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This article is personal and rather anecdotal as it is an attempt to sum up my experience of 30 years of Ofsted inspections. The key questions remain what they always were. How do you deal with the sometimes conflicting requirements of support and accountability, objectivity and impartiality, styles of inspection, reporting and grading? Perhaps most importantly, how do you try to ensure that inspection leads to improvement?

Negative campaigning has long concerned scholars because of the potential effects on the electorate and on democracy. Most scholarship has focused on single-election studies in the United States, whereas less is known about how campaigns go on the attack in the UK, and few compare two elections. Drawing from a dataset of Facebook posts by parties and leaders in Great Britain during the five weeks of campaigning in the 2017 and 2019 General Elections (N = 3560), we use supervised machine learning to categorise posts as negative campaigning and distinguish between attacks focused on issues and attacks on candidates' images. Our findings show that the 2019 election was more negative than in 2017, and that larger parties were more inclined to adopt attacks as a campaign strategy. Moreover, we found that party accounts posted more attack messages than leader accounts and were more focused on attacking based on issues, rather than personal character or image. Finally, we found that attack messages elicit stronger engagement from audiences, with attack messages receiving more attention, particularly attacks on image. [ABSTRACT FROM AUTHOR]

Active, student-centered pedagogies such as project-based learning (PjBL) can offer significant potential for engaging undergraduates with complex sustainability issues. Driven by institution-wide curriculum changes and informed by educational theories and evidence from previous studies, a trial PjBL activity was designed and delivered on three separate occasions, to three different student groups, at a university in the United Kingdom. In these trials, students from geography, Earth, and environmental science (GEES) programs worked in small (5 to 6 people), multiple-discipline teams to explore a single research question focused on a global sustainability issue. The perceptions and experiences of the trial participants (students and faculty) were investigated using data from surveys and interviews, and the findings applied to designing a new, multiple-disciplinary module focused on energy and climate change. In general, all participants engaged positively with the PjBL approach, although issues around the nature and extent of support available to the students and appropriate methods of assessing PjBL outputs emerged as requiring further consideration. The findings demonstrate that a single research question need not constrain the approach students take when completing a PjBL activity and identify clear potential benefits in terms of developing students' wider professional skills. This study also highlights the value to curriculum developers in trialing new pedagogic approaches, as the opportunity to "have a go" enabled potential issues for learners and instructors to be identified and mitigated prior to the final module design and implementation.

Risks of contralateral kidney abnormalities and chronic kidney disease necessitate follow-up for unilateral multicystic dysplastic kidneys (MCDK). A nationwide survey of senior UK pediatricians was conducted. Of the 60 responses obtained, 62% routinely perform a dimercaptosuccinic acid scan to confirm diagnosis. Eight percent routinely perform a cystogram to investigate contralateral vesicoureteric reflux. Sixty-two percent would routinely measure renal function (frequency ranging from once only to "every 2 years"). Twenty-five percent recalled MCDK nephrectomy being performed within the previous 5 years. Respondents voiced concerns that national guidance may result in an overcautious approach but could balance consensus and safe variation, and offer families choice and reassurance. The mean estimated cost of follow-up from birth to 18 years ranged from £258 to £3854. Results demonstrate significant variation in management, highlighting the need for a clear pathway to decrease unwanted variability and to ensure those at high risk of renal sequelae are recognized early, without undue investigatory burden. [ABSTRACT FROM AUTHOR]

Background: The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention. Methods: This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical). Results: A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0–100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5–100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays. Conclusions: Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care. The Mastitis and Mammary Abscess Management Audit (MAMMA) is the first international audit, conducted in 69 hospitals across the UK and Ireland, involving contemporaneous data capture on the presentation and management of 1312 patients with mastitis and breast abscess. Key results included a substantial inpatient admission rate (22.5 per cent), a high overall rate of surgical incision and drainage (21.0 per cent), and a comparatively low use of ultrasound-guided aspiration (61.0 per cent). The data also identified significantly increased odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment, if patients presented at the weekend compared with on a weekday. Lay Summary: Mastitis and breast abscess is a painful infection of the breast. It is an extremely common breast problem. One in three women can get this condition at some stage in their life. To treat a breast abscess, the pus inside should be drained out of the body. This can be done either by cutting into the breast using surgery or by inserting a fine needle using an ultrasonography scan (which uses ultrasound). Fine-needle drainage has the benefit that it does not require admission to hospital. Surgery can cause the breast to look misshapen. It is unknown which method is used more often in the UK and Ireland. The aim of this study was to describe how mastitis and breast abscesses are treated in the UK and Ireland. This study involved a survey of practice (phase 1) and collection of data, which are routinely recorded for these patients (phase 2). This study involved 69 hospitals and 1312 patient records. One in five women had an operation for a breast abscess. This was higher than expected. Six in 10 women had a pus drainage using a fine needle. The chance of having an operation depended on the hospital. Women that came to hospital at the weekend were almost twice as likely to have an operation. One in five women were admitted to hospital. The chances of that more than doubled if a woman came to hospital at the weekend. There are differences in treatment of mastitis and breast abscesses across the UK and Ireland. Changes need to be put in place to make access to treatment more equal. [ABSTRACT FROM AUTHOR]

Project-based learning (PjBL) is argued to foster a more democratic approach to education, particularly through increasing students' autonomy over their learning. This article presents the findings of research into students' views relating to autonomy over topic choice and group constitution during a series of trial interdisciplinary PjBL activities with first-year geography, earth and environmental sciences (GEES) undergraduates in a UK university. Semi-structured interviews with participating students and tutors, in addition to audio-recordings of staff-student discussion during student-led presentation sessions, formed the data set analysed for this article. Findings suggest that while some degree of autonomy was welcomed, participants largely favoured prescription regarding research question and group membership. This has implications for the implementation of PjBL and its potential to foster democratization within the GEES disciplines.

Background: There is growing evidence of the anti-inflammatory effect of the anti-diabetic drug metformin and its use to reduce pain. However, we currently lack studies investigating whether metformin is associated with a reduction in chronic back pain prevalence when considering physical activity levels, body mass index (BMI), and age. Objective: To investigate whether use of metformin is associated with lower levels of reporting of chronic back pain in a large cohort with type 2 diabetes when stratified for physical activity, BMI, and age. Methods: This is a cross-sectional study of 21,889 participants with type 2 diabetes who were drawn from the UK Biobank database. We investigated whether people using metformin reported a higher prevalence of chronic low back pain than those who did not. Type 2 diabetes, chronic back pain, and metformin were self-reported. Participants were stratified according to their physical activity level (low, moderate and high), BMI (normal, overweight, and obese), and age (40 to <50; 50 to < 60; and ≥60 years). Logistic regression models were built for each physical activity level, BMI and age category to investigate the prevalence of chronic back pain amongst those using and not using metformin. Results: Participants who were using metformin and who had low levels of physical activity [OR 0.87, 95%CI 0.78 to 0.96] or who were obese [OR 0.90, 95%CI 0.86 to 0.98] or older [OR 0.85, 95%CI 0.78 to 0.93] had lower odds of reporting chronic back pain than their counterparts. Conclusion: The anti-diabetic drug metformin might reduce prevalence of chronic low back pain in people who are older, overweight, or less active. These findings should be confirmed in studies using a longitudinal design. [ABSTRACT FROM AUTHOR]

Aims: To describe the aetiologies of paediatric rhabdomyolysis and explore the medium‐term renal consequences. Methods: Retrospective, single‐centre review of children with rhabdomyolysis. Results: Two hundred and thirty‐two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%). Trauma was identified as a cause in 18% of children, seizures in 10% and immune‐mediated mechanisms in 8%. Acute kidney injury (AKI) was present in 32% of the cases overall. Children with AKI tended to be younger, with higher peak creatine kinase (CK) and active urinary sediment on urinalysis at presentation. AKI and the need for renal replacement therapy (RRT) were associated with a prolonged hospital stay (15 (interquartile range, IQR 6.5–33) vs. 2 (IQR 0–7) days). A total of 18 children and young people required RRT, with a mean duration of 7.1 ± 4.3 days. Those who received RRT were more likely to have abnormalities on urinalysis at presentation (46% vs. 5%). Over the period of the study, 9% of children died and 2% met criteria for a diagnosis of chronic kidney disease. Conclusions: This large paediatric rhabdomyolysis case series provides new and unique insights into the condition. Our results highlight the common aetiologies and provide evidence of good renal recovery overall, even in the most severely affected cases. Abnormalities of urinalysis appear to be important in predicting the development of AKI and the need for RRT. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic highlighted the need for mental health interventions that can be easily disseminated during a crisis. Behavioural activation (BA) is a cost-effective treatment that can be administered by non-specialists; however, it is unclear whether it is still effective during a time of lockdown and social distancing, when opportunities for positive activity are significantly constrained. Methods: Between May and October 2020, we randomised 68 UK participants with mild to moderate low mood to either a 4-week online programme of non-specialist administered BA or to a passive control group. Before and after the intervention, we collected self-report data on mood and COVID-related disruption, as well as measuring emotional cognition as an objective marker of risk for depression. Results: In comparison to the control group, the BA group showed a significant decrease in depression, anxiety and anhedonia after the intervention, as well as an increase in self-reported activation and social support. Benefits persisted at 1-month follow-up. BA also decreased negative affective bias on several measures of the Facial Emotion Recognition Task and early change in bias was associated with later therapeutic gain. Participants rated the intervention as highly acceptable. Conclusion: This study highlights the benefits of online BA that can be administered by non-specialists after brief training. These findings can help inform the policy response towards the rising incidence of mental health problems during a crisis situation such as a pandemic. They also highlight the use of objective cognitive markers of risk across different treatment modalities. [ABSTRACT FROM AUTHOR]

Background: The proportion of energy from free sugars and saturated fat currently exceeds the UK-recommended intake across all age groups. Recognising the limits of reformulation programmes, the government in England has announced their intention to introduce legislation to restrict the promotion of foods high in free sugars, salt, and saturated fats in prominent store locations. Here, we evaluated a grocery store intervention to remove seasonal confectionery from prominent locations within a major UK supermarket. Methods and findings: A nonrandomised controlled intervention study with interrupted time series (ITS) analysis was used. Data were analysed from 34 intervention stores located in 2 London boroughs and 151 matched control stores located elsewhere in the UK owned by the same retailer. Stores were matched based on store size and overall sales during the previous year. Between 15 February 2019 and 3 April 2019 (before Easter), stores removed free-standing promotional display units of seasonal confectionery from prominent areas, although these products were available for purchase elsewhere in the store. Store-level weekly sales (units, weight (g), and value (£)) of seasonal chocolate confectionery products were used in primary analyses, with data from 1 January 2018 to 24 November 2019. Secondary outcomes included total energy, fat, saturated fat, and sugars from all in-store purchases. Multivariable hierarchical models were used to investigate pre/post differences in weekly sales of confectionery in intervention versus control stores. ITS analyses were used to evaluate differences in level and trends after intervention implementation. Over a preintervention baseline period (15 February 2018 to 3 April 2018), there were no significant differences in sales (units, weight, and value) of all chocolate confectionery between intervention versus control stores. After intervention implementation, there was an attenuation in the seasonal increase of confectionery sales (units) in intervention stores compared to control (+5% versus +18%; P < 0.001), with similar effects on weight (g) (+12% versus +31%; P < 0.001) and value (£) (−3% versus +10%; P < 0.001). ITS analyses generally showed statistically significant differences in the level at the point of intervention (P ranges 0.010 to 0.067) but also in the trend afterwards (P ranges 0.024 to 0.053), indicating that the initial difference between intervention and control stores reduced over time. There was a significant difference in level change in total energy sold, adjusted for the total weight of food and drink (kcal/g, P = 0.002), and total fat (fat/g) (P = 0.023), but no significant changes in saturated fat or sugars from total sales in ITS models. There was no evidence that the main results varied across store deprivation index. The limitations of this study include the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity. Conclusions: Removal of chocolate confectionery from prominent locations was associated with reduced purchases of these products, of sufficient magnitude to observe a reduction in the energy content of total food purchases. These results from a "real-world" intervention provide promising evidence that the proposed legislation in England to restrict promotions of less healthy items in prominent locations may help reduce overconsumption. Trial registration: https://osf.io/br96f/. Carmen Piernas and team evaluate purchasing behaviour associated with a grocery store intervention to remove seasonal confectionery from prominent locations within a major UK supermarket. Author summary: Why was the study done?: The prevalence of obesity in the UK is continuing to increase especially in the most deprived areas. The proportion of energy from free sugars and saturated fat currently exceeds the UK-recommended intake across all age groups. Despite ambitious sugar reduction targets set by Public Health England, there has been little change in the confectionery category. Recognising the limits of reformulation programmes, the Government in England has announced their intention to introduce legislation to restrict the promotion of foods high in free sugars, salt, and saturated fats in prominent locations in grocery stores. What did the researchers find?: We partnered with a large UK food retailer to evaluate an intervention to remove seasonal chocolate confectionery from prominent areas of the store, specifically end-of-aisles and entrance areas, over 7 weeks before the Easter period. The intervention showed a significant attenuation of the seasonal increase in confectionery sales in intervention stores compared to control stores, with an absolute difference of approximately 127 units (approximately 21 kg) of confectionery per store per week. During the intervention period, there were significant reductions in total energy and fat from all food-related purchases in the stores implementing the intervention, but no significant changes in saturated fat or total sugars. There was no evidence that the main results varied according to the store deprivation index. What do these findings mean?: The Government in England has recently signalled its intention to bring forward legislation to restrict promotions of less healthy items in prominent locations in grocery stores, to help reduce overconsumption. This study provides new evidence that the government proposals to restrict foods high in fat, sugar, and salt from prominent locations in stores could lead to measurable reductions in total energy (calories) from purchases. [ABSTRACT FROM AUTHOR]

Background: Governments are increasingly looking for policies to change supermarket environments to support healthier food purchasing. We evaluated 6 interventions within major United Kingdom grocery stores, including availability, positioning, promotions, and signage strategies to encourage selection of healthier products. Methods and findings: Nonrandomised controlled study designs were used, except for one intervention that was rolled out nationwide using a pre/post within-store design. Store-level weekly sales (units, weight (g), and value (£)) of products targeted in the interventions were used in primary analyses using multivariable hierarchical models and interrupted time series (ITS) analyses. Stocking low fat chips next to regular chips was associated with decreases in sales of regular chips (units) in intervention versus control stores (−23% versus −4%; P = 0.001) with a significant level change in ITS models (P = 0.001). Increasing availability of lower energy packs of biscuits was associated with increased sales but reduced sales of regular biscuits in intervention versus control stores (lower energy biscuits +18% versus −2%; P = 0.245; regular biscuits −4% versus +7%; P = 0.386), although not significantly, though there was a significant level change in ITS models (P = 0.004 for regular biscuits). There was no evidence that a positioning intervention, placing higher fibre breakfast cereals at eye level was associated with increased sales of healthier cereal or reduced sales of regular cereal. A price promotion on seasonal fruits and vegetables showed no evidence of any greater increases in sales of items on promotion in intervention versus control stores (+10% versus +8%; P = 0.101) but a significant level change in ITS models (P < 0.001). A nationwide promotion using Disney characters was associated with increased sales of nonsugar baked beans (+54%) and selected fruits (+305%), with a significant level change in ITS models (P < 0.001 for both). Shelf labels to highlight lower sugar beverages showed no evidence of changes in purchasing of lower or higher sugar drinks. These were all retailer-led interventions that present limitations regarding the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity. Conclusions: Increasing availability and promotions of healthier alternatives in grocery stores may be promising interventions to encourage purchasing of healthier products instead of less healthy ones. There was no evidence that altering positioning within an aisle or adding shelf edge labelling is associated with changes in purchasing behaviours. Trial registration: https://osf.io/br96f/. Carmen Piernas and team evaluate six interventions within major UK grocery stores, including a variety of strategies to encourage selection of healthier products and their associations with purchasing behaviour. Author summary: Why was this study done?: Dietary targets for saturated fat, dietary fibre, free sugars, and salt are not being met in the UK, and poor diets are an important risk factor for chronic diseases. Despite dietary recommendations and public heath campaigns, progress on dietary change has been slow, and socioeconomic inequalities persist. Evidence from systematic reviews of in-store interventions have suggested that interventions based on price, promotions, placement, or availability may be effective, but most reviews have highlighted the lack of high-quality evidence in real supermarkets, especially for interventions to reduce purchases of less healthy options. As part of a multiretailer partnership, we conducted an independent evaluation of 6 in-store interventions within 3 major UK food retailers aimed at improving food purchasing behaviours. What did the researchers do and find?: Increasing the availability of healthier options within a category (e.g., lower fat frozen chips or lower energy biscuit packs) was associated with significant increases in purchases of the healthier items. Promotions led to a significant initial uplift in sales of target products, but these changes declined over time. However, there was no evidence of changes in purchasing behaviours from altering the positioning of healthier cereals within an aisle or shelf edge labelling of lower/nonsugar beverages. There was no evidence that the observed results varied according to the level of deprivation in the area where the store was sited. What do these findings mean?: Some choice architecture interventions implemented within stores, including availability and promotions, were associated with short-term changes in food purchasing behaviours in the intended direction. The effects of promotions on consumer behaviour may diminish with time and are less likely to be sustainable for retailers over longer time periods. Strategies aiming at informing customers about healthier options are unlikely to work in isolation. [ABSTRACT FROM AUTHOR]

This study examines trainees' experiences of paediatric education and training during the COVID-19 pandemic. Paediatric trainees across the UK undertook an online survey. 368 of approximately 4000 trainees responded; quantitative and qualitative data were collected. Although the majority of trainees remained in their specialties, there was significant disruption to training events, teaching and learning opportunities. Despite this, for many, novel opportunities presented themselves that may not have otherwise been accessible. Trainees reported increased virtual learning, reflection, leadership and management opportunities. A breadth of trainee-identified web-based paediatric training resources were also highlighted. As the COVID-19 pandemic persists, these trainee experiences inform educators to adopt helpful training practices from other regions, including sharing of virtual learning regionally and acting-up opportunities. Trainees highlighted previously under-recognised areas of concern that can inform quality improvement initiatives, such as enhancing patient safety through tackling trainee fatigue, combating reduced clinical experience or instituting protected supporting professional activity time. [ABSTRACT FROM AUTHOR]

All UK H&I laboratories and transplant units operate under a single national kidney offering policy, but there have been variations in approach regarding when to undertake the pre‐transplant crossmatch test. In order to minimize cold ischaemia times for deceased donor kidney transplantation we sought to find ways to be able to report a crossmatch result as early as possible in the donation process. A panel of experts in transplant surgery, nephrology, specialist nursing in organ donation and H&I (all relevant UK laboratories represented) assessed evidence and opinion concerning five factors that relate to the effectiveness of the crossmatch process, as follows: when the result should be ready for reporting; what level of donor HLA typing is needed; crossmatch sample type and availability; fairness and equity; risks and patient safety. Guidelines aimed at improving practice based on these issues are presented, and we expect that following these will allow H&I laboratories to contribute to reducing CIT in deceased donor kidney transplantation. [ABSTRACT FROM AUTHOR]

Online abuse directed at female politicians has the potential to present barriers to the political representation of women in the digital age. Previous research has produced mixed results, with some finding little difference between the extent of abuse received by male and female MPs, while others found that women and minority groups are subjected to specific kinds of abuse. While straightforward examples of abuse and discrimination are easy to identify, categorise and quantify, tweets which include more subtle microaggressions that position women and minority MPs as unqualified and unwelcome in politics deserve attention. This research therefore employs a qualitative thematic analysis of 11,543 tweets sent to UK members of Parliament. The analysis identified four themes: 1. 'overt online abuse', 2. 'everyday sexism and othering', 3. 'dismissing discrimination and victim blaming', and 4. 'claiming reverse discrimination'. We argue that these digital microaggressions serve as constant reminders of the marginalised status of female representatives, and women of colour specifically, and should be conceptualised as forms of psychological and semiotic violence that reconstitute online political spaces as a hostile environment for women and may discourage women from seeking political office or compel women representatives to leave. Digital microaggressions may therefore be as damaging to women's democratic representation as outright abuse. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of common mental disorders in adolescents and young adults, and their association with poor health and socio-economic outcomes throughout the lifespan, many young people do not seek or receive help for such disorders. There is growing interest in the community sector in supporting mental health in young people; however, there is little by way of experimental research in this area. During the COVID-19 pandemic and lockdown, we designed an online cultural experience to reduce anxiety and depression and support mental health in people aged 16-24.Methods/design: The O-ACE POP (Online Active Community Engagement Proof of Principle) study is a UK-based online randomised controlled trial of an online cultural experience named Ways of Being, involving human centred narratives and viewpoints, compared with a typical museum website (the Ashmolean Museum). We aim to compare efficacy on  affect,  symptoms of epression and anxiety, flourishing and loneliness as well as investigating potential mechanisms of action.Discussion: The COVID-19 pandemic has provided a unique opportunity to design an innovative approach to supporting mental health in young adults. Findings derived from this study will allow us to evaluate the efficacy of this intervention and will inform the design of studies to further refine the resource and test it further.Trial Registration: ClinicalTrials.gov NCT04663594. Registered on 11 December 2020 (submitted in same form 27 November 2020). Protocol v1.0: 27 November 2020. Date recruitment began: 4 December 2020. Recruitment complete (estimate): February 2021. [ABSTRACT FROM AUTHOR]

Recently, widely reported studies assessed messages sent to UK female MPs online and concluded that they suffer high levels of abuse. However, these studies tended to focus on the most high-profile MPs and the worst instances of abuse or did not include male MPs in their study for comparison. This study aims to assess more subtle forms of incivility and othering and the experiences of less prominent MPs online. It takes a mixed-methods approach to analyzing 117,802 tweets sent to MPs over a 14-day period for evidence of incivility. Firstly, models assessing the factors associated with receiving incivility on Twitter are presented, and furthermore, an in-depth thematic analysis of gendered tweets is conducted. The findings suggest that for the receipt of certain types of incivility, there is little difference between female and male MPs. However, female MPs were more likely to receive generally uncivil tweets, tweets with stereotypes about their identity, and tweets questioning their position as politicians than male MPs. Qualitatively, in terms of gendered othering, we found several instances of tweets containing misogynistic abuse, tweets demonizing, and objectifying female MPs, as well as tweets feminizing male MPs. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between people's feelings about dirt, and an apparent reduction in the lifetime of vacuum cleaners. The short life-spans of vacuum cleaners is a significant environmental issue. In addition to the waste generated, they have an impact on climate change: vacuum cleaners account for the second largest embodied greenhouse gas emissions of electrical goods in the UK after televisions, largely because of their high sales volumes. Drawing from qualitative and quantitative research undertaken for the UK Department for Environment, Food & Rural Affairs (Defra), the paper demonstrates that one motivation for vacuum cleaner replacement is the increased enjoyment from dirt removal that a new vacuum cleaner may provide. The paper also shows that premature disposal can occur once a product becomes dirty and visually damaged, and whilst functional, is perceived to be less effective. Solutions to premature disposal were explored through the co-creation of design concepts and design features were tested via an online survey. Vacuum cleaner users were clustered into four cleaner types; Spartan, Minimal, Caring and Manic. Overall, respondents reported that improving the ease of maintaining vacuum cleaners would be the most effective way to help them to increase their vacuum cleaner's longevity. Across all cleaner types maintenance levels were low, although Caring and Manic cleaners were significantly more likely to undertake such tasks. Motivations for disposal were similar across cleaner types and we found no evidence that Caring and Manic cleaners disposed of their machines earlier because they were 'worn out.' We discovered that Caring and Manic cleaners spend the most on their vacuum cleaners, vacuum more often and are the most likely to replace their machine after the shortest period. Those willing to do 'a lot more' to help the environment were significantly more likely to want to 'keep the floors in my home spotlessly clean' and significantly more likely to indicate that they preferred their vacuum cleaner to look new. Consequently, the paper proposes that design interventions to increase vacuum longevity should be targeted toward Caring and Manic cleaners and concludes with key design recommendations for these two cleaner types. [ABSTRACT FROM AUTHOR]

The article assesses the importance placed on women during the 2017 general election in Great Britain. Topics discussed include the attempt of political parties to appeal to women voters, Theresa May's accession to the Tory leadership after the Brexit referendum, and the representation of women in parliament.

Leaders’ debates have become a feature of contemporary election campaigning. While an historical feature of the US landscape, in the United Kingdom, they are a more recent phenomenon. The second UK 2015 general election leadership debate comprised seven candidates, of which three were women. Using qualitative thematic analysis and adopting the notion that gender is ‘performed’, we explore three features of coverage of the debate. First, the ways in which the debate itself was constructed as a masculine activity through a series of highly gendered metaphors; second, how newspaper frames reinforced gendered notions of masculinity and femininity in respect of political leadership; and third, how the success of women in the debates was constructed as the emasculation of their male rivals. Crucially, we focus not just on the ‘feminisation’ of women in the political arena, but also on the ways in which masculinity is posited as the criterion for the evaluation of politicians of all genders. [ABSTRACT FROM AUTHOR]

The wives of politicians are a longstanding feature of electoral campaign coverage in the UK, and yet until now there has been no systematic study examining their role and mediated representation in political reporting. By drawing upon a sample of 630 newspaper items from five daily newspapers, this article will demonstrate that between 1918 and 2010 the representation of political wives has changed in three main ways. Firstly, their role in the campaign process changed from focusing more on their political function as active campaigners, to becoming more focused on their private lives. Secondly, the coverage has narrowed from focusing on a broad range of politicians’ wives, to being centred almost entirely on the spouses of political party leaders. The final change is that the press reportage of politicians’ spouses has become increasingly negative and critical of their presence on the campaign trail. [ABSTRACT FROM PUBLISHER]

This article examines representations of identity in two British Overseas Territories: St Helena in the South Atlantic and the British Virgin Islands in the Caribbean. While local forms of representative government exist here, political authority over several significant areas of political life is retained by the British state. As such, the connections between sovereignty, politics and identity are less clearly demarked than in many states. Based on interviews carried out on the islands in 2011, the article explores the way in which national and local identities in the territories are understood in relation to their link with the United Kingdom. The research identifies the importance of geography and economics as key elements in the construction of identity discourses in these territories. This emphasis points to the importance material factors have in shaping the way communities are imagined, particularly where sovereignty is held externally. [ABSTRACT FROM AUTHOR]

Objectives: This study reviews the current state of global health education (GHE) in the United Kingdom (UK) through the collation and synthesis of data on undergraduate and postgraduate global health degree programmes. It examines both the curriculum provided and profile of the student currently studying global health in the UK. Study design: Descriptive, case study design. Methods: A systematic review of the literature identified a set of global health 'core competencies' that students could acquire through their chosen programme of study. Those competencies were synthesized and then compared to core and elective courses currently offered by global health degree programmes at UK universities. A questionnaire was designed and sent electronically to all global health Programme Directors requesting generic information regarding the profile of their global health students. Results: Fifteen universities in the UK, based in England and Scotland, offered twenty-five postgraduate and six undergraduate global health degree programmes in 2012-13. Two Universities were developing a full, three-year, undergraduate degree programme in global health. Sixteen core competencies for a medical and non-medical student constituency were identified. Of these, just three 'core competencies' -- epidemiology of tropical diseases, health systems (including health system management), and health care services - corresponded directly to core and elective courses offered by >50% of UK universities. The five most frequently offered subjects were: health systems (including health system management), research methods, public health (including specialisations in prevention, treatment and care), epidemiology, and health economics. Conclusions: GHE in UK universities has seen comparable growth to North American institutions, becoming Europe's regional hub for undergraduate and postgraduate courses and programmes. As with the US and Canadian experience, GHE at the undergraduate level is offered primarily to medical students through intercalated degree programmes. At the postgraduate level, there is more innovation in content and mode of delivery, with a small number of UK universities providing students from a diversity of backgrounds the opportunity to study global health from multidisciplinary perspectives. Distance learning is also seeking to make the delivery of GHE truly global, with a growing number of universities recognizing its potential to further innovate in global health pedagogy. While demand for GHE is predicted to remain robust, to ensure the needs of students and practitioners are met, more critical reflection on global health curricula, the desired profile of graduates, and equity of access is required. [ABSTRACT FROM AUTHOR]

Background: Neural responses to rewarding food cues are significantly different in the fed vs. fasted (> 8 h food-deprived) state. However, the effect of eating to satiety after a shorter (more natural) intermeal interval on neural responses to both rewarding and aversive cues has not been examined. Objective: With the use of a novel functional magnetic resonance imaging (fMRI) task, we investigated the effect of satiation on neural responses to both rewarding and aversive food tastes and pictures. Design: Sixteen healthy participants (8 men, 8 women) were scanned on 2 separate test days, before and after eating a meal to satiation or after not eating for 4 h (satiated vs. premeal). fMRI blood oxygen level-dependent (BOLD) signals to the sight and/or taste of the stimuli were recorded. Results: A whole-brain cluster-corrected analysis (P < 0.05) showed that satiation attenuated the BOLD response to both stimulus types in the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex, nucleus accumbens, hypothalamus, and insula but increased BOLD activity in the dorsolateral prefrontal cortex (dlPFC; local maxima corrected to P ≤ 0.001). A psychophysiological interaction analysis showed that the vmPFC was more highly connected to the dlPFC when individuals were exposed to food stimuli when satiated than when not satiated. Conclusions: These results suggest that natural satiation attenuates activity in reward-related brain regions and increases activity in the dlPFC, which may reflect a “top down” cognitive influence on satiation. This trial was registered at clinicaltrials.gov as NCT02298049. Am J Clin Nutr 2015;101:697-704. [ABSTRACT FROM AUTHOR]

Background:The British Society of Audiology has produced clear guidelines as to how otoscopy should be undertaken; however, no nationally recognised guidelines exist for the wider clinical community. Images of otoscopy appear in many books, journals, magazines and websites.Objective:This study aimed to determine the rate of non-compliance with good practice in images of otoscopy, the seriousness of the breach, and whether this is more common in sites for professionals or the general public.Method:Google Images was searched using the terms ‘otoscopy’ and ‘ear examination’. A total of 200 images were identified and collated. The images were reviewed for compliance with good practice standards.Results:Only 12.75 per cent of the images were graded as having no breach of good practice standards.Conclusion:Professional websites have a responsibility to show best practice. When choosing an image, the source of the image needs to be carefully considered. [ABSTRACT FROM PUBLISHER]

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy. [ABSTRACT FROM AUTHOR]

Certain groups of female voters have long been recognized as potentially vital in deciding the outcome of elections. This paper explores and compares efforts made by the British Conservatives to focus on addressing the concerns of mothers with children. The party made a significant attempt to cultivate this kind of woman during the 2010 campaign through the use of a layperson, Julie, whose personal testimony and image was central to this effort. Here comparisons are drawn with the intriguingly similar figure of Sylvia used by the Conservatives 40 years before. Discussion also focuses on another important gendered aspect of the election relating to the growth of new social media platforms and especially how they are represented through the still-important medium of agenda-setting newspapers to promote certain perspectives that can be highly partisan in their selectivity if not their intent. [ABSTRACT FROM PUBLISHER]

Phthalates are ubiquitous in the environment and thus exposure to these compounds can occur in various forms. Foods are one source of such exposure. There are only a limited number of studies that describe the levels of phthalates (diesters, monoesters and phthalic acid) in foods and assess the exposure from this source. In this study the levels of selected phthalate diesters, phthalate monoesters and phthalic acid in total diet study (TDS) samples are determined and the resulting exposure estimated. The methodology for the determination of phthalic acid and nine phthalate monoesters (mono-isopropyl phthalate, mono-n-butyl phthalate, mono-isobutyl phthalate, mono-benzyl phthalate, mono-cyclohexyl phthalate, mono-n-pentyl phthalate, mono-(2-ethylhexyl) phthalate, mono-n-octyl phthalate and mono-isononyl phthalate) in foods is described. In this method phthalate monoesters and phthalic acid are extracted from the foodstuffs with a mixture of acidified acetonitrile and dichloromethane. The method uses isotope-labelled phthalic acid and phthalate monoester internal standards and is appropriate for quantitative determination in the concentration range of 5–100 µg kg–1. The method was validated in-house and its broad applicability demonstrated by the analysis of high-fat, high-carbohydrate and high-protein foodstuffs as well as combinations of all three major food constituents. The methodology used for 15 major phthalate diesters has been reported elsewhere. Phthalic acid was the most prevalent phthalate, being detected in 17 food groups. The highest concentration measured was di-(2-ethylhexyl) phthalate in fish (789 µg kg–1). Low levels of mono-n-butyl phthalate and mono-(2-ethylhexyl) phthalate were detected in several of the TDS animal-based food groups and the highest concentrations measured corresponded with the most abundant diesters (di-n-butyl phthalate and di-(2-ethylhexyl) phthalate). The UK Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) considered the levels found and concluded that they did not indicate a risk to human health from dietary exposure alone. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cancer for women in the United Kingdom and topic on which there is much information. This article discusses the principles behind breast awareness and breast health, detailing common benign breast diseases that cause disproportionate anxiety. The NHS Breast Screening Programme is celebrating 20 years of screening this year, and in all randomized controlled trials of women aged 50 and over, mortality from breast cancer is reduced in those offered screening compared with unscreened controls (although the reduction is not statistically significant in all trials). Once a breast cancer is diagnosed, the different characteristics and stage of the disease can be identified through histopathology and scans. These factors will be discussed later in this article, including illustrating if a cancer is hormone sensitive or HER-2 positive, for example. These factors enable clinicians to recommend a treatment pathway suitable for each individual. [ABSTRACT FROM AUTHOR]

The article discusses the importance of encouraging women to becoming breast aware as a way to help them take a more active role in their health. It explains the notion about breast awareness. It presents statistical data on women with breast abnormalities that will be referred to hospital annually in Great Britain. Patients with benign breast disease also need continuing support, and any new lumps or further changes to the breast must be referred to a breast care unit for diagnosis.

The development of the ground ?ora, and survival and height growth of tree seedlings, were observed annually over the 5-year period following a mast year in an oak woodland in southern England. After removal of the coppice understorey and thinning of the tree-canopy to leave 60–70 per cent cover there was a rapid development of the ground ?ora which was dominated throughout by Rubus fruticosus (bramble), although the frequency and amount of Pteridium aquilinum (bracken) increased with time. More than 10 woody species regenerated but only three, Quercus robur (oak), Fraxinus excelsior (ash) and Betula pendula (birch), were found in substantial amounts. Many birch and Corylus avellana (hazel) seedlings grew suf?ciently well to emerge above the bramble and bracken; in contrast, after 2 years few oak and ash were taller than the bramble and none were taller than the bracken. The number of oak and ash seedlings was positively related to the number and proximity of parent trees. There were no consistent relationships between decreases in the sizes of the seedling populations and the type, amount and height of vegetation. The size of seedling populations generally declined with time with annual reductions varying from 0 to 90 per cent depending on species and year; for most of the study, oak and ash populations fell by 40–50 per cent each year. There were some signi?cant relationships between seedling height and site characteristics but these were inconsistent, varying between tree species and year. Results are discussed in relation to the natural regeneration of oak. [ABSTRACT FROM AUTHOR]

Summary: 1. During the last decade the use of natural regeneration has become an accepted method of restocking British woodlands after harvesting. However, in many broad-leaved woodlands there are insufficient numbers of established tree seedlings of adequate size to ensure that restocking is successful. This lack of seedlings may be related to a number of factors, including competition from the ground flora and browsing by deer. 2. The numbers of deer (Capreolus capreolus, Cervus elaphus and Dama dama) are rising throughout Britain and population densities frequently exceed those known to have a significant impact on broadleaved trees. This experiment, which took place at four sites over a 5-year period, studied the effects of competition from the ground flora and severe, simulated, browsing by deer during summer, on the growth and mortality of naturally occurring Acer pseudoplatanus, Fraxinus excelsior, Fagus sylvatica and Quercus robur seedlings. 3. The seedlings were initially 30-40 cm tall with stem diameters of 2 6-6 2 mm. Competition from the ground flora was removed by maintaining circular areas, 1 m in diameter, free of vegetation using a general herbicide. Browsing was simulated by clipping new shoots that were longer than 1 cm in June and August. 4. The control of the ground flora had little effect on the growth and survival of seedling trees. 5. In general, the number of tree seedlings producing sufficient growth to receive the simulated browsing treatment decreased with time, but for those seedlings that were clipped there were no consistent trends in either numbers or weights of shoots removed. Unclipped seedlings continued to grow. The height and stem diameter increments varied with species and site, but after 5 years unclipped plants were 50-200 taller with stem diameters 20-130 greater than at the start of the experiment. 6. The mortality of unclipped seedlings was low and 80 or more survived. Clipping significantly reduced the survival of... [ABSTRACT FROM AUTHOR]

Focuses on hormone replacement therapy and survival after surgery for ovarian cancer in Great Britain. Analysis of data using Cox regression; Comparison between landmark and time dependent covariate methods; Discussion on hormone replacement therapy as an effective tool in alleviating unpleasant vasomotor symptoms of menopause and osteoporosis.

Comments on various issues related to medicine in Great Britain. Deficiencies in the necropsy service; Reactions to whooping cough vaccines; Complications of neonatal circumcision; Correlation between maternal psychological stress and premature birth; Role of radiotherapy in the treatment of ovarian cancer.

The article presents the authors' analysis on how the politics of feminism intersects with the party and celebrity politics. The authors discusses issues and presents images that appeared in the "Grazia" magazine which represents the primary female candidates in major political parties in Great Britain. The authors argue that concerns on celebrity image, feminism, and party politics have to be carefully negotiated by journalists, female politicians, and readers alike.

The article announces that October is Breast Cancer Awareness month, and reviews information on the disease. It cites the increased incidences of breast cancer among high risk women in the country. It also discusses the diagnosis and treatment for the disease. A summary of the breast screening programme of the British National Health Service (NHS) is provided. It describes the signs and symptoms of breast cancer.

Tweets, or posts from the microblogging web site Twitter showing the responses of community practitioners (CP) in Great Britain on how they are carrying out crucial work while staying safe during the coronavirus disease-2019 (COVID-19) pandemic are presented.

Editorial. Discusses problems concerning anesthesia within the British medical school research community. Reasons for disinvestment in anesthesia by universities; Research funding opportunities within anesthesia; Most medical schools' view of academic anesthesia departments as key players in the curriculum.

The author reflects on the chemotherapy of sarcomata in Great Britain. He states that chemotherapy can produce worthwhile responses in cases of sarcoma. The cases where this tumor has developed overt metastases we know of none surviving more than three years. He suggests that one must present themselves every week at the joint clinic and hope to give better services to patients through experts treatment.