Search

Aims: To undertake a Priority Setting Partnership (PSP), identifying the most important unanswered questions in type 1 diabetes in Ireland and the United Kingdom and to compare these to priorities identified in a 2011 PSP. Methods: A steering committee (including eight individuals with lived experience/charity representatives and six clinicians) designed a survey which asked stakeholders to list three questions about type 1 diabetes. This was disseminated through social media, direct email contact, and printed posters. Following analysis, a second survey asked participants to rank these priorities in order of importance. The top questions were then carried forward to an online, 2 days final workshop where the final top 10 were ranked. Results: There were 1050 responses (64% female, 78% adults living with type 1 diabetes, 9% healthcare professionals, 9% family members) to the first survey and 2937 individual questions were submitted. Sixty‐five summary questions were submitted into a second survey, completed by 497 individuals (76% adults living with type 1 diabetes, 9% healthcare professionals, and 11% family members). Nineteen questions from the interim survey progressed to a final workshop, which identified the top 10 priorities through group discussion. As in 2011, there was emphasis on psychological health, diabetes‐related complications, and hypoglycaemia. New themes prioritised included artificial intelligence and women's health. Conclusions: The research priorities, which have been identified using a robust and proven methodology, highlight the key concerns of those living with type 1 diabetes, their families and representatives, as well as clinicians in Ireland and the UK. [ABSTRACT FROM AUTHOR]

Objectives: There has been an increased focus in policy discourse on individuals with severe, multiple and complex needs. This paper seeks to understand how best to enable these individuals to take greater control over their health. Design: Qualitative, user-led, peer research. Setting: Large urban UK city. Method: Trained peer researchers with previous experience in contexts of severe and multiple disadvantage gathered data using a snowball sampling approach from 21 individuals engaged in a service specifically designed to provide for their needs. Results: The study identified enabling factors that create conditions for individuals with severe and multiple disadvantage to take greater control of factors impacting on their health and social situations. These included working holistically with individuals, understanding the interconnected issues impacting on health, developing trusting relationships with professionals and working within a positive framework that fosters self-belief and which is focused on salutogenesis rather than pathogenesis. Conclusion: There exists a set of enabling factors that may support individuals facing particular challenges in their lives. While derived from within a specific geographical context, findings have relevance to other settings in relation to ways of working. Peer research demonstrates itself to be a research approach well suited to understanding lived experiences.

There is a limited understanding about how an association with those that download Child Sexual Abuse Material (CSAM), a highly stigmatized crime, impacts the lives of their innocent family members. Non-offending family members are often considered a valuable protective resource for offender desistance and in safeguarding children from abuse. Therefore, the present study aimed to explore the lived experiences of female family members of CSAM offenders in Ireland and the United Kingdom to both identify and target areas for intervention thus ameliorating their ability to protect. A qualitative research design was adopted, and data analyzed via reflexive thematic analysis. Fifteen individuals self-selected for participation and interviews resulted in the identification of three key themes: Shattered Worldview, The Injured Self; Contamination by Association. The analysis highlighted how non-offending family members experienced considerable shame, trauma, and stigma with consequences that reached into every aspect of their lives. The findings are discussed in the context of the limited available literature along with research implications and recommendations for both policy and practice. [ABSTRACT FROM AUTHOR]

Prostate cancer, the most common cause of cancer in men in the UK and one of the most common around the world to date, has no consensus on screening. Multiple large-scale trials from around the world have produced conflicting outcomes in cancer-specific and overall mortality. A main part of the issue is the PSA test, which has a high degree of variability, making it challenging to set PSA thresholds, as well as limited specificity. Prostate cancer has a predisposition in men from black backgrounds, and outcomes are worse in men of lower socioeconomic groups. Mobile targeted case finding, focusing on high-risk groups, may be a solution to help those that most need it. The aim of this systematic review was to review the evidence for mobile testing for prostate cancer. A review of all mobile screening studies for prostate cancer was performed in accordance with the Cochrane guidelines and the PRISMA statement. Of the 629 unique studies screened, 6 were found to be eligible for the review. The studies dated from 1973 to 2017 and came from four different continents, with around 30,275 men being screened for prostate cancer. Detection rates varied from 0.6% in the earliest study to 8.2% in the latest study. The challenge of early diagnosis of potentially lethal prostate cancer remains an issue for developed and low- and middle-income countries alike. Although further studies are needed, mobile screening of a targeted population with streamlined investigation and referral pathways combined with raising awareness in those communities may help make the case for screening for prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Advanced therapy medicinal products such as Chimeric antigen receptor T-cell therapy offer ground-breaking opportunities for the treatment of various cancers, inherited diseases, and chronic conditions. With development of these novel therapies continuing to increase it's important to learn from the experiences of patients who were among the first recipients of ATMPs. In this way we can improve the clinical and psychosocial support offered to early patient recipients in the future to support the successful completion of treatments and trials. Study design: We conducted a qualitative investigation informed by the principles of the key informant technique to capture the experience of some of the first patients to experience CAR-T therapy in the UK. A directed content analysis was used to populate a theoretical framework informed by Burden of Treatment Theory to determine the lessons that can be learnt in supporting their care, support, and ongoing self-management. Results: A total of five key informants were interviewed. Their experiences were described within the three domains of the burden of treatment framework; (1) The health care tasks delegated to patients, Participants described the frequency of follow-up and the resources involved, the esoteric nature of the information provided by clinicians; (2) Exacerbating factors of the treatment, which notably included the lack of understanding of the clinical impacts of the treatment in the broader health service, and the lack of a peer network to support patient understanding; (3) Consequences of the treatment, in which they described the anxiety induced by the process surrounding their selection for treatment, and the feeling of loneliness and isolation at being amongst the very first recipients. Conclusions: If ATMPs are to be successfully introduced at the rates forecast, then it is important that the burden placed on early recipients is minimised. We have discovered how they can feel emotionally isolated, clinically vulnerable, and structurally unsupported by a disparate and pressured health service. We recommend that where possible, structured peer support be put in place alongside signposting to additional information that includes the planned pattern of follow-up, and the management of discharged patients would ideally accommodate individual circumstances and preferences to minimize the burden of treatment. [ABSTRACT FROM AUTHOR]

The phrase 'in it together' has been used liberally since the outbreak of COVID‐19, but the extent that frontline workers felt 'in it together' is not well understood. Here, we consider the factors that built (or eroded) solidarity while working through the pandemic, and how frontline workers navigated their lives through periods of disconnection. Semi‐structured interviews with 21 frontline workers, across all sectors, were conducted in the United Kingdom and Ireland. The qualitative data were analysed systematically using reflexive thematic analysis. The three themes identified in the data were: (1) Solidarity as central to frontline experiences; (2) Leadership as absent, shallow and divisive: highlighting 'us‐them' distinctions and (3) The rise of 'us' and 'we' among colleagues. Our research offers insights into how frontline workers make sense of their experiences of solidarity and discordance during the first year of the COVID‐19 pandemic, with relevance for government and organizational policy‐makers shaping future conditions for frontline workers. [ABSTRACT FROM AUTHOR]

Meyer and Land's work (among subsequent others) on threshold concepts (TCs) has been influential in numerous subjects, particularly in higher education. However, despite its growing international interest, its application into the domain of music in schools is a highly under-researched area. This article draws on the notion of TCs focusing on the context of lower-secondary school (Key Stage 3: ages 11–14) group composing. Using video-recorded and interview data from three case-study schools in the English Midlands, examples of TCs are presented and how formative assessment was, or could have been, a key process in them being crossed is discussed. [ABSTRACT FROM AUTHOR]

Despite growing interest in the influence of social and institutional settings on the nature of career trajectories, research into comparative differences in boundaryless careers is scarce. Informed by the Varieties of Capitalism approach, which emphasizes the embeddedness of employment practices within discrete types of capitalist market economy, and based on rich qualitative data from in-depth interviews with 32 self-employed and directly employed information and communications (ICT) professionals based in the UK and Germany, we investigate variation in their experience of, and attitudes towards, boundaryless careers. The research findings provide scant evidence that ICT professionals embrace boundaryless careers, despite working in a sector where positive engagement with boundarylessness, if it is going to be found anywhere, should be evident. The findings also point to cross-national differences; directly employed ICT professionals based in Germany are more concerned about the insecurity than their UK-based counterparts. In highlighting the complex and subtle influences on how boundaryless careers are experienced and understood, the research builds on existing work which both attests to the importance of context in influencing boundarylessness and its consequences and questions an overly crude distinction between 'bounded' and 'boundaryless' careers, to emphasize the value of an approach which is concerned with understanding comparative variation in the degree of career boundarylessness. [ABSTRACT FROM AUTHOR]

Frontline workers have shown extraordinary resilience and sustained efforts since the outbreak of COVID-19. The present study used semi-structured interviews with 38 frontline workers in the UK and Ireland to explore the psychological impact of working through COVID-19. The qualitative data were analysed systematically using thematic analysis. Four themes were interpreted: 1)) "I've stopped turning the telly on. I've had to because the news was making me ill": An ecosystem of influence; 2) "Dead, dead, dead": The emotional and psychological toll: 3) "It's shone a light on what we're failing on as well": Injustices, hierarchies and heroes: and 4) "I definitely think COVID happened for a reason to stop us in our tracks and to slow us down": Unexpected positives. This research offers insights into how frontline workers make sense of their experiences during periods of enormous societal and occupational stress. The learnings generated have relevance for government and organisational policy-makers who have opportunities to shape future conditions for frontline workers. [ABSTRACT FROM AUTHOR]

One feature of 'flexibilisation' concerns the growth of more individualised employment arrangements and career trajectories less connected to employing organisations. Informed by the Varieties of Capitalism approach, which emphasises the embeddedness of employment practices within discrete types of capitalist market economy, and based on rich qualitative data from interviews with 32 self‐employed and directly employed ICT professionals in the United Kingdom and Germany, we investigate comparative variation in their experience of flexibilisation. The research findings not only indicate some commonality, particularly in respect of perceptions of independence, but also highlight notable differences with regard to work pressures and insecurity. The paper advances theory by characterising two discrete varieties of flexibilisation, a 'liberalised' form evident in the United Kingdom and a more 'regulated' type apparent in Germany, contributing to a better understanding of comparative differences in flexibilisation. [ABSTRACT FROM AUTHOR]

New Zealand has its educational roots in 19th and 20th century British educational systems with close similarities between English and New Zealand secondary school education structures. In the last two decades, however, secondary school education in both countries has experienced multiple and sometimes radical reforms. Educational policy has diverged markedly at times. In this article, we present the findings of research into the professional autonomy of 15 secondary school music, art and drama teachers from England and New Zealand. The aim was to explore whether teachers believed themselves to be professionally autonomous and to what extent educational policy and external structures impacted their practice. Findings suggest despite similarities between jurisdictions, England teachers report a highly performative regime that restricts, governs and isolates them and the arts in school. This contrasts a progressive, even permissive, professional environment where the New Zealand teachers believe their students' needs come first and feel primarily accountable to their local and disciplinary communities. [ABSTRACT FROM AUTHOR]

The context of Covid-19 has offered an unusual cultural landscape for examining how workers view their own position relative to others, and how individuals respond to prolonged exposure to workplace stress across different sectors and cultures. Through our recent work tracking the well-being of frontline workers in the UK and Ireland (the CV19 Heroes project), we have uncovered additional psychological factors that have not been accounted for in previous models of occupational stress or burnout. In recent months, frontline workers have worked to protect the community from the threat of SARS-CoV-2 and, simultaneously, have evaluated their perceptions of collective efforts of others as either congruent or incongruent with collective goals (e.g., lowered mortality and morbidity): we call this novel aspect solidarity appraisal. These frontline workers have been hailed as heroes, which we argue has led to the creation of an implicit psychological contract (the hero contract) between frontline workers and the public. Here, the heroes are willing to "go above and beyond" for the greater good, with the expectation that we (the public) do our part by adhering to public health guidelines. Where frontline workers perceive incongruence between the words and actions of others in working toward collective goals this drives negative affect and subsequent burnout. In this perspective article, we evaluate the cultural context of the pandemic in the UK and Ireland and suggest important socio-cultural factors that contribute to perceptions of solidarity, and how this may relate to burnout and worker welfare during and beyond the pandemic context. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as "frontline," such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom (UK) government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland (RoI). Individuals were eligible if they were a frontline worker (in health and social care, community supply chain, or other emergency services) in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government's handling of the crisis, and measurement of psychological variables associated with heroism (altruism, meaning in life, and resilient coping). A total of 1,305 participants (N = 869, 66.6% from the UK) provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government's response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK. [ABSTRACT FROM AUTHOR]

Chronic Graft versus Host Disease (cGvHD) is an important cause of late non-relapse morbidity and mortality following allogeneic hemopoietic stem cell transplantation (allo-HSCT) [[1]]. 85% of patients had cutaneous disease, in keeping with the frequency of skin involvement, and the recommendation for ECP as second line therapy cutaneous disease. Patients with progressive disease received fewer cycles of ECP compared to patients who completed a treatment course (medians of 18.5 and 31 cycles respectively I p i <.001***, Figure 1(h)). These data highlight the importance of prompt consideration of ECP therapy in second line treatment of cGvHD, which may significantly reduce corticosteroid and immunosuppressant therapy, and reduce the infection risk. [Extracted from the article]

The clothing industry is currently focused on 3D virtual fitting. Many companies use size 12 as the core size; however, in recent years the average size has increased. For example, in the United Kingdom, the average size is now 16. Many companies have not updated their core size and often use size 12 as the size they are the most familiar with. The purpose of this paper is to compare real plus size body shapes with artificial avatars in relation to the fabric draping. This paper will investigate, how the body shape changes with an age (body height decreases, skin elasticity is lower, the shoulders are hunched, buttocks sag and fatness pockets are accumulated around the waist area). These factors are not considered in virtual avatars, but have a big impact on virtual fitting. [ABSTRACT FROM AUTHOR]

Reviews recent and current research and development projects in the United Kingdom dealing with online information systems. Main areas of research (systems design, impact on user behavior and organizational structure, ergonomics and bibliographic factors) and research techniques (features analysis, transaction log analysis, surveys and comparative studies) are identified and discussed. (CLB)

The Whole Class Ensemble Tuition (WCET) is a model of teaching and learning music which takes place in many English primary schools. It is a relative newcomer to music pedagogy in the primary school. In the groundbreaking study reported in this paper, two new models of teaching and learning music are proposed. These are (a) Music education starts with the instrument and (b) Music education takes place via the instrument. Conceptualised descriptions of classroom music pedagogies are not commonplace, and so this paper makes a significant contribution to the music education research literature by delineating, describing and labelling two of these with reference to the WCET programme. These distinctions are of international significance and are useful to describe differences between programmes, which constitutes a major contribution to music curricula discussions. The paper concludes that clarity on the purposes of teaching and learning is fundamental to effective musical pedagogy and that this is a matter that education systems worldwide should be considering. [ABSTRACT FROM AUTHOR]

Aim. To explore patient experiences of a structured exercise intervention for men with prostate cancer (PCa). Sample. 41 men with either localised or advanced PCa who had been referred for a structured exercise programme by their physician and then subsequently consented to a telephone survey. Method. Participants underwent a 10-week supervised exercise programme within a large cancer centre hospital consisting of 8 sessions. They then completed a short multiple choice telephone survey, elaborating on their responses where appropriate. Views expressed by participants were analysed using an affinity diagram and common themes were identified. Results. Feedback from our telephone surveys was consistently positive and suggests that the structured exercise intervention provides exercise confidence, motivation to exercise, and social support and promotes positive health behaviour change in the context of exercise. Individual differences arose amongst participants in their perceived utility of the intervention, with 73.3% expressing a preference for structured exercise classes and 19.5% expressing a preference for exercising independently. Conclusion. Design of a structured exercise intervention for patients with PCa should embrace the positive aspects outlined here but consider patients’ individual differences. Ongoing feedback from patients should be utilised alongside traditional study designs to inform intervention design in this area. [ABSTRACT FROM AUTHOR]

Objective: To determine the short-term cognitive and symptomatic outcome following mild traumatic brain injury. Methods: Setting: Emergency Departments of two UK tertiary referral hospitals. Participants: Adult patients presenting to the Emergency Departments of the Royal London Hospital and Salford Royal Hospital with suspected traumatic brain injury within 24 hours and Glasgow Coma Score > 8. A non-TBI comparison group included adult patients with no head or neck injury. Design: Prospective multi-centre cohort study. Main measures: The Standardized Assessment of Concussion (SAC), the Concussion Symptom Inventory (CSI) and total number of symptoms, measured at baseline and 72 hours. Results: This study enrolled 189 patients with and 51 patients without TBI. Patients with TBI had marked cognitive impairment which persisted at 72 hours (SAC score at baseline = 25 [23-27] vs 72 hours = 25 [22-27]; p = 0.1). Patients with TBI had persistent high symptom severity, although this had decreased at 72 hours (CSI score at baseline = 9 [4-22] vs 72 hours = 5 [1-19], p = 0.002). A similar pattern was observed with the total number of symptoms (baseline = 4 [2-8] vs 72 hours = 0 [0-4]; p < 0.001). Patients with TBI had worse neurocognitive function, higher overall symptom severity and higher total number of symptoms compared with patients without TBI. Patients without TBI' neurocognitive function and symptom severity remained constant, but the number of symptoms reduced between baseline and 72 hours. Conclusion: There is a cognitive deficit and symptom burden in patients with mild TBI presenting to the Emergency Department which persists at 72 hours. [ABSTRACT FROM AUTHOR]

Asset-based approaches seek to identify and mobilise the personal, social and organisational resources available to communities. Asset mapping is a recognised method of gathering an inventory of neighbourhood assets and is underpinned by a fundamentally different logic to traditional needs assessments. The aim of this paper is to explore how asset mapping might be used as a tool for health improvement. It reports on a qualitative evaluation of a pilot asset mapping project carried out in two economically disadvantaged neighbourhoods in Sheffield, UK. The project involved community health champions working with two community organisations to identify assets linked to the health and wellbeing of their neighbourhoods. The evaluation was undertaken in 2012 after mapping activities had been completed. A qualitative design, using theory of change methodology, was used to explore assumptions between activities, mechanisms and outcomes. Semi structured interviews were undertaken with a purposive sample of 11 stakeholders including champions, community staff and strategic partners. Thematic analysis was used and themes were identified on the process of asset mapping, the role of champions and the early outcomes for neighbourhoods and services. Findings showed that asset mapping was developmental and understandings grew as participatory activities were planned and implemented. The role of the champions was limited by numbers involved, nonetheless meaningful engagement occurred with residents which led to personal and social resources being identified. Most early outcomes were focused on the lead community organisations. There was less evidence of results feeding into wider planning processes because of the requirements for more quantifiable information. The paper discusses the importance of relational aspects of asset mapping both within communities and between communities and services. The conclusions are that it is insufficient to switch from the logic of needs to assets without building asset mapping as part of a broader planning process. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the 2nd largest cause of cancer related mortality in the UK with 40 000 new patients being diagnosed each year. Complications of CRC surgery can occur in the perioperative period that leads to the requirement of organ support. The aim of this study was to identify pre-operative risk factors that increased the likelihood of this occurring. Methods: This is a retrospective observational study of all 6441 patients who underwent colorectal cancer surgery within the West of Scotland Region between 2005 and 2011. Logistic regression was employed to determine factors associated with receiving postoperative organ support. Results: A total of 610 (9 %) patients received organ support. Multivariate analysis identified age ≥65, male gender, emergency surgery, social deprivation, heart failure and type II diabetes as being independently associated with organ support postoperatively. After adjusting for demographic and clinical factors, patients with metastatic disease appeared less likely to receive organ support (p = 0.012). Conclusions: Nearly one in ten patients undergoing CRC surgery receive organ support in the post operative period. We identified several risk factors which increase the likelihood of receiving organ support post operatively. This is relevant when consenting patients about the risks of CRC surgery. [ABSTRACT FROM AUTHOR]

Background: Single pulse transcranial magnetic stimulation (sTMS) is a novel treatment for acute migraine. Previous randomised controlled data demonstrated that sTMS is effective and well tolerated in the treatment of migraine with aura. The aim of the programme reported here was to evaluate patient responses in the setting of routine clinical practice. Methods: Migraine patients with and without aura treating with sTMS had an initial review ( n = 426) and training call, and then participated in telephone surveys at week six ( n = 331) and week 12 during a 3-month treatment period ( n = 190). Results: Of patients surveyed with 3 month data (n = 190; episodic, n = 59; chronic, n = 131), 62 % reported pain relief, finding the device effective at reducing or alleviating migraine pain; in addition there was relief reported of associated features: nausea- 52 %; photophobia- 55 %; and phonophobia- 53 %. At 3 months there was a reduction in monthly headache days for episodic migraine, from 12 (median, 8-13 IQ range) to 9 (4-12) and for chronic migraine, a reduction from 24 (median, 16-30 IQ range) to 16 (10-30). There were no serious or unanticipated adverse events. Conclusion: sTMS may be a valuable addition to options for the treatment of both episodic and chronic migraine. [ABSTRACT FROM AUTHOR]

Background: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. Methods: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). Intervention: Peer-based interventions. Comparators: Review questions 3 and 4 compared peer and professionally led approaches. Outcomes: Prisoner health or determinants of health; organisational/process outcomes; views of prison populations. Study designs: Quantitative, qualitative and mixed method evaluations. Results: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. [ABSTRACT FROM AUTHOR]

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based ‘business champions’ to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the ‘business champion’ emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments. [ABSTRACT FROM AUTHOR]

Daily gas demand in the UK is variable. This is partly due to weather patterns and the changing nature of electricity markets, where intermittent wind energy levels lead to variations in the demand for gas needed to produce electricity. This uncertainty makes it difficult for traders in the market to analyse the market. As a result, there is an increasing need for models of the UK natural gas market that include stochastic demand. In this paper, a Rolling Optimisation Model (ROM) of the UK natural gas market is introduced. It takes as an input stochastically generated scenarios of demand. The outputs of ROM are the flows of gas, i.e., how the different sources of supply meet demand, as well as how gas flows in to and out of gas storage facilities. The outputs also include the daily System Average Price of gas in the UK. The model was found to fit reasonably well to historic data (from the UK National Grid) for the years starting on the 1st of April for both 2010 and 2011. These results allow ROM to be used to predict future flows and prices of gas and to investigate various stress-test scenarios in the UK natural gas market. [ABSTRACT FROM AUTHOR]

The article discusses the nature of accommodation in Great Britain, Canada, and Scotland. Topics discussed include the British North America (BNA) Act of 1867 which created a devolved system of government and a federated state, a comparable Home Rule which include a revived Parliament in Edinburgh, England, and the Great Reform Act of 1832.

ABSTRACT Background The critical care environment has felt the overwhelming impact of the growing problem of alcohol abuse. However, there is ambiguity concerning the assessment and management of this patient group. Aim The aim of this study was to explore current practice in the use of assessment and management tools for alcohol-related admissions in UK intensive care units ( ICU). Methods Two hundred and forty-eight lead consultants across England, Scotland, Northern Ireland and Wales were sent an electronic survey using the SurveyMonkey® ( www.surveymonkey.com) website. Results A total of 103 (41·05%) lead consultants responded to the survey. Most units (67%) utilized the volume of alcohol consumed per week to assess patient alcohol use. Furthermore, 12 units (11%) used the Clinical Institute Withdrawal Assessment tool, 5 units (5%) used the Glasgow Modified Alcohol Withdrawal Scale and 79 units (73%) used no tool for the management of alcohol withdrawal syndrome. Conclusion There appears to be a diverse approach to the assessment and management of alcohol-related admissions in UK ICUs. Further research is required in this area to identify the most effective way to assess and manage alcohol-related admissions within intensive care. Relevance to clinical practice Under recognition and poor assessment of alcohol use can have major implications for critically ill patients. [ABSTRACT FROM AUTHOR]

This article reports the findings from the one-to-one interviews with the main UK faith and belief leaders which were commissioned by the Organ Donation Taskforce as part of its evidence gathering. Interviews were arranged with the main faith and belief organisations within the UK. Interviews covered a range of issues related to organ donation. Although some faith groups had some reservations regarding organ donation, interviews with these leaders demonstrated that none of these faith groups have reached a consensus against organ donation. The interviewees stated that the majority opinion in their faith or belief group is to permit organ donation, with some actively supporting it. Interviewees were keen to stress that there is a broad spectrum of opinion on organ transplantation within each faith and belief group and that consequently it is difficult to speak on behalf of an entire group. One complication mentioned by interviewees is that as organ transplantation is a relatively new medical procedure, there is no explicit reference to it in many original religious texts. Consequently, positions on the receipt and donation of organs are based on interpretation. It was felt that a much greater level of engagement is needed, as organ donation is currently not a priority for many faith and belief groups. [ABSTRACT FROM AUTHOR]

This paper examines lay interpretations of lay health worker roles within three UK community-based health promotion projects. It argues that understanding lay health worker roles requires critical analysis of the complex interrelationships between professionals, lay workers and the communities receiving a programme. Findings are presented that are drawn from a qualitative study of lay engagement in public health programme delivery where a key objective was to examine the perspectives of community members with the experience of receiving services delivered by lay health workers. Interviews and focus groups were conducted with 46 programme recipients from three case study projects; a breastfeeding peer support service, a walking for health scheme and a neighbourhood health project. The results show how participants interpreted the function and responsibilities of lay health workers and how those roles provided personalized support and facilitated engagement in group activities. Further insights into community participation processes are provided revealing the potential for active engagement in both formal and informal roles. The paper concludes that social relationships are core to understanding lay health worker programmes and therefore analysis needs to take account of the capacity for community members to move within a spectrum of participation defined by increasing responsibility for others. [ABSTRACT FROM PUBLISHER]

Background The aim of this study was to quantify and compare the burden of disease attributable to five major lifestyle-related risk factors in a UK Primary Care Trust (Wirral) using World Health Organizations' (WHO) comparative risk assessment (CRA) methodology to demonstrate its practical utility for informing local policy initiatives. Methods WHO CRA methodology was adopted using exposure data from a local lifestyle survey, disease risk factor relationships published by the WHO and local mortality data to calculate risk factor attributable deaths and years of life lost (YLL). Results Smoking remains by far the leading cause of deaths followed by overweight and obesity and low fruit and vegetable intake. Alcohol ranked last by number of deaths, but second by YLL indicating its high contribution to deaths at younger ages. Conclusions We have demonstrated the utility of WHO CRA methodology to influence health-related policy-making at a local level. Primary prevention should remain high on the agenda of government initiatives to reduce the future burden of ill health. Future research in this area could look at more in-depth national data to cover a wider range of risk factors addressing some of the methodological and data shortcomings identified in this study. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to provide a snapshot of contemporary thoracic anesthetic practice in the United Kingdom and Ireland. Design: An online survey. Setting: United Kingdom. Participants: An invitation to participate was e-mailed to all members of the Association of Cardiothoracic Anaesthetists. Intervention: None. Measurements and Main Results: A total of 132 responses were received; 2 were excluded because they did not originate from the United Kingdom. Values are number (percent). Anesthetic Technique: The majority of respondents (109, 85%) maintain anesthesia with a volatile anesthetic agent, with a lesser proportion (20, 15%) reporting use of a total intravenous anesthetic technique. The majority of respondents (78, 61%) favor pressure control ventilation over volume control (50, 39%); just under half (57, 45%) report the routine use of positive end-expiratory pressure (median = 5 cmH2O [interquartile range (IQR), 4-5]). Fifty-two (40%) respondents report ventilating to a target tidal volume (median = 6 mL/kg [IQR, 5-7]). Most (114, 89%) respondents routinely ventilate with an FIO2 less than 1.0. Thoracic epidural blockade (TEB) is favored by nearly two thirds of respondents (80, 62%) compared with paravertebral block (39, 30%) and other analgesic techniques (10, 8%). Anesthesiologists favoring TEB are significantly less likely to prescribe systemic opioids (17, 21% v 39, 100% [p < 0.001]). Proponents of TEB are significantly more likely to “routinely” use vasopressor infusions both intra- and postoperatively (16, 20% v 0, 0% [p = 0.003] and 28, 35% v 4, 11% [p =0.013], respectively). Most respondents (127, 98%) report a double-lumen tube as their first choice. Many (82, 64%) report “rarely” using bronchial blockers. Conclusions: The authors hope this survey both provides interest and serves as a useful resource reflecting the current practice of thoracic anesthesia. [ABSTRACT FROM AUTHOR]

Background: The National Institute for Health and Clinical Excellence (NICE) guidelines recommend a timeline of 6 weeks from referral to neurology consultation and then 6 weeks to a diagnosis of multiple sclerosis (MS).Objectives: We audited the clinical management of all new outpatient referrals diagnosed with MS between January 2007 and May 2010.Methods: We analysed the timelines from referral to first clinic visit, to MRI studies and lumbar puncture (LP) (if performed) and the overall interval from first visit to the time the diagnosis was given to the patient.Results: Of the 119 diagnoses of MS/Clinically Isolated Syndrome (CIS), 93 (78%) were seen within 6 weeks of referral. MRI was performed before first visit in 61% and within 6 weeks in a further 27%. A lumbar puncture (LP) was performed in 83% of all patients and was done within 6 weeks in 78%. In total, 63 (53%) patients received their final diagnosis within 6 weeks of their first clinic visit, with 57 (48%) patients having their diagnosis delayed. The main rate-limiting steps were the availability of imaging and LP, and administrative issues.Conclusions: We conclude that, even with careful scheduling, it is difficult for a specialist service to obtain MRI scans and LP results so as to fulfil NICE guidelines within the optimal six-week period. An improved service would require MRI scans to be arranged before the first clinic visit in all patients with suspected MS. [ABSTRACT FROM AUTHOR]

Purpose – The paper aims to explore the relationship between rough sleepers, welfare and policy in the city of Liverpool, taking Liverpool City Council's Homelessness Strategy 2008-2011 as a starting point. The paper takes as its premise the notion of rough sleepers as among the most vulnerable and marginalised in society, and questions how well they are protected by policy. Design/methodology/approach – The approach used is analysis and contextualisation of the strategy document in terms of welfare and criminological perspectives. Findings – The paper posits that the city's European Capital of Culture Status for 2008 has acted as a springboard for further consumerist and regeneration-driven aspirations, facilitated by restriction of entitlement to access city space for groups such as rough sleepers. The piece explores responses to rough sleepers and other "undesirable" city centre space users in Liverpool and contends that their behaviour and activities are criminalised. Ultimately, it is argued that the city, whilst it prioritises its goal of becoming a "world-class city", fails to deliver in terms of its welfare obligations. Originality/value – It is argued that the failure of the strategy to adequately consider the direct needs of rough sleepers renders them subject to other approaches, namely criminalisation. The article is valuable to both academics interested in aspects of social justice and practitioners engaged in policy making, in that it highlights some of the ways in which policy can fail to meet its basic requirements. [ABSTRACT FROM AUTHOR]

The author reflects on maternity mortality related to pregnancy in Great Britain. He reports on the Maternal Mortality Ratio (MMR) based on direct and indirect maternal deaths where 155 out of 261 are the maternal deaths identified in the death certificates. He also discusses several causes of maternal deaths including the direct deaths related to the use of anesthesia and sepsis.

The Road Traffic Act 1988 gives police in the United Kingdom the power to seize motor vehicles which they have reasonable grounds for believing are being driven without a valid driver's licence or motor insurance. Drivers may then have to pay a fee to have their vehicles returned. When exercising this power of seizure, the police may rely on information contained on the Police National Computer (PNC) which is linked to the National Insurance Database (NID). Whilst these databases are undoubtedly invaluable in this endeavour, they are not always accurate, and incidents have occurred whereby motorists who are in fact driving with valid insurance have had their vehicles seized and retained. Focusing on the case of Lisa, whose vehicle was wrongly impounded by Merseyside Police in 2007, and other cases, we explore the legitimacy and legality of such activity. We question both the discretionary power of the police in taking such action, and the validity of their (over) reliance on technology. We posit that the taking of money in cases such as Lisa's is evidence of the turn within public policing towards marketisation, and consider the capacity for harm to innocent individuals and the implications for justice and fairness. Ultimately, we contend that police accountability is compromised and that a new approach is required. We close the piece with some recommendations for improved police practice. [ABSTRACT FROM AUTHOR]

A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%–80% [6%–100%]), 12% (9%–16% [3%–93%]), 4% (2%–5% [<1%–18%]), for category-1 caesarean section, categories 1–3 (non-elective/emergency) and category-4 (elective) caesarean section, respectively. The main operating theatre for caesarean section is on the delivery suite in 151 (88%) units, and 112 (66%) units also have a second theatre in the same location. One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline’s recommended decision-delivery intervals for category-1 (≤ 30 min), category-2 (≤ 30 min) and category-3 (≤ 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units. [ABSTRACT FROM AUTHOR]

This article reports the findings from the one-to-one interviews with the main UK faith and belief leaders, which were commissioned by the Organ Donation Taskforce. Interviews were arranged with the main faith and belief organizations within the UK and covered a range of issues related to organ donation. No faith or belief groups were against organ donation in principle. The interviewees stated that the majority opinion in their faith or belief group is to permit organ donation, with some actively supporting it. Interviewees were keen to stress that there is a broad spectrum of opinions on organ transplantation within each faith and belief group, and that consequently it is difficult to speak on behalf of an entire group. One complication mentioned by interviewees is that as organ transplantation is a relatively new medical procedure, there is no explicit reference to it in many original religious texts. Consequently positions on the receipt and donation of organs are based on interpretation. It was felt that a much greater level of engagement is needed, as organ donation is currently not a priority for many faith and belief groups. [ABSTRACT FROM AUTHOR]

Background: The critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits.Aims: To test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome.Method: We recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study.Results: Negative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI.Conclusions: These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis. [ABSTRACT FROM AUTHOR]

There is a paucity of information regarding the extent and nature of caring provided by minority ethnic communities. The proportion of older people from these communities will dramatically increase in the next 20 years, which will be accompanied by increasing health and social care needs and an increased demand for carers. A qualitative, exploratory study was conducted to identify the health and social care needs of informal carers, who were caring for a dependent adult from a Bangladeshi community in South Wales, UK. This paper focuses on Bangladeshi carers’ access to formal support services provided by the statutory, private and voluntary sectors to assist them with their caring responsibilities. The findings are based on data collected using face-to-face, focused interviews with 20 Bangladeshi carers. Purposive and snowball sampling were used to recruit the sample. The data were analysed using thematic content analysis. The dimensions of accessibility and equity of quality of care were drawn upon to aid understanding of the findings. Bangladeshi carers faced a number of barriers in accessing health and social service provision, which impeded uptake of these services. Additionally, there was evidence of inequity in service provision. Recommendations for improving the accessibility of health and social care services are proposed, which may assist in promoting more equitable services for carers from the Bangladeshi community. [ABSTRACT FROM AUTHOR]

Background and objectives: The American Heart Association guidelines from 2000 recommend that family members be allowed to witness cardiopulmonary resuscitation. This is controversial and opponents fear litigation and family interference during family witnessed resuscitation (FWR). The extent of FWR in UK Emergency Departments is unknown. Methods: A telephone survey of a selection of UK Emergency Departments was performed asking about experience with FWR. Results: One-hundred-and-sixty-two UK Emergency Departments with an average attendance of 47000 patients per year participated. FWR was allowed by 128 (79%) for an adult patient and 93% for a child. Of these, 50% invited relatives to witness and only 21 % did not permit FWR. The perceived benefits were: accepting that all possible has been done (48%), accepting the death (48%) and help with grieving (38%). Two percent did not think FWR was of help. Few had encountered any problems or interference from the family. Never being asked was the commonest reason not allowing FWR followed by staff reluctance. Most respondents would wish to be present if their child (85%), spouse/partner (64%) or elderly relative (52%) was being resuscitated. Conclusions: FWR is common in UK Emergency Departments. It is more common when children are being resuscitated than adults. Further research is needed to demonstrate whether it is of benefit to the patient or relatives and its applicability to other areas such as intensive care. [ABSTRACT FROM AUTHOR]

Six subspecialists with considerable experience in fetal ultrasound viewed a selection of pre-recorded ultrasound scans. Scans from 18 patients recorded on VHS video-tape were supplied from five centres in the UK and Ireland, each made on a high-resolution ultrasound machine by an experienced sonologist at a referral centre. Each observer viewed the scans on a large display monitor in an individual viewing booth. The scans were viewed in random order, at randomly selected bandwidths. Observers, who were blinded to both recording and bandwidth, assessed the technical quality on a five-point Likert scale. They also recorded their diagnosis. The six observers each carried out 32 viewing sessions, which gave a total of 192 viewings. There was no significant difference in the perceived technical quality of the scans between the two bandwidths used (P = 0.09). Of the 84 recordings transmitted at 1920 kbit/s, 71 (85%) were diagnosed correctly or 'half correctly' and 13 (15%) were misdiagnosed. Of the 95 recordings transmitted at 384 kbit/s, 66 (69%) were diagnosed correctly or 'half correctly' and 29 (31%) were misdiagnosed. This difference was significant (P = 0.03). The results indicate that although there were no perceived differences in technical quality between recordings transmitted at 384 or 1920 kbit/s, diagnostic accuracy was marginally worse at the lower bandwidth. This suggests that the higher bandwidth conveys more detail and information to the observer, which in turn enables more accurate diagnosis. However, further work is required before a definitive choice can be made about the optimum transmission bandwidth for remote fetal ultrasound studies. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Our laboratory receives many routine requests for plasma zinc analysis from intensive care units (ICUs) throughout Scotland. However, such requests are inappropriate because plasma zinc concentrations fall independently of nutritional deficiency during the systemic inflammatory response and, therefore, in critically ill patients. This survey was performed to investigate how widespread this practice was and if low plasma zinc concentrations were interpreted as zinc deficiency so triggering inappropriate initiation of zinc supplementation. Materials and Methods: A questionnaire was sent to ICUs throughout the UK; nonresponders were contacted by telephone, and the questionnaire details were recorded. The questionnaire asked if plasma zinc was routinely requested, the frequency of requests, whether patients were supplemented with zinc, and if so, the grounds for supplementation and the dose given. Results: Plasma measurement of zinc was routinely performed in 18% of UK ICUs. Zinc supplementation was given in 10%, usually as a result of finding low plasma zinc concentrations. Dosages of supplementation varied widely between ICUs: from 0.4 to 135 mg zinc per day. Approximately 6% of ICUs gave very high supplements of zinc of 90 and 135 mg/d. Conclusions: The finding of a low plasma zinc concentration in Intensive Therapy Unit patients is often misinterpreted as indicating zinc deficiency and inappropriately prompts zinc supplementation. There is no evidence base to support high-dose zinc supplementation in ICU patients. This practice is justifiable only if future randomized trials demonstrate a benefit. [Copyright &y& Elsevier]

Many men report unmet needs in erectile dysfunction self-care management following treatment of prostate cancer. While it is important to ensure timely access to survivorship care, increasing patient volume challenges current survivorship pathways and resources. This quality improvement project implemented and evaluated a new prostate cancer survivorship pathway for men postrobotic assisted laparoscopic prostatectomy to better address their needs in a timely manner. [ABSTRACT FROM AUTHOR]

Objective: The authors developed and validated a clozapine-specific side-effects scale capable of eliciting the subjectively unpleasant side-effects of clozapine.Methods: Questions from the original Glasgow Antipsychotic Side-effects Scale (GASS) were compared to a list of the most commonly reported clozapine side-effects and those with a significant subjective burden were included in the GASS for Clozapine (GASS-C). The original authors of the GASS and a group of mental health professionals from the UK and Ireland were enlisted to comment on the questions in the GASS-C based on their clinical experience. 110 clozapine outpatients from two sites completed the GASS-C, the original GASS and a repeat GASS-C. Statistical analyses were performed using SPSS for Windows version 19.Results: The GASS-C was shown to have construct validity, in that Spearman's correlation coefficient was 0.816 (p<0.001) with the original GASS, whilst Cohen's kappa coefficient was >0.77 (p<0.001) for one question and >0.81 (p<0.001) for remaining relevant questions. GASS-C was also shown to have strong test-retest reliability, in that Cronbach's alpha coefficient was >0.907 (p<0.001), whilst Cohen's kappa coefficient was >0.81 (p<0.001) for 12 questions and >0.61 (p<0.001) for the remaining four questions.Conclusion: The GASS-C is a valid and reliable clinical tool to enable a systematic assessment of the subjectively unpleasant side-effects of clozapine. Future research should focus on how the scale can be utilised as a clinical tool to improve real-world outcomes such as adherence to clozapine therapy and quality of life. [ABSTRACT FROM AUTHOR]