reliable predictor of those weaning at 26 weeks, together with the Internet being the most influential source of advice. Understanding of the current weaning guidelines is high and is a key independent predictor of weaning age in this population. [ABSTRACT FROM AUTHOR]

Background: It is uncertain whether saturated fatty acids (SFAs) impair endothelial function and contribute to arterial stiffening. Objective: We tested the effects of replacing SFAs with monoun-saturated fatty acids (MUFAs) or carbohydrates on endothelial function and arterial stiffness. Design: With the use of a parallel-designed randomized controlled trial in 121 insulin-resistant men and women, we measured vascular function after 1 mo of consumption of a high-SFA (HS) diet and after 24 wk after random assignment to the HS diet or diets that contained <10% SFAs and were high in either MUFAs or carbohydrates. The primary outcome was a change in flow-mediated dilation (FMD), and secondary outcomes were changes in carotid to femoral pulse wave velocity (PWV) and plasma 8-isoprostane F2α-III concentrations. Results: For 112 participants with data available for analysis on the specified outcomes, no significant differences were shown. FMD with the HS reference diet was 6.7 ± 2.2%, and changes (95% CIs) after 6 mo of intervention were +0.3 (-0.4, 1.1), -0.2 (-0.8, 0.5), and -0.1 (-0.6, 0.7) with HS, high-MUFA (HM), and high-carbohydrate (HC) diets, respectively. After consumption of the HS reference diet, the geometric mean (±SD) PWV was 7.67 ± 1.62 m/s, and mean percentages of changes (95% CIs) were -1.0 (-6.2, 4.3) with the HS diet, 2.7 (-1.4, 6.9) with the HM diet, and -1.0 (-5.5, 3.4) with the HC diet. With the HS reference diet, the geometric mean (±SD) plasma 8-isoprostane F2α-III concentration was 176 ± 85 pmoI/L, and mean percentage of changes (95% CIs) were 1 (-12, 14) with the HS diet, 6 (-5, 16) with the HM diet, and 4 (-7, 16) with the HC diet. Conclusion: The replacement of SFAs with MUFAs or carbohydrates in healthy subjects does not affect vascular function. This trial was registered at Current Controlled Trials (http://www.controlled-trials. com/lSRCTN) as ISRCTN 29111298. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of the present study was to explore knowledge of the UK weaning guidelines and the sources of weaning advice used by UK first-time mothers.DesignAn online survey of UK parents; analysed using mixed methods.SettingParticipants were recruited from a selection of parenting websites that hosted a link to the survey.SubjectsIn total, 1348 UK first-time mothers were included in the analysis.ResultsKnowledge of the guidelines was high (86 %) and associated with later weaning (P < 0·001), although 43 % of this sample weaned before 24 weeks. The majority of parents used multiple sources of information, the most influential being the health visitor (26 %), the Internet (25 %) and books (18 %). Fifty-six per cent said they received conflicting advice. Younger mothers and those of lower educational attainment were more likely to be influenced by advice from family, which was likely to be to wean earlier. Furthermore, those most influenced by their mother/grandmother were less likely to have accurate knowledge of the guidelines. In this population the Internet was used for weaning advice across all sociodemographic groups and was associated with a later weaning age, independently of sociodemographic factors (P < 0·001). Data from responses to a free-text question are used in illustration.ConclusionsThe study suggests that first-time mothers have a good understanding of the weaning guidelines but seek weaning information from multiple sources, much of which is conflicting. Informal sources of weaning advice appear most influential in younger mothers and those of lower educational attainment, and result in earlier weaning. [ABSTRACT FROM AUTHOR]

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BACKGROUND:Many methods are available to determine energy requirements, however, all have limitations, particularly when used for the obese.OBJECTIVES:The aim of this survey was to investigate current practice in the estimation of energy requirements in an underweight and obese hospitalised patient in a large cohort of UK dietitians.SUBJECT/METHODS:A cross-sectional anonymous online survey of UK registered dietitians was performed.RESULTS:A total of 672 responses were received. Underweight patient: prediction equations with adjustment for metabolic stress and physical activity were most commonly used (90%). The median estimated energy requirement was 2079 kcals/day. The estimated energy requirement using calorie per kilogram method was significantly lower compared with equations (P<0.001). The median target volume of feed prescribed was 2000 mls/day. A significant reduction in feed prescribed compared with estimated energy requirements was found (P<0.001). Obese patient: prediction equations to estimate the basal metabolic rate alone were most commonly used (51%). Nutrition support dietitians used a lower stress factor compared with non-nutrition support dietitians (P=0.016). Method used to estimate the energy requirements was associated with years in clinical practice and place of work (P<0.001, 0.001). Calorie per kilogram used in the obese case study (median: 25 kcal/kg) was significantly lower than calorie per kilogram used in the underweight case study (median: 30 kcal/kg; P=0.014).CONCLUSIONS:A significant variation in the methods used by dietitians to estimate the energy requirements was found, particularly in the obese patient group. In an age of rapidly increasing rates of obesity a professional consensus of treatment of this patient group is needed. [ABSTRACT FROM AUTHOR]

Background:Artificial nutrition support is used in treating hospital patients and has been shown to reduce hospital stays. The NICE (National Collaborating Centre for Acute Care) guidelines are the first national consensus guidelines for dietetic practice in artificial nutrition. The aim of the current survey was to explore the influence of local and national guidelines, and clinical experience on enteral tube feeding practices in a large cohort of UK dietitians.Methods:A cross-sectional anonymous online survey of UK registered dietitians was performed.Results:A total of 681 responses were received. In all, 85% deemed 'clinical experience' to be of greatest influence when initiating a tube feeding regimen; the influence of 'clinical experience' was significantly associated with the number of years in practice (P=<0.001). A total of 70% of respondents were aware of a department feeding protocol with 67% of protocols using a start rate of 24-49 ml/h; furthermore, 65% of respondents reported most commonly using a feeding start rate of 24-49 ml/h and 75% of them reported that their department had a protocol for preventing refeeding syndrome; 23% had mandatory implementation of NICE guidelines.Conclusions:Enteral feeding practice varies among practitioners. Clinical experience and published clinical guidelines have a pivotal role when treating adult patients that require enteral tube feeding. [ABSTRACT FROM AUTHOR]

Background: Gastrostomy feeding in head and neck cancer patients is recognised standard practice in some cancer centres with beneficial effects on outcomes for appropriately selected patients. However, the impact on patients and care-givers needs consideration. The present study aimed to understand the daily impact of gastrostomy feeding on head and neck cancer patients and their care-givers to identify improvements to services. Methods: Twenty-one adult patients were randomly selected from the Head and Neck centre at University College London Hospital. Six head and neck cancer patients and three care-givers participated in focus groups. The sessions were recorded, fully transcribed and qualitatively thematically analysed, and the resulting data were tabulated. Results: Patients and care-givers expressed opposite experiences within knowledge and understanding of why the tube was necessary; their personal perceptions and objectives of nutritional support. Themes expressing similar experiences included: developing positive coping strategies; preventing nutritional decline; tube dependency; dentures; finance; active care; and psychological support. Furthermore, both groups expressed the benefits of retaining a support network for rehabilitation with the hospital-based specialist team. Also patients and carers recognised that the gastrostomy tube helped patient survival and, with timely dietetic management, helped them wean off the tube reliance with more confidence. Conclusions: It is essential that patients and care-givers attend pretreatment clinics to discuss nutritional support via the artificial route; their quality of life can be enhanced if guided through a specialist support pathway based at the clinical site where they initiated their care, with links to key agencies. [ABSTRACT FROM AUTHOR]

Jerome Francis Gahory, better known as Jeremy Gohory, was dancing-master to the English royal family from 1660 possibly until his death in 1703. His will, only recently rediscovered, reveals not only his considerable wealth but also several hitherto unsuspected relationships with leading English and French dancingmasters. This article summarizes the terms and bequests in Gahory’s will. It also investigates the identity of Francis Thorpe, Gahory’s nephew, who was granted the reversion of his post as royal dancing-master in 1681 and appointed executor of his English estate on Gahory’s death. It presents evidence that Francis Thorpe was in fact Mr Isaac, dancing-master to Princess (later Queen) Anne and a leader of the profession by the early 18th century. The article raises the possibility of a quasi-hereditary aspect to the post of royal dancing-master, since Gahory’s will reveals that Anthony L’Abbé, who was appointed to the post after the accession of George I, was also Francis Thorpe Isaac’s brother-in-law. [ABSTRACT FROM AUTHOR]

A melting point measurement facility for the UK has been developed and accredited to ISO/IEC 17025 Calibration status for the determination of the liquefaction temperature of pure substances from 35 to 250°C. The facility is based upon a commercial instrument, i.e. an oil bath fitted with an aluminium block (Isotech, model 798 EHT), a precision multimeter (Isotech TTI-7), a thermocouple directly inserted in the sample under investigation and a platinum resistance thermometer (PRT) tracking the block temperature. The homogeneity of temperature bath/block was investigated and the PRT used for the traceability of the measurements was calibrated by NPL and traceable to ITS-90. The process was validated using four current LGC Certified Reference Materials (CRMs): [ABSTRACT FROM AUTHOR]

The publication of More Genes Direct by the Human Genetics Commission is a timely reminder of the potential impact that 'over-the-counter' genetic testing (that is, a direct genetic test without the need for a medical referral) may have on the NHS. This article considers the relevance of current genetic research on complex common diseases and how this might translate into risk estimates for developing conditions such as dementia, cancer, and cardiovascular disease. The implications for primary care include the need to understand the current limitations of genetic testing and its commercial application over the counter, and the importance of continuing to make risk assessments using family history. The authors recommend caution in the premature introduction of over-the-counter testing without a sound evidence base. [ABSTRACT FROM AUTHOR]

Abstract-Partial discharges (PDs) generate wideband radio-frequency interference which can be used for noninvasive monitoring of discharges. This paper presents a novel method based on this principle for PD monitoring of substations. The significant advantage of this method lies in the ability to detect PD sources in energized equipment anywhere within a substation compound during normal operating conditions. The results obtained from the prototypes installed in the U.K. and U.S. substations are reported. Results include correlation with apparent charge and daily recordings obtained before, during, and after the failure of a 132-kV current transformer and 69-ky voltage transformer. [ABSTRACT FROM AUTHOR]

An ephemeral estuarine turbidity maximum (ETM) occurs at high water in the macrotidal Taf estuary (SW Wales, United Kingdom). A new mechanism of ETM formation, due to resuspeusion and advection of material by flood tidal currents, is observed that differs from classical mechanisms of gravitational circulation and tidal pumping. The flood tide advances across intertidal sand flats in the main body of the estuary, progressively entraining material from the rippled sands. Resuspeusion creates a turbid front that has suspended sediment concentrations (SSC) of about 4,000 mg l-1 by the time it reaches its landward limit which is also the landward limit of salt penetration. This turbid body constitutes the ETM. Deposition occurs at high slack water but the ETM retains SSC values up to 800 mg l-1, 1–2 orders of magnitude greater than ambient SSC values in the river and estuarine waters on either side. The ETM retreats down the estuary during the ebb; some material is deposited thinly across emergent intertidal flats and some is flushed out of the estuary. A new ETM is generated by the next flood tide. Both location and SSC of the ETM scale on Q/R³ where Q is tidal range and R is river discharge. The greatest expression of the ETM occurs when a spring tide coincides with low river discharge. It does not form during high river discharge conditions and is poorly developed on neap tides. Particles in the ETM have effective densities (120–160 kg m-3) that are 3–4 times less than those in the main part of the estuary at high water. High chlorophyll concentrations in the ETM suggest that floes probably originate from biological production in the estuary, including production on the intertidal sand flats. [ABSTRACT FROM AUTHOR]

Focuses on stage dancing in the 1700s which was a part of the entertainments offered on the stages of the London theaters, while highlighting the impact of the Licensing Act of 1737. Effect of the Licensing Act of 1737 on London's theatrical life; Achievements which dance had accomplish; Reference to entertainments of dancing created by John Weaver; Concern of the development of stage dancing, in style, technique and subject matter to dancing-masters.

Explores the contexts, origins, nature and evaluation of a modular in `Quality in FE' staff development program developed in England by local education authorities (LEA) evaluation teams and a university. Modules included in the program; Phases of the program session; Accreditation and progression features of the program.

The article provides an account of the life and works of English dancing master Edmund Pemberton in Great Britain. Pemberton was known for his mastery of the Beauchamp-Feuillet notation. The first work he published in association with John Walsh and Joseph Hare was entitled "An Essay for the Further Improvement of Dancing," a collection of figured minuets and dances by dancing masters in England and France.

An abstract of the article "Estimating energy requirements in obese and non-obese patients: a survey of dietetic practice in the United Kingdom," by D. Judges, E. Graham, A. Knight, and L. Goff is presented.