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The diabetes inpatient specialist nurse (DISN) workforce has grown in number and recognition since the first National Diabetes Inpatient Audit in 2010. DISNs provide vital support for people with diabetes during admission to hospital and for the healthcare providers responsible for their care. To address gaps in our understanding of the DISN workforce and their needs, and to help with the development of more specific training, support tools and ongoing workforce development, a national survey was conducted. A questionnaire was emailed to all 375 members of the DISN UK Group and to national diabetes speciality leads for dissemination, which generated 182 responses. Insights gained included how the DISN workforce is comprised, its workload and working practices, how it is trained and what support it needs from the DISN UK Group. The survey highlighted a need for greater equity in the DISN role and services, a formal DISN education, training and competency pathway, access to shared resources, the sharing of best practice initiatives and guidelines adapted for nurses. [ABSTRACT FROM AUTHOR]

Increased left atrial volume and decreased left atrial function have long been associated with atrial fibrillation. The availability of large-scale cardiac magnetic resonance imaging data paired with genetic data provides a unique opportunity to assess the genetic contributions to left atrial structure and function, and understand their relationship with risk for atrial fibrillation. Here, we use deep learning and surface reconstruction models to measure left atrial minimum volume, maximum volume, stroke volume, and emptying fraction in 40,558 UK Biobank participants. In a genome-wide association study of 35,049 participants without pre-existing cardiovascular disease, we identify 20 common genetic loci associated with left atrial structure and function. We find that polygenic contributions to increased left atrial volume are associated with atrial fibrillation and its downstream consequences, including stroke. Through Mendelian randomization, we find evidence supporting a causal role for left atrial enlargement and dysfunction on atrial fibrillation risk. In this study, a deep learning-based model of left atrial size in UK Biobank enabled genome-wide association studies in 35,049 healthy participants. Several lines of evidence, including the PITX2 locus, linked left atrial dysfunction to atrial fibrillation risk. [ABSTRACT FROM AUTHOR]

Credit card minimum payments are designed to ensure that individuals pay down their debt over time, and scheduling minimum automatic repayments helps people avoid forgetting to repay. Yet minimum payments have additional, unintended psychological default effects by drawing attention away from the card balance due. First, once individuals set the minimum automatic repayment as the default, they then neglect to make the occasional larger repayments they made previously. As a result, individuals incur considerably more credit card interest than late payment fees avoided. Using detailed transaction data, the authors show that approximately 8% of all of the interest ever paid is due to this effect. Second, manual credit card payments are lower when individuals are prompted with minimum payment information. In an experiment, the authors test two new interventions to mitigate this effect—a prompt for full repayment and a prompt asking those repaying little to pay more—yielding large counter effects. Thus, shrouding the minimum payment option for automatic and manual payments and directing attention to the full balance may remedy the unintended effects of default minimum payments. [ABSTRACT FROM AUTHOR]

This article features the University of Liverpool's arts and humanities library, which applies a new search tool to improve the user experience. In nearly every way imaginable, the Sydney Jones Library and the Harold Cohen Library--the university's two libraries that serve science, engineering, and medical students--support the lives of their users (as opposed to expecting the students to conform to the library). Considering their focus on the users' experience, it is no surprise that the Liverpool librarians were among the first--not just in the UK but the world--to investigate using a discovery tool to improve how their user community can get to the library's content. Discovery tools, which include ProQuest's Summon and EBSCO's Discovery Service (EDS), allow the user--through a single search box--to search a base index of metadata as well as many of the library's digital resources such as proprietary databases, the catalog, and institutional repositories. Mimicking the Google experience, results from both internal and external sources can be served up in a single relevancy-ranked batch.

For any given body mass index (BMI), individuals vary substantially in fat distribution, and this variation may have important implications for cardiometabolic risk. Here, we study disease associations with BMI-independent variation in visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) fat depots in 40,032 individuals of the UK Biobank with body MRI. We apply deep learning models based on two-dimensional body MRI projections to enable near-perfect estimation of fat depot volumes (R2 in heldout dataset = 0.978-0.991 for VAT, ASAT, and GFAT). Next, we derive BMI-adjusted metrics for each fat depot (e.g. VAT adjusted for BMI, VATadjBMI) to quantify local adiposity burden. VATadjBMI is associated with increased risk of type 2 diabetes and coronary artery disease, ASATadjBMI is largely neutral, and GFATadjBMI is associated with reduced risk. These results – describing three metabolically distinct fat depots at scale – clarify the cardiometabolic impact of BMI-independent differences in body fat distribution. Different location of adipose tissue may have different consequences to cardiometabolic risk. Here the authors report that deep learning enabled accurate prediction of specific adipose tissue volumes, and that after adjustment for BMI, visceral adiposity was associated with increased risk of cardiometabolic disease, while gluteofemoral adiposity was associated with reduced risk. [ABSTRACT FROM AUTHOR]

Prediction models are commonly used to estimate risk for cardiovascular diseases, to inform diagnosis and management. However, performance may vary substantially across relevant subgroups of the population. Here we investigated heterogeneity of accuracy and fairness metrics across a variety of subgroups for risk prediction of two common diseases: atrial fibrillation (AF) and atherosclerotic cardiovascular disease (ASCVD). We calculated the Cohorts for Heart and Aging in Genomic Epidemiology Atrial Fibrillation (CHARGE-AF) score for AF and the Pooled Cohort Equations (PCE) score for ASCVD in three large datasets: Explorys Life Sciences Dataset (Explorys, n = 21,809,334), Mass General Brigham (MGB, n = 520,868), and the UK Biobank (UKBB, n = 502,521). Our results demonstrate important performance heterogeneity across subpopulations defined by age, sex, and presence of preexisting disease, with fairly consistent patterns across both scores. For example, using CHARGE-AF, discrimination declined with increasing age, with a concordance index of 0.72 [95% CI 0.72–0.73] for the youngest (45–54 years) subgroup to 0.57 [0.56–0.58] for the oldest (85–90 years) subgroup in Explorys. Even though sex is not included in CHARGE-AF, the statistical parity difference (i.e., likelihood of being classified as high risk) was considerable between males and females within the 65–74 years subgroup with a value of − 0.33 [95% CI − 0.33 to − 0.33]. We also observed weak discrimination (i.e., < 0.7) and suboptimal calibration (i.e., calibration slope outside of 0.7–1.3) in large subsets of the population; for example, all individuals aged 75 years or older in Explorys (17.4%). Our findings highlight the need to characterize and quantify the behavior of clinical risk models within specific subpopulations so they can be used appropriately to facilitate more accurate, consistent, and equitable assessment of disease risk. [ABSTRACT FROM AUTHOR]

Inter-individual variation in fat distribution is increasingly recognized as clinically important but is not routinely assessed in clinical practice, in part because medical imaging has not been practical to deploy at scale for this task. Here, we report a deep learning model trained on an individual's body shape outline—or "silhouette" —that enables accurate estimation of specific fat depots of interest, including visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) adipose tissue volumes, and VAT/ASAT ratio. Two-dimensional coronal and sagittal silhouettes are constructed from whole-body magnetic resonance images in 40,032 participants of the UK Biobank and used as inputs for a convolutional neural network to predict each of these quantities. Mean age of the study participants is 65 years and 51% are female. A cross-validated deep learning model trained on silhouettes enables accurate estimation of VAT, ASAT, and GFAT volumes (R2: 0.88, 0.93, and 0.93, respectively), outperforming a comparator model combining anthropometric and bioimpedance measures (ΔR2 = 0.05–0.13). Next, we study VAT/ASAT ratio, a nearly body-mass index (BMI)—and waist circumference-independent marker of metabolically unhealthy fat distribution. While the comparator model poorly predicts VAT/ASAT ratio (R2: 0.17–0.26), a silhouette-based model enables significant improvement (R2: 0.50–0.55). Increased silhouette-predicted VAT/ASAT ratio is associated with increased risk of prevalent and incident type 2 diabetes and coronary artery disease independent of BMI and waist circumference. These results demonstrate that body silhouette images can estimate important measures of fat distribution, laying the scientific foundation for scalable population-based assessment. [ABSTRACT FROM AUTHOR]

For any given level of overall adiposity, individuals vary considerably in fat distribution. The inherited basis of fat distribution in the general population is not fully understood. Here, we study up to 38,965 UK Biobank participants with MRI-derived visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) adipose tissue volumes. Because these fat depot volumes are highly correlated with BMI, we additionally study six local adiposity traits: VAT adjusted for BMI and height (VATadj), ASATadj, GFATadj, VAT/ASAT, VAT/GFAT, and ASAT/GFAT. We identify 250 independent common variants (39 newly-identified) associated with at least one trait, with many associations more pronounced in female participants. Rare variant association studies extend prior evidence for PDE3B as an important modulator of fat distribution. Local adiposity traits (1) highlight depot-specific genetic architecture and (2) enable construction of depot-specific polygenic scores that have divergent associations with type 2 diabetes and coronary artery disease. These results – using MRI-derived, BMI-independent measures of local adiposity – confirm fat distribution as a highly heritable trait with important implications for cardiometabolic health outcomes. The inherited basis of body fat distribution is not fully understood. Here, the authors use genetic data and MRI-derived measures of local adiposity to highlight fat depot-specific genetic architecture with implications for cardiometabolic health. [ABSTRACT FROM AUTHOR]

We study nudges that turn out to have precise null effects in reducing long‐run credit card debt. We test nudges across two field experiments covering 183,441 UK cardholders. Our first experiment studies nudges added to monthly credit card statements. Our second experiment studies letters and email nudges (separate from monthly statements) sent to cardholders who signed up to automatically pay the minimum required payment. In a follow‐up survey to our second experiment, we find that 96% of respondents underestimate the time it would take to fully repay a debt if the cardholder made only the minimum required payment. The nudges reduce this confusion, but underestimation remains overwhelmingly common. [ABSTRACT FROM AUTHOR]

This article compares how individuals from two different Salafi‐jihadi groups disengage from high‐risk activism and political violence. Drawing on original interviews, we explore the "push" and "pull" factors that influence our respondents' decisions to leave. We identify numerous push‐and‐pull factors that are consistent with previous research, including disagreements with group leaders over strategy and practices and educational and employment opportunities. We also contribute to existing research by including "persistent activists" in our sample who did not disengage. Surprisingly, these respondents remained in their groups despite experiencing some of the same push‐and‐pull factors as those who left. Including this variation allows us to separate necessary but insufficient conditions of disengagement from factors that exert a more profound impact. We highlight the influence of one key factor—and its absence—in our discussion: alternative social networks with supportive outsiders for those who left and the lack of such meaningful relationships for those who remained. We conclude by discussing the implications of our research for countering violent extremism. [ABSTRACT FROM AUTHOR]

Background/aims: Healthcare professionals play an important role in vocational rehabilitation for people receiving welfare support. The research questions for this study were: how do qualified healthcare professionals operate in UK welfare-to-work settings? What factors influence healthcare professionals' practice within a UK welfare-to-work setting? Methods: A qualitative methodology was adopted. Four semi-structured interviews were conducted and additional documents (the awarded Work and Health Programme bids and job descriptions) about the healthcare professionals' roles were reviewed. Inductive thematic analysis was undertaken. Results: Five themes were generated from the interview data: supporting frontline staff to understand clients' health needs; moving clients with complex needs closer to work; getting it right for the client by individualising support; gaining consent and maintaining confidentiality; and seeking and organising clinical supervision. These themes were corroborated with the document data. Conclusions: Healthcare professionals have a key role within welfare-to-work provision. Further research is needed to determine if the proposed healthcare professional roles have come to fruition, to identify their prevalence, and to explore their effectiveness. [ABSTRACT FROM AUTHOR]

Includes five articles that discusses c-space as a visualization schema related to keyword distribution in information retrieval; academic librarians and alternative information providers, such as Google and eBay; electronic journal use in higher education in the United Kingdom; digital object identifiers; and international audiences for digital cultural content. (LRW)

Many older people in Britain spend Christmas day alone. The Christmas period may be especially difficult for older people who are socially isolated, living with dementia or who have physical impairments, and may feel particularly marginalised at this time of year. This paper draws on evaluative research findings from a community Christmas event held in December 2014 at the University of Salford for older people and their carers who would be on their own on Christmas day. A multi-method approach was employed, seven guests took part in semi-structured interviews to explore their experiences and perceptions of the event, seven staff and student volunteers participated in a group interview to explore and discuss their participation in the event. Data collection took place during April and May 2015. Interview transcripts were subjected to thematic analysis. Three overarching themes were identified from the interviews: 'reasons for participants attending the event', 'a different Christmas day: the impact on guests and volunteers', and 'learning, planning and moving forwards'. The findings illustrate that a range of people participated in the Christmas day event for a variety of reasons. The event itself had a positive impact, including the shared experience of social belonging, for all involved. There are tangible longer term benefits as a result of the event, such as ongoing contact between participants and the development of supportive networks in the local community. [ABSTRACT FROM AUTHOR]

Before joining the RCN as professional lead for mental health, I spent most of 2020 advancing career pathways for senior NHS nurses at band 7 and beyond. [ABSTRACT FROM AUTHOR]

The political prisoner is a figure taken for granted in historical discourse, with the term being used broadly to describe any individual held in captivity for oppositional activities. This article argues for understanding the political prisoner, for whom prison becomes a vehicle of politics, as the product of modem states and political movements. The earlier practices of the "imprisoned political," for whom prison was primarily an obstacle to politics, gave way to prisoners who used the category creatively against the regimes that imprisoned them. Using the cases of Polish socialists in the Russian Empire, Fenians in Ireland, suffragettes in Britain, and satyagrahi in British South Africa, this article explains how both regimes and their prisoners developed common practices and discourses around political incarceration in the years 1865-1910. [ABSTRACT FROM AUTHOR]

Analyzing how the virtual absence of women in high judicial office in the United Kingdom came to concern policy makers expands our understanding of agenda setting. By identifying the idiosyncratic barriers that impeded diffusion of innovation, this case suggests that an issue may get on the governmental agenda and policy change occur without a threshold groundswell of support or consensus that one sees in more typical cases. Policy change may help more to produce a consensus after the fact than reflect it. This case also seems exceptional for both feminist policy change and change driven by legal mobilization in that a very few uncoordinated actors made the difference. The agents of change in this case linked their cause to other governmental priorities as key personnel changed. Litigation provided one vehicle for this discursive work. [ABSTRACT FROM AUTHOR]

BACKGROUND: Almost 10 years ago senior United Kingdom nurses met at Heathrow Airport to discuss the challenges and opportunities facing nursing. One aspect of this 'Heathrow Debate' was to encourage nurses to work closer with members of the public. The resulting report stated that nurses have not been effective in working outside their professional area and, in particular, they have not been adept at working in partnership with the public. AIM: The aim of this paper is to report a study to obtain the views of general practitioners (GPs), community nurses and members of the public on how the public perceive community nursing. A further aim was to explore the perceptions of senior health care managers and policymakers about public involvement in primary care. METHODS: A two-stage Delphi investigation was undertaken with community nurses (n = 38), GPs (n = 14) and members of the public (n = 8). In addition, one-to-one interviews were carried out with 34 senior health service managers and policymakers. FINDINGS: There was agreement on the following issues: community nurses must work more closely with members of the public; there is a lack of public understanding on the roles of community nurses and specialist nurses; there is public support for nurse prescribing; there is a preference for seeing the community nurse as opposed to the GP; and people prefer one nurse to care for them rather than a variety of nurses. Comments from managers and senior policymakers showed agreement on the public being involved in primary care, but an acknowledgement that this was problematic. A number of recommendations are outlined. [ABSTRACT FROM AUTHOR]

Studies transformation of the system of selecting judges in Great Britain in the area of integration of women. Lawsuits that place the gender of judges on the agenda; Changes in public perception of judges and the role of courts; Ways in which women are changing the political climate; Role of feminists in demanding changes to the composition of the judiciary.

On April 7–8, 2014, the European Hydration Institute hosted a small group of experts at Castle Combe Manor House, United Kingdom, to discuss a range of issues related to human hydration, health, and performance. The meeting included 18 recognized experts who brought a wealth of experience and knowledge to the topics under review. Eight selected topics were addressed, with the key issues being briefly presented before an in-depth discussion. Presented here is the executive summary and conclusions from this meeting. [ABSTRACT FROM AUTHOR]

Abstract: The health needs of women imprisoned in England and Wales have not been systematically co-ordinated or evaluated. This review discusses the available literature on the health of women prisoners and highlights areas in need of improved service and research. The importance of taking the opportunity to improve the immediate and long-term health of incarcerated women is emphasised. [ABSTRACT FROM AUTHOR]

Focuses on a study which documented the extent to which maternity data in England are collected and how they are recorded. Identification of problems that may affect the data's availability throughout the National Health Service in Great Britain; Methods; Results; Conclusions.

Forensic psychiatrists throughout mainland UK and Northern Ireland were sent a postal questionnaire to determine their practice in cases where a restriction order was deemed appropriate and also their attitudes to the use of restricted hospital orders. Data were obtained about the estimated number of reports completed by each respondent and recommendations for restriction orders. In particular, the reasons why a restricted hospital order might be recommended or considered appropriate were sought. Out of the original sample of 97 psychiatrists, 74 (76%) returned completed questionnaires. They had written in excess of 3,000 legal reports in the previous 12 months and 60 (81%) had been involved in cases where a restriction order was considered appropriate in the same period. Of the 74 who responded, 33 (45%) said that they would specify the need for a restriction order when necessary, 27 (36%) stated that they would make no mention of it, and the remainder said that their practice would vary. Time-limited orders were not favoured. Some respondents said they would always recommend a restricted hospital order for certain types of offence; 18 (24%) said so for homicide. The majority agreed that the most important consideration when making a recommendation for a restriction order was the fact that it ensured long-term follow-up in cases where there was evidence of previous breakdown in arrangements. The findings strongly suggest that forensic psychiatrists consider restriction orders a clinically useful tool in some cases rather than primarily a punitive or purely legal instrument. [ABSTRACT FROM AUTHOR]

In this article we have stressed the need for the training officer to be as systematic in his preparation for job training analysis as in actually carrying it out. We have emphasised the importance of groundwork as a foundation for successful systematic training but have said little about the analytical techniques themselves as these are described very fully elsewhere. The algorithm will, we hope, be of help especially to newly appointed training officers as one way of approaching the systematic training of semi-skilled employees. [ABSTRACT FROM AUTHOR]

As the largest conduit vessel, the aorta is responsible for the conversion of phasic systolic inflow from ventricular ejection into more continuous peripheral blood delivery. Systolic distention and diastolic recoil conserve energy and are enabled by the specialized composition of the aortic extracellular matrix. Aortic distensibility decreases with age and vascular disease. In this study, we sought to discover epidemiologic correlates and genetic determinants of aortic distensibility and strain. We trained a deep learning model to quantify thoracic aortic area throughout the cardiac cycle from cardiac magnetic resonance images and calculated aortic distensibility and strain in 42,342 UK Biobank participants. Descending aortic distensibility was inversely associated with future incidence of cardiovascular diseases, such as stroke (HR: 0.59 per SD; P = 0.00031). The heritabilities of aortic distensibility and strain were 22% to 25% and 30% to 33%, respectively. Common variant analyses identified 12 and 26 loci for ascending and 11 and 21 loci for descending aortic distensibility and strain, respectively. Of the newly identified loci, 22 were not significantly associated with thoracic aortic diameter. Nearby genes were involved in elastogenesis and atherosclerosis. Aortic strain and distensibility polygenic scores had modest effect sizes for predicting cardiovascular outcomes (delaying or accelerating disease onset by 2%-18% per SD change in scores) and remained statistically significant predictors after accounting for aortic diameter polygenic scores. Genetic determinants of aortic function influence risk for stroke and coronary artery disease and may lead to novel targets for medical intervention. [Display omitted] [ABSTRACT FROM AUTHOR]

Considers the medical fees charged by physicians to fellow physicians in Great Britain. Proposal to change the practice; Variations in the intensity of reluctance to charge; Implications of the practice for private health insurance companies.

Examines the incidence of laparoscopic clip sterilization failure in Great Britain. Shrinkage of the lumen during the preparation of the specimen; Consideration between the effectiveness of laparoscopic clip sterilization and laparoscopic tubal electrocoagulation; Proper application of clips in the uterine tubes.

Background: The left ventricular outflow tract (LVOT) and ascending aorta are spatially complex, with distinct pathologies and embryologic origins. Prior work examined the genetics of thoracic aortic diameter in a single plane.Objectives: We sought to elucidate the genetic basis for the diameter of the LVOT, aortic root, and ascending aorta.Methods: Using deep learning, we analyzed 2.3 million cardiac magnetic resonance images from 43,317 UK Biobank participants. We computed the diameters of the LVOT, the aortic root, and at 6 locations of ascending aorta. For each diameter, we conducted a genome-wide association study and generated a polygenic score. Finally, we investigated associations between these scores and disease incidence.Results: A total of 79 loci were significantly associated with at least 1 diameter. Of these, 35 were novel, and most were associated with 1 or 2 diameters. A polygenic score of aortic diameter approximately 13 mm from the sinotubular junction most strongly predicted thoracic aortic aneurysm (n = 427,016; mean HR: 1.42 per SD; 95% CI: 1.34-1.50; P = 6.67 × 10-21). A polygenic score predicting a smaller aortic root was predictive of aortic stenosis (n = 426,502; mean HR: 1.08 per SD; 95% CI: 1.03-1.12; P = 5 × 10-6).Conclusions: We detected distinct genetic loci underpinning the diameters of the LVOT, aortic root, and at several segments of ascending aorta. We spatially defined a region of aorta whose genetics may be most relevant to predicting thoracic aortic aneurysm. We further described a genetic signature that may predispose to aortic stenosis. Understanding genetic contributions to proximal aortic diameter may enable identification of individuals at risk for aortic disease and facilitate prioritization of therapeutic targets. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a retrospective survey which assessed the accuracy of the selective screening programme for hepatitis B infection. The survey was undertaken in the antenatal clinics of West Lambeth Health Authority during 1988 and 1990. Forty per cent of hepatitis B positive patients were not screened, which highlights the problems associated with selective screening programmes. The implications for obstetricians and midwives are discussed, and recommendations are made.