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Background: Intravenous immunoglobulin (IVIg) for Clostridioides difficile infection (CDI) no longer features in treatment guidelines. However, IVIg is still used by some clinicians for severe or recurrent CDI (rCDI) cases. The main objective of this study was to investigate the efficacy of IVIg and to identify possible predictors of disease resolution post IVIg administration for patients with CDI. Methods: This retrospective observational cohort study of patients ≥2 years old hospitalised with severe, relapsing, or rCDI treated with IVIg therapy was performed in a large UK tertiary hospital between April 2018 and March 2023. Scanned electronic notes from patient admissions and clinical reporting systems were used to collect relevant data. Results: In total, 20/978 patients diagnosed with CDI over the 5-year study were treated with IVIg. Twelve (60%) had hospital-onset CDI. Eleven of the twenty patients (55%) responded to treatment, with a mean of 8.6 (SD 10.7) days to disease resolution. Sixteen (80%) patients were treated for severe CDI and four (20%) for rCDI (n = 3) and relapsing CDI (n = 1). There were no statistically significant differences in possible independent predictors of disease resolution post IVIg administration between groups. There was an average of 6.2 (4.9) days to IVIg administration after diagnosis with no difference between responders and non-responders (p = 0.88) and no further significant difference in additional indicators. Four (36%) of the responders were immunosuppressed compared to just one (11%) of the non-responders (p = 0.15). Six of the responders (two with recurrent and four with severe CDI) improved rapidly within 2 days, and three of these were immunosuppressed. Conclusion: We observed disease resolution post IVIg therapy in over 50% of patients with refractory CDI. Our data also support a potential enhanced effect of IVIg in immunosuppressed individuals. Thus, the role of IVIg for CDI treatment, particularly in the immunosuppressed, warrants future case–control studies coupled to mechanistic investigations to improve care for this ongoing significant healthcare-associated infection. [ABSTRACT FROM AUTHOR]

Background: Autistic people are more likely to experience stigma, communication barriers and anxiety during healthcare. Autism Health Passports (AHPs) are a communication tool that aim to provide information about healthcare needs in a standardised way. They are recommended in research and policy to improve healthcare quality. Aim: To explore views and experiences of AHPs among Autistic people from the UK who have been pregnant. Methods: We developed an online survey using a combination of open and closed questions focused on healthcare impairments and views and experiences of AHPs. Data were anlaysed using descriptive statistics, Kruskal-Wallis tests, and content analysis. Findings: Of 193 Autistic respondents (54% diagnosed, 22% undergoing diagnosis and 24% self-identifying), over 80% reported anxiety and masking during healthcare always or most of the time. Some significant differences were identified in healthcare (in)accessibility by diagnostic status. Only 4% of participants knew a lot about AHPs, with 1.5% of participants using one at least half of the time. Almost three quarters of respondents had not previously seen an AHP. Open text responses indicated that the biggest barrier to using an AHP was a belief that health professionals would discriminate against Autistic patients. Additional barriers included staff lack of familiarity with AHPs and respondents expecting a negative response to producing an AHP. Conclusions: Our findings suggest that AHPs are not reducing health inequalities for Autistic adults who have been pregnant. Alternative solutions are needed to reduce health inequalities for Autistic people. [ABSTRACT FROM AUTHOR]

Background: Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient-level risk stratification are not followed. It is unclear how prioritisation decisions are made in real-world settings and the effect of this prioritisation on outcomes., Methods: This was a prespecified analysis of an observational cohort study of adult patients undergoing inpatient surgery, conducted in 274 hospitals across the UK and Australasia during 2017. The primary outcome was postoperative morbidity at day 7. Logistic regression models were used to evaluate the relationship between critical care admission and patient and health system factors. The causal effect of critical care admission on outcome was estimated using variation in critical care occupancy as a natural experiment in an instrumental variable analysis., Results: A total of 19,491 patients from 248 hospitals were eligible for analysis, of whom 2107 were directly admitted to critical care postoperatively. Postoperative morbidity occurred in 2829/19,491 (15%) patients. Increasing surgical risk was associated with critical care admission, as was increased availability of critical care beds (odds ratio (95%CI) 1.04 (1.01-1.06), p = 0.002) per available bed; however, the probability of admission varied significantly between hospitals (median odds ratio 3.05). There was no evidence of a difference in postoperative morbidity with critical care admission (odds ratio (95%CI) 0.91 (0.57-1.45), p = 0.710)., Discussion: Postoperative critical care admission is variable and related to bed availability. Statistical methods that adjust for unobserved confounding lowered the estimates of harm previously reported to have been associated with postoperative critical care admission. Our findings provide a rationale for a clinical trial which would evaluate any potential benefits for postoperative critical care admission for patients in whom there is no absolute indication for admission., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Although small and medium-sized enterprises (SMEs) were particularly hard hit by the coronavirus disease 2019 (COVID-19) pandemic, some performed relatively well, maintaining or increasing employment growth. We study these differences in performance through the lens of dynamic capabilities (DCs) theory, which we extend by incorporating the moderating effect of government support during COVID-19. We analyse responses from 1421 UK SMEs and find that government support and DCs positively impact employment. We also show that government support moderates the link between DCs and employment with a negative effect after the first COVID-19 lockdown. The findings highlight the role of government policy intervention in discouraging SMEs from effectively exercising DCs during a crisis and the general importance of DCs and government support in enabling SMEs to cope with shocks. [ABSTRACT FROM AUTHOR]

The ageing of populations is increasing pressure on health and social care systems. Potentially, assistive technologies are a way to support the independence of older adults in their daily activities. Among existing assistive technologies, ambient sensing technologies have received less attention than wearable systems. Moreover, there has been little research into cheaper technologies capable of using multiple modalities. A systematic review of the acceptability of assisted living or smart homes in the United Kingdom and the simultaneous use of sounds and vibrations in remote monitoring of assisted living or smart homes will inform and encourage the use of digital monitoring technologies. The acceptability of sensing technologies depends on whether there is any social stigma about their use, for example, the extent to which they invade privacy. The United Kingdom studies reviewed suggest a lack of measurements of the perceived efficacy or effectiveness of the monitoring devices. The primary use of vibration or acoustic technologies has been for detecting falls rather than monitoring health. The review findings suggest the need for further exploration of the acceptability and applicability of remote monitoring technologies, as well as a need for more research into the simultaneous use of sounds and vibrations in health monitoring. [ABSTRACT FROM AUTHOR]

Feelings of happiness have been associated with better performance in creative and flexible thinking and processing. Less is known about whether happier individuals have better performance on basic cognitive functions and slower rate of cognitive decline. In a large sample from the UK Biobank (N = 17,885; Age 40–70 years), we examine the association between baseline happiness and cognitive function (speed of processing, visuospatial memory, reasoning) over four assessment waves spanning up to 10 years of follow-up. Greater happiness was associated with better speed and visuospatial memory performance across assessments independent of vascular or depression risk factors. Happiness was associated with worse reasoning. No association was found between happiness and the rate of change over time on any of the cognitive tasks. The cognitive benefits of happiness may extend to cognitive functions such as speed and memory but not more complex processes such as reasoning, and happiness may not be predictive of the rate of cognitive decline over time. More evidence on the association between psychological well-being and different cognitive functions is needed to shed light on potential interventional efforts. [ABSTRACT FROM AUTHOR]

Achieving ambitious carbon reduction targets requires transformative change to society, with behaviour change playing an important role. Climate change mitigation ('net zero') policies are needed to accelerate and support such behaviour change. This study examined factors and framing effects in public support for net zero policies in the United Kingdom (UK), making use of a large probability sample (ntotal = 5,665) survey conducted in August 2021. It found that net zero policies are widely supported, with only taxes on red meat and dairy products being supported by less than half of the UK public. Climate worry and perceived fairness were the strongest and most consistent predictors of policy support for net zero policies. The results further suggest that support for net zero policies can be increased by emphasising the co-benefits of the policies, in particular where they are beneficial for health. However, the framing effects were very small. In contrast, public support for net zero policies is lower when potential lifestyle and financial costs are mentioned. This suggests that perceived fairness of the distribution of costs and lifestyle implications of policies are crucial for building and maintaining support for net zero. [ABSTRACT FROM AUTHOR]

Cement and concrete are essential for global development. However, cement manufacture is responsible for around 7–8% of global greenhouse gas emissions, with significant growth anticipated. Beyond efficiencies in cement manufacturing, other strategies for using less cement in construction through applying the principles of efficient design, circular economy and reuse also have the potential to reduce emissions. A further option is to move towards cements with different compositions and inherently lower embodied carbon dioxide. This paper focuses on these materials and the challenges to their widespread adoption, drawing mainly on applied research, trials and standardisation activities conducted in the UK and the EU. In addition to modification of standards, basic technical and practical information such as strength development curves, durability, site considerations and a shared broad body of evidence are key for specifiers to consider when using any new cement. The paper describes the role of standards and specifications and the underpinning information (applied research, published case studies and experience) essential in getting any new cement adopted. It also shows how a range of evidence from research and application can feed into a simple conceptual model and evidence base. [ABSTRACT FROM AUTHOR]

Product returns in retail are inherently wasteful and have considerable negative environmental impacts. Besides the monetary costs, they lead to increased transportation, packaging and processing, and the returned items are often discarded. We present strategies and practices retailers can adopt to manage their product returns in a way that reduces environmental impacts. With eCommerce flourishing, product returns have increased significantly. Whilst highest for online sales, they are a challenge across all channels. The importance of developing sustainability management in operations and supply chains is evident from the growing body of literature, but there is a gap regarding the management of product returns in a more environmentally sustainable manner. To address this gap, we interviewed multichannel retailers, retail experts and return service providers operating in the UK and North America. The findings reveal that although retailers have started paying attention to the financial impact of returns, there is little awareness of the scale of environmental impacts. In addition, retailers lack a comprehensive approach to addressing the environmental impact of product returns. Based on our findings, we (1) unpack the barriers inhibiting retailers from developing environmental sustainability plans in returns management, (2) present a set of strategies for retailers to reduce the environmental impact of returns and (3) develop a framework for environmental sustainability in returns management. Our findings and proposed framework have implications for research and practice on addressing the environmental impact of product returns. [ABSTRACT FROM AUTHOR]

"Rehabilitating Dad's Army: Britain's Secret Defenses" by Andrew Chatterton explores the often overlooked and misunderstood contributions of the civilian volunteers who defended Britain during World War II. Chatterton focuses on three secret organizations within the Home Guard: the Auxiliary Units, the Special Duties Branch, and Section VII. These groups were involved in anti-invasion efforts, sabotage, intelligence gathering, and even assassination. Chatterton's book provides new insights and challenges the comedic portrayal of the Home Guard in the popular television series "Dad's Army." While not groundbreaking, the book serves as a useful introduction to the topic and a starting point for further research. [Extracted from the article]

Background: Monte Carlo (MC) simulations are used in nuclear medicine imaging as they provide unparalleled insight into processes that are not directly experimentally measurable, such as scatter and attenuation in an acquisition. Whilst MC is often used to provide a 'ground-truth', this is only the case if the simulation is fully validated against experimental data. This work presents a quantitative validation for a MC simulation of a single-photon emission computed tomography (SPECT) system. Methods: An MC simulation model of the Mediso AnyScan SCP SPECT system installed at the UK National Physical Laboratory was developed in the GATE (Geant4 Application for Tomographic Emission) toolkit. Components of the detector head and two collimator configurations were modelled according to technical specifications and physical measurements. Experimental detection efficiency measurements were collected for a range of energies, permitting an energy-dependent intrinsic camera efficiency correction function to be determined and applied to the simulation on an event-by-event basis. Experimental data were collected in a range of geometries with 99 m Tc for comparison to simulation. The procedure was then repeated with 177 Lu to determine how the validation extended to another isotope and set of collimators. Results: The simulation's spatial resolution, sensitivity, energy spectra and the projection images were compared with experimental measurements. The simulation and experimental uncertainties were determined and propagated to all calculations, permitting the quantitative agreement between simulated and experimental SPECT acquisitions to be determined. Statistical agreement was seen in sinograms and projection images of both 99 m Tc and 177 Lu data. Average simulated and experimental sensitivity ratios of ( 0.991 ± 0.011 ) were seen for emission and scatter windows of 99 m Tc, and ( 0.897 ± 0.014 ) and ( 0.839 ± 0.014 ) for the 113 and 208 keV emissions of 177 Lu, respectively. Conclusions: MC simulations will always be an approximation of a physical system and the level of agreement should be assessed. A validation method is presented to quantify the level of agreement between a simulation model and a physical SPECT system. [ABSTRACT FROM AUTHOR]

Background: The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. Method: We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. Results: There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. Limitations: Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. Conclusions: This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS. [ABSTRACT FROM AUTHOR]

Telomere attrition is one of biological aging hallmarks and may be intervened to target multiple aging‐related diseases, including Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). The objective of this study was to assess associations of leukocyte telomere length (TL) with AD/ADRD and early markers of AD/ADRD, including cognitive performance and brain magnetic resonance imaging (MRI) phenotypes. Data from European‐ancestry participants in the UK Biobank (n = 435,046) were used to evaluate whether mid‐life leukocyte TL is associated with incident AD/ADRD over a mean follow‐up of 12.2 years. In a subsample without AD/ADRD and with brain imaging data (n = 43,390), we associated TL with brain MRI phenotypes related to AD or vascular dementia pathology. Longer TL was associated with a lower risk of incident AD/ADRD (adjusted Hazard Ratio [aHR] per SD = 0.93, 95% CI 0.90–0.96, p = 3.37 × 10−7). Longer TL also was associated with better cognitive performance in specific cognitive domains, larger hippocampus volume, lower total volume of white matter hyperintensities, and higher fractional anisotropy and lower mean diffusivity in the fornix. In conclusion, longer TL is inversely associated with AD/ADRD, cognitive impairment, and brain structural lesions toward the development of AD/ADRD. However, the relationships between genetically determined TL and the outcomes above were not statistically significant based on the results from Mendelian randomization analysis results. Our findings add to the literature of prioritizing risk for AD/ADRD. The causality needs to be ascertained in mechanistic studies. [ABSTRACT FROM AUTHOR]

There is an increasing expectation that advanced, computationally expensive machine learning (ML) techniques, when applied to large population‐wide neuroimaging datasets, will help to uncover key differences in the human brain in health and disease. We take a comprehensive approach to explore how multiple aspects of brain structural connectivity can predict sex, age, general cognitive function and general psychopathology, testing different ML algorithms from deep learning (DL) model (BrainNetCNN) to classical ML methods. We modelled N = 8183 structural connectomes from UK Biobank using six different structural network weightings obtained from diffusion MRI. Streamline count generally provided the highest prediction accuracies in all prediction tasks. DL did not improve on prediction accuracies from simpler linear models. Further, high correlations between gradient attribution coefficients from DL and model coefficients from linear models suggested the models ranked the importance of features in similar ways, which indirectly suggested the similarity in models' strategies for making predictive decision to some extent. This highlights that model complexity is unlikely to improve detection of associations between structural connectomes and complex phenotypes with the current sample size. [ABSTRACT FROM AUTHOR]

Extensive use of petrochemical plastic packaging leads to the greenhouse gas emission and contamination to soil and oceans, posing major threats to the ecosystem. The packaging needs, hence, are shifting to bioplastics with natural degradability. Lignocellulose, the biomass from forest and agriculture, can produce cellulose nanofibrils (CNF), a biodegradable material with acceptable functional properties, that can make packaging among other products. Compared to primary sources, CNF extracted from lignocellulosic wastes reduces the feedstock cost without causing an extension to agriculture and associated emissions. Most of these low value feedstocks go to alternative applications, making their use in CNF packaging competitive. To transfer the waste materials from current practices to the packaging production, it is imperative to assess their sustainability, encompassing environmental and economic impacts along with the feedstock physical and chemical properties. A combined overview of these criteria is absent in the literature. This study consolidates thirteen attributes, delineating sustainability of lignocellulosic wastes for commercial CNF packaging production. These criteria data are gathered for the UK waste streams, and transformed into a quantitative matrix, evaluating the waste feedstock sustainability for CNF packaging production. The presented approach can be adopted to decision scenarios in bioplastics packaging conversion and waste management. [ABSTRACT FROM AUTHOR]

This study aims to explore the role of small and medium-sized enterprises (SMEs) in developing data-driven solutions to address the direct and indirect challenges posed by COVID-19. A sample of six case studies of SMEs from the UK and Portugal were selected to explore in-depth the experience of these companies in proposing innovative solutions in the pandemic context. The findings reveal that the pandemic caused amplifying effects on the digitalization of organizations and the emergence of data-driven solutions. However, the development of a data-driven approach involves not only technologies but also the digitalization of processes and highly skilled human resources. The pandemic was also a catalyst for the emergence of collaborative initiatives that have enabled the development of solutions involving diverse players from science, business, and civilian society. This study offers innovative contributions by focusing exclusively on companies developing data-driven solutions supported by technologies such as the internet of things (IoT), big data, and artificial intelligence. [ABSTRACT FROM AUTHOR]

Based on data on 67,000 articles published in 100 high-impact journals in the twenty years between 2000 and 2019, I analyse the scientific contribution of European political science scholarly communities in the global context. The scholars contributing to the global scientific production are largely concentrated in a few countries, with the US and UK alone accounting for more than half of the articles published in high-impact journals. However, the tendency is towards increasing diversity in the geographic basis of the international scientific production; and European countries are central to this change. Contributing to international collaborative publications has been a key engine of the increased scientific production of scholars based in Europe. This was a generalised global tendency, and a spectacular one for certain national scholarly communities. The network analysis of international collaborations points to the consolidation of three clusters within a growing and increasingly dense network. The US, followed by the UK, are central to a global cluster of collaborations. European countries are primarily clustered in two groups: a larger and growing cluster; and a smaller but even more integrated, highly productive and connected cluster of scholars based in seven northern European countries. All bibliometric indicators consistently point to a generalised growth in the output and internationalisation of the scientific contribution provided by the European political science community. [ABSTRACT FROM AUTHOR]

Contributing to scholarship on diversity and inclusion (D&I) and careers within UK retailing, this paper documents the lived experiences of minority‐ethnic women working in retail. Given the extensive research on both the career obstacles faced by women in a highly feminized sector and the disadvantages experienced by minority‐ethnic workers in the UK labor market more broadly, consideration of social identity categories beyond gender and their impact on retailing careers in the existing literature is limited. Here we use intersectionality theory to explain how individual‐level identity categories, such as gender, ethnicity and religion, intersect with wider organisational practices, which disadvantage the career progression of minority‐ethnic women in UK retail. In a service‐driven sector dependent upon consumers, we conclude that there is a need to consider intersectional identity experiences and power relations within the customer‐employee relationship, as this disproportionately affects minority‐ethnic women and the realization of their career goals in retail. [ABSTRACT FROM AUTHOR]

Tropical cyclones tend to result in distinctive spatial and temporal characteristics in the upper ocean, which suggests that traditional, parametrisation‐based background‐error covariances in oceanic data assimilation (DA) may not be suitable. Using the case study of Cyclone Titli, which affected the Bay of Bengal in October 2018, we explore hybrid methods that combine the traditional covariance modelling strategy used in variational methods with flow‐dependent estimates of the ocean's error covariance structures based on a short‐range ensemble forecast. This hybrid approach is investigated in the UK Met Office's state‐of‐the‐art system. Single‐observation experiments in the ocean reveal that the hybrid approach is capable of producing analysis increments that are time‐varying, more anisotropic and vertically less uniform. When the hybrid oceanic covariances are incorporated into a weakly coupled DA system, the sea‐surface temperature (SST) in the path of the cyclone is changed, not only through the different specifications of background‐error covariances used in the SST assimilation, but also through the propagation of subsurface temperature differences to the surface as a result of vertical mixing associated with the cyclone's strong winds. The coupling with the atmosphere then leads to a discrepancy in the cyclone's central pressure, which brings forth further SST differences due to the different representations of the cyclone's emerging cold wake. [ABSTRACT FROM AUTHOR]

A large literature at the crossroads of biology and cognitive psychology has shown that individuals hold generally positive expectations about future events. Despite this evidence, to date it remains unclear whether optimism has positive or negative implications for entrepreneurial activities. We examine this question in the context of the Covid-19 pandemic, which provides a unique way to study the role of optimism on the (in)ability of firms to overcome exogenous shocks. Using a large-scale longitudinal survey covering 1,632 UK firms, we find that entrepreneurs who score high on optimism were more likely to innovate and make organizational changes to their firms during the Covid-19 outbreak. Moreover, optimistic entrepreneurs experienced higher revenue growth during the pandemic. Collectively, our study sheds light on one of the psychological factors explaining why some firms can prosper and some others struggle in the wake of an external shock. [ABSTRACT FROM AUTHOR]

Background: Biliary sludge (BS) frequently is identified on ultrasonographic examination and is described as incidental. It is hypothesized that biliary stasis and hypersecretion play a role in both BS and gallbladder mucocele (GBM) formation. Recent studies have documented similarities in composition of BS and GBM, and there are several examples of progression from BS to GBM in the veterinary literature. Objectives: To assess the relationship between the presence of BS and later development of GBM in dogs, over time periods >12 months. Animals: A total of 154 dogs with BS and ultrasonographic follow‐up >12 months. Methods: Medical records were retrospectively collected from 9 UK‐based referral centers for all available time points. A semiobjective scoring system was used to track volume of BS within the gall bladder (GB) over time. Results: Twenty dogs developed GBM during the study period. Shetland Sheepdogs (odds ratio [OR], 40.99; 95% confidence interval [CI], 3.61‐465.95; P =.003) and Border Terriers (OR, 11.66; 95% CI, 3.28‐46.63; P <.001) were independent risk factors for the development of GBM. Non–gravity‐dependent BS (NDBS) was noted to form before GBM development in 9/20 dogs, and breeds at‐risk for GBM were more likely to have NDBS. Odds for the development of GBM increased with BS score. Conclusions and Clinical Importance: Dogs with NDBS may be at risk for the development of GBM and a stratified BS scoring system could allow for semiobjective monitoring over time, particularly in at‐risk breeds. [ABSTRACT FROM AUTHOR]

Applying tenets of legal origin theory, this paper traces the origins of banking financial accountability resting behind paragraphs 78 to 82 of the First Schedule of the Companies Act 1862 (UK), where the timely disclosure of a balance sheet and statement of income and expenditure to stakeholders are scrutinised. Comparative legal analysis of 503 banking enactments of the US, Canada and England during the eighteenth and nineteenth centuries reveals that expectations of formal accounts raised by the Companies Act 1862 (UK) were informed by the Colombia Banking Act 1817 (CO) in the US, the Canadian Mauritius Regulations 1830 and the Joint Stock Banks Act 1844 (UK). [ABSTRACT FROM AUTHOR]

Background: Certain autistic characteristics (such as hyper-focus and attention to detail) are valued by veterinary surgeons and autistic adults may disproportionately self-select into the profession. Links between mental wellbeing and retention in the veterinary profession highlight an imperative to profile autistic veterinary surgeons' mental wellbeing and identify protective factors. The psychosocial work environment may represent one such protective factor. We aimed to assess autistic veterinary surgeons' mental wellbeing, the extent to which their psychosocial working conditions achieved UK government management standards and links between these., Methods: Eighty-five autistic veterinary surgeons completed the Warwick-Edinburgh Mental Wellbeing Scale and the Health and Safety Executive's Management Standards Indicator Tool. Descriptive comparisons were drawn with normative data; correlation and linear regression analyses examined relations between mental wellbeing and psychosocial working conditions., Results: Mental wellbeing and psychosocial work environment quality were markedly below veterinary surgeon and general workforce norms. Psychosocial working conditions accounted for 44% of the unique variance in mental wellbeing, with 'control' and 'role' making a significant contribution., Limitation: This exploratory study involved a small self-selecting sample, raising the possibility of response bias., Conclusion: Work design centred on the enhancement of control and role clarity would likely support mental wellbeing in this population., (© 2023 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

The history of Britain's main manifestation of inter-war fascism, Oswald Mosley's British Union of Fascists [BUF], continues to be a hotly contested field of study. A new biography of Mosley, work on gender and the BUF, and the incorporation of new models of generic fascism have made important contributions to the historiography of the BUF. However, until recently, almost no historical consideration of the BUF's career in Scotland had been attempted. But work by Tony Milligan and Henry Maitles has opened up the topic of fascism in Scotland between the wars. This article seeks to build on these contributions, and examines two groups of factors that led to the failure of fascism in Scotland. The inability of the BUF to find political space in Scotland, allied to internal organisational weaknesses, compounded by the indifference of the English fascist movement to the BUF in Scotland created flaws that characterised the Scottish BUF from the outset. These weaknesses were exacerbated by the failure of the BUF to understand the Scottish dimensions of politics, such as the cross-cutting appeal of Scottish nationalism, and religious tensions. Finally, anti-fascist opposition proved to be especially problematic for the Scottish BUF. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the effects of long-term/recurrent use of antibiotics in childhood on developing cognitive impairment in middle and old age from UK Biobank Database. Methods: UK Biobank recruited participants aged 37–73 years. Cognitive impairment was ascertained by fluid intelligence questionnaire. Primary outcome was the occurrence of cognitive impairment in middle and old age. Multivariate logistic regression models were used to explore the relationship between long-term/recurrent use of antibiotics and cognitive impairment. Results: Over 3.8–10.8 years' follow-up, 4,781 of the 35,921 participants developed cognitive impairment. The odds of cognitive impairment in middle and old age among long-term/recurrent use of antibiotics in childhood were increased by 18% compared with their counterparts (adjusted odd ratio 1.18, 95% confidence interval 1.08–1.29, p < 0.01). The effect of long-term/recurrent use of antibiotics in childhood on cognitive impairment was homogeneous across different categories of various subgroup variables such as sex, age, APOE4, ethnic groups, income before tax, smoking status, alcohol status, BMI, hypertension and diabetes but the effect of long-term/recurrent use of antibiotics in childhood was modified by the educational qualification (p- value for interaction <0.05). Conclusion: Long-term/recurrent use of antibiotics in childhood may increase the risk of cognitive impairment in middle and old age. [ABSTRACT FROM AUTHOR]

We investigate the impact of COVID-19 on 42,401 UK SMEs and how government intervention affects their capability to survive the pandemic. The results show that, without governmental mitigation schemes, 59% of UK SMEs report negative earnings and that their residual life is reduced from 164 to 139 days. The analysis shows that government support scheme reduces the number of SMEs with negative earnings to 49% and allows extending the residual life for SMEs with negative earnings to 194 days. In addition, the support scheme reduces the number of jobs at risk in our sample by around 20%. However, our results suggest that weaker firms benefit more than strong ones. Besides, industries that are worst hit by COVID-19 are not those that benefit most from the government support scheme. We ascribe this result to the fact that the schemes do not discriminate between those firms that deserve support and those that do not deserve it. [ABSTRACT FROM AUTHOR]

Background: Cranial cruciate ligament rupture (CCLR) is one of the most common causes of pelvic limb lameness in dogs. Risk factors for CCLR include breed (especially large and giant breeds), body weight, gender and spay/neuter status, and age. Few studies have evaluated physical activity and fitness indicators, however, as risk factors for disease. This study used an online questionnaire distributed primarily via social media to assess risk factors for CCLR in dogs actively engaged in agility training or competition to determine demographic and physical activity factors associated with rupture. Results: Data from 260 dogs with CCLR were compared to similar data from 1006 dogs without CCLR. All dogs were actively training or competing in agility at the time of CCLR or the time of data submission, respectively. Physical characteristics associated with increased risk of CCLR included younger age, spayed female sex, greater body weight, and greater weight to height ratio. Agility activities associated with increased odds ratios included competition in events sponsored by the North American Dog Agility Council (NADAC), competing at novice and intermediate levels, and competing in fewer than 10 events/year. Odds ratios were lower in dogs that competed in events sponsored by United Kingdom Agility International (UKI). Other activities associated with increased odds ratio for CCLR included involvement in flyball activities and short walks or runs over hilly or flat terrain on a weekly basis. Activities associated with decreased odds ratio included involvement in dock diving, barn hunt, nosework, or lure coursing/racing activities and participation in core balance and strength exercises at least weekly. Conclusions: These results are consistent with previous studies demonstrating that body weight and spay/neuter status are risk factors for CCLR in dogs. This is the first report to demonstrate that risk of CCLR in agility dogs is decreased in dogs that engage in regular core strengthening exercises, compete more frequently, compete at higher levels, and compete in more athletically challenging venues. [ABSTRACT FROM AUTHOR]

The invasive Asian date mussel (Arcuatula senhousia) inhabits diverse global coastal environments, in some circumstances posing significant ecological and economic risks. Recently recorded in the Greater North Sea ecoregion, an established population has not previously been confirmed. Combining historical and field data, we provided baseline information from the UK and recorded colonisation in a variety of habitats. Gonadal development was assessed using the gonadosomatic index (GSI) to determine if an intertidal soft-sediment population is self-sustaining. Arcuatula senhousia records from subtidal muddy/mixed-sediment within a major estuarine system from 2007 to 2016 were also analysed. First detected in 2011, spatial distribution was variable across the years within the subtidal, with individuals found at 4–9 out of 25 sites, and densities per site varying from 10 to 290 individuals per m2. The intertidal population was, in part, associated with seagrass (Zostera spp.) and attached to bivalves. In marinas, individuals were attached to concrete tiles, associated with live Mytilus edulis, and to dead Ostrea edulis. Mean GSI from the intertidal population differed across months, peaking in July before declining in September/October, but with high inter-individual variability. Arcuatula senhousia is reproducing and maintaining viable populations. Using a natural capital approach, we identify the potential impacts on Europe's functionally important habitats, fisheries and aquaculture if its spread continues. [ABSTRACT FROM AUTHOR]

Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although barriers and levers to engagement with public health programmes are well documented, there is a lack of proven strategies in the literature addressing these. This paper details the development of a participant engagement intervention aimed at promoting enrolment and attendance to a community-based pre-school obesity prevention programme delivered in UK children's centres; HENRY (Health, Exercise, Nutrition for the Really Young). The Behaviour Change Wheel framework was used to guide the development of the intervention. The findings of a coinciding focused ethnography study identified barriers and levers to engagement with HENRY that informed which behaviours should be targeted within the intervention to promote engagement. A COM-B behavioural analysis was undertaken to identify whether capability, opportunity or motivation would need to be influenced for the target behaviours to occur. APEASE criteria were used to agree on appropriate intervention functions and behaviour change techniques. A multi-level participant engagement intervention was developed to promote adoption of target behaviours that were proposed to promote engagement with HENRY, e.g. ensuring the programme is accurately portrayed when approaching individuals to attend and providing 'taster' sessions prior to each programme. At the local authority level, the intervention aimed to increase buy-in with HENRY to increase the level of resource dedicated to engagement efforts. At the centre level, managers were encouraged to widen promotion of the programme and ensure that staff promoted the programme accurately. HENRY facilitators received training to increase engagement during sessions, and parents that had attended HENRY were encouraged to recruit their peers. This paper describes one of the first attempts to develop a theory-based multi-level participant engagement intervention specifically designed to promote recruitment and retention to a community-based obesity prevention programme. Given the challenges to implementing public health programmes with sufficient reach, the process used to develop the intervention serves as an example of how programmes that are already widely commissioned could be optimised to enable greater impact. [ABSTRACT FROM AUTHOR]

This paper presents a semi‐quantitative review of measures to achieve net‐zero greenhouse gas emissions ("decarbonization") in the cementitious materials (CMs) cycle, that is, activities directly related to cement spanning extraction through to end of life. It focuses on the United Kingdom and Europe in order to relate these measures, comprising emissions, energy, and material efficiency, to the policy landscape. We summarize our findings in an annotated CMs cycle, produced by reconciling the diverse yet relatively underdeveloped literature on the topic, to quantify decarbonization potentials of the various measures in a systematic manner. We find that decarbonization measures with significant potential exist along the entire CMs cycle, although upstream (of use), energy, and emission efficiency measures are better quantified than downstream (of use) and material efficiency measures. Notably, the decarbonization potentials of recycling technologies and the ways in which technological advancements may transform the CMs cycle and thus the stocks, flows, and processing of materials, as well as effectiveness of decarbonization measures, are poorly understood. Therefore, this paper provides a basis to systematically understand the effects of emissions, energy, and material efficiency measures on decarbonization of the CMs cycle and, in this context, the interplay between technology, economic actors, and policy. This article met the requirements for a gold–gold JIE data openness badge described at http://jie.click/badges. [ABSTRACT FROM AUTHOR]

Increased recycling and reuse rates are a central part of the objectives laid out by the COP21. Nonetheless, the practical implementation of what has been called the circular economy, as well as its true potential, are not easily established. This is because the impact and implementation time scales of any intervention depend on knowing the lifetime of products, which is frequently unknown. This is particularly true in construction, responsible for 39% of worldwide emissions, 11% of which are embodied. Most material flow analysis (MFA) models will simply assume a range of plausible life expectancies when bottom‐up data are lacking. In this work, we propose a novel method of identification using the high quality but highly aggregated trade data available and use it to establish a "mortality curve" for buildings and other long‐lasting products. This identification method is intended to provide more reliable inputs to existing MFA models. It is widely applicable because of the general availability of the underlying data. Using it on United Kingdom trade data, we identify product classes at 1 year for packaging/home scrap, 1 to around 10 years for vehicles/equipment, and around 50 years for construction. The identification approach was then validated by using classical approaches using bottom‐up data for vehicles. [ABSTRACT FROM AUTHOR]

Energy and material flows and material stocks are key requirements for the supply of goods and services, which in turn support societal development. However, most resource accounting methods restrict the analysis to resource flows, which fails to acknowledge the increasing role of in‐use stocks in service provision. Using the UK transport sector as a case study, we undertook a material flow analysis through the lens of the stock–flow–service (SFS) nexus. We used the latter to identify how steel consumption and accumulation in vehicles contributed to passenger mobility between 1960 and 2015. Our results show that the efficiency of the steel stock contained in cars and motorcycles decreased from 37.5 to 28.0 passenger‐km (pkm)/kg‐year. The steel service for buses decreased from 63.6 to 32.1 pkm/kg‐year, while that of the national railway increased from 23.8 to 70.3 pkm/kg‐year steel. London Underground steel stock–service efficiency improved from 31.5 to 57.0 pkm/kg‐year steel. The annual fraction of flows that maintained the steel stock varied according to vehicle category and was between 3.4% and 8.2%. In terms of the stock expansion rate, the greatest change (on average, an annual increase of 3%) was that of "cars and motorcycles." This reflects the demographic transitions and the growing consumer demand for car‐based mobility. We discussed how the SFS nexus contributes to a more comprehensive form of resource accounting and reflect upon some of its limitations and how they might be addressed. [ABSTRACT FROM AUTHOR]

Intersectionality allows better understanding of the differences between individuals' experiences. In this article, I use intersectionality to explore how my lived experience of marginalization is different from one context to another. I reflect on how the nature of intersectionality and the intensity of oppression are altered by context. Grounded in a brief reflection of my fragmented experience in two different contexts, I explore how my identities and their intersection "mutate" from the Egyptian context to the UK context. Then, I reflect on how the intensity of oppression changed with this alteration in my intersectionality. In contextualizing my intersectional experience, first I problematize viewing intersectionality as a fixed acontextual ontology. Second, as a student immigrant and racialized minority in the United Kingdom, I seek to extend intersectionality and move beyond the traditional categories of race, class, gender, religion, and sexuality to include precarity as a pivotal social category that amplifies the intensity of oppression and marginalization, especially when intersected with race and gender. Finally, in sharing my reflection as a Middle Eastern woman, I contribute my unique experiences into the conversation, and a voice that has been muted, invisibled, marginalized, and excluded from the literature. [ABSTRACT FROM AUTHOR]

The INHAND (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions) Project (www.toxpath.org/inhand.asp) is a joint initiative of the societies of toxicologic Pathology from Europe (ESTP), Great Britain (BSTP), Japan (JSTP), and North America (STP) to develop an internationally accepted nomenclature for proliferative and nonproliferative lesions in laboratory animals. The purpose of this publication is to provide a standardized nomenclature for classifying lesions observed in most tissues and organs from the dog used in nonclinical safety studies. Some of the lesions are illustrated by color photomicrographs. The standardized nomenclature presented in this document is also available electronically on the internet (http://www.goreni.org/). Sources of material included histopathology databases from government, academia, and industrial laboratories throughout the world. Content includes spontaneous lesions, lesions induced by exposure to test materials, and relevant infectious and parasitic lesions. A widely accepted and utilized international harmonization of nomenclature for lesions in laboratory animals will provide a common language among regulatory and scientific research organizations in different countries and increase and enrich international exchanges of information among toxicologists and pathologists. [ABSTRACT FROM AUTHOR]

The impact of Brexit is strategic. Several governmental institutions must redefine and revise their relations with the European Union (EU); and consider some critical resolutions to avoid prejudicial fragmentation in the post-Brexit security cooperation model. Focusing on internal security and law-enforcement co-ordination with the EU, the paper argues that the EU's approach to future security partnerships reflects common concerns, such as the fight against terrorism and other types of trans-national organised crime. On the other hand, the United Kingdom (UK) will no longer be bound by the EU Charter of Fundamental Rights (CFR) after the Brexit transition period. This poses substantial challenges for the EU and the UK, concerning future agreements on judicial co-operation in cross-border policing and trans-national criminal investigations. From this perspective, it is vital to decide how the data exchange regime and operational collaboration between the British authorities and respective EU agencies are organised. It would be rational to expect that the UK will actively search for closer bilateral ties with several EU member states and potential new partners, to maintain its international position and cross-border security interests. [ABSTRACT FROM AUTHOR]

Objectives: Humans live in environments that reduce the impact of seasonal cues. However, studies suggest that many aspects of human biology, such as birth, metabolism, health, and death are still annually rhythmic. Methods: Using UK Biobank, a large (N = 502 536) population‐based resource, we investigated the influence of seasonality on birth rate, basal metabolic rate, health, reaction speed, and sleep. We also investigated the association between season of birth and regional brain volumes, basal metabolic rate, health, reaction speed, and sleep. Results: Our results showed that annual birth rate peaks in April and May. Individuals had the highest basal metabolic rate in December and January. Poorer subjective general health and slower reaction time were observed in May. Susceptibility to insomnia showed an opposite trend that peaked in autumn and winter. People reported shorter periods of sleep, easier waking, earlier chronotype, more daytime dozing, and napping in summer compared with winter. Our results suggest that season of birth may influence later‐life characteristics. We also observed that the effect of season of birth is in the opposite direction of the seasonal rhythm for basal metabolic rate, reaction time, and insomnia. Moreover, our analysis showed that prevalence of allergy is higher among people born in spring compared to autumn. Conclusions: Overall, our findings indicate a significant effect of seasonality on a range of human traits and that early‐life seasons appear to have an effect on health and behaviors in adulthood. [ABSTRACT FROM AUTHOR]

Objectives: To report the mortality rate within a cohort of dogs undergoing cholecystectomy and investigate the impact of intra‐operative hypotension on mortality. Materials and Methods: Clinical records at five UK referral centres were reviewed for dogs undergoing cholecystectomy. Data collected included presenting signs, pre‐operative blood test results, intra‐operative data including frequency and duration of hypotension and the incidence and type of post‐operative complications. Results: Data from 119 dogs were included. Sixteen dogs (13%) died before discharge and by 28 days after surgery the total mortality was 19 dogs (17%). Hypotension lasting over 10 minutes during general anaesthesia occurred in 65 dogs (54.6%), with a mean ± sd duration of 36.1 ± 30.0 minutes. Intra‐operative hypotension or the number of hypotensive episodes did not appear to be associated with in‐hospital or 28‐day mortality. American Society of Anaesthesiologists grade (of fitness for surgery) was significantly associated with both in‐hospital and 28‐day mortality on univariable analysis, as were post‐operative hypoproteinaemia, ileus and pancreatitis. However on multivariable analysis, only ileus and pancreatitis were found to significantly impact mortality. Clinical Significance: Dogs presenting with a higher American Society of Anaesthesiologists grade appear to have a higher risk of mortality, although intra‐operative hypotension did not appear to be part of this risk. [ABSTRACT FROM AUTHOR]

This article examines the role of the devolved governments of Scotland and Wales in promoting the voluntary Living Wage. It shows that active promotion of the Living Wage standard has emerged in both countries from a broader commitment to an economic policy of 'inclusive growth'. Employment law is not a devolved matter, and the article identifies a broad range of economic incentives and soft forms of regulation that have been used by the devolved governments to promote the Living Wage in the absence of hard power to legislate. Non‐legislative forms of state intervention are often regarded sceptically, but the article shows that the attempts of devolved governments to spread the Living Wage have been impactful, particularly in Scotland. [ABSTRACT FROM AUTHOR]

This commentary explores the manner in which the current COVID-19 crisis is affecting key sources of entrepreneurial finance in the United Kingdom. We posit that the unique relational nature of entrepreneurial finance may make it highly susceptible to such a shock owing to the need for face-to-face interaction between investors and entrepreneurs. The article explores this conjecture by scrutinising a real-time data source of equity investments. Our findings suggest that the volume of new equity transactions in the United Kingdom has declined markedly since the outbreak of the COVID-19 pandemic. It appears that seed finance is the main type of entrepreneurial finance most acutely affected by the crisis, which typically goes to the most nascent entrepreneurial start-ups facing the greatest obstacles obtaining finance. Policy makers can utilise these real-time data sources to help inform their strategic policy interventions to assist the firms most affected by crisis events. [ABSTRACT FROM AUTHOR]

The percentage of products being returned in multichannel retail are high and further increasing, yet many retailers and manufacturers are unaware of the importance and scale of this issue. They consider dealing with returns as a cost of doing business and are oblivious of the potential for conflicts between their corporate social responsibility commitments and their returns practices. This article investigates how far sustainable practices and circular economy concepts have been implemented in retail returns systems; it identifies vulnerabilities, barriers, and challenges to the implementation of sustainable, circular practices and suggests ways to overcome them, as sustainability, loss prevention, and profit optimisation can go hand in hand with the right approach to the organisation of the reverse supply chain. Implications of this research on strategic management are outlined. The research was conducted using in‐depth interviews and observations with four major retailers in the United Kingdom, 17 structured interviews, 100 retailer website reviews, and three retail community workshops, all with British and other European retailers. [ABSTRACT FROM AUTHOR]

Importance: People with major psychiatric disorders (MPDs) have a 10- to 20-year shorter life span than the rest of the population, and this difference is mainly due to comorbid cardiovascular diseases. Genome-wide association studies have identified common variants involved in schizophrenia (SCZ), bipolar disorder (BIP), and major depression (MD) and body mass index (BMI), a key cardiometabolic risk factor. However, genetic variants jointly influencing MPD and BMI remain largely unknown.Objective: To assess the extent of the overlap between the genetic architectures of MPDs and BMI and identify genetic loci shared between them.Design, Setting, and Participants: Using a conditional false discovery rate statistical framework, independent genome-wide association study data on individuals with SCZ (n = 82 315), BIP (n = 51 710), MD (n = 480 359), and BMI (n = 795 640) were analyzed. The UK Biobank cohort (n = 29 740) was excluded from the MD data set to avoid sample overlap. Data were collected from August 2017 to May 2018, and analysis began July 2018.Main Outcomes and Measures: The primary outcomes were a list of genetic loci shared between BMI and MPDs and their functional pathways.Results: Genome-wide association study data from 1 380 284 participants were analyzed, and the genetic correlation between BMI and MPDs varied (SCZ: r for genetic = -0.11, P = 2.1 × 10-10; BIP: r for genetic = -0.06, P = .0103; MD: r for genetic = 0.12, P = 6.7 × 10-10). Overall, 63, 17, and 32 loci shared between BMI and SCZ, BIP, and MD, respectively, were analyzed at conjunctional false discovery rate less than 0.01. Of the shared loci, 34% (73 of 213) in SCZ, 52% (36 of 69) in BIP, and 57% (56 of 99) in MD had risk alleles associated with higher BMI (conjunctional false discovery rate <0.05), while the rest had opposite directions of associations. Functional analyses indicated that the overlapping loci are involved in several pathways including neurodevelopment, neurotransmitter signaling, and intracellular processes, and the loci with concordant and opposite association directions pointed mostly to different pathways.Conclusions and Relevance: In this genome-wide association study, extensive polygenic overlap between BMI and SCZ, BIP, and MD were found, and 111 shared genetic loci were identified, implicating novel functional mechanisms. There was mixture of association directions in SCZ and BMI, albeit with a preponderance of discordant ones. [ABSTRACT FROM AUTHOR]

Background: Studies in the United States show that school students from some ethnic backgrounds are susceptible to stereotype threat, that this undermines their academic performance, and that a series of virtually zero‐cost self‐affirmation writing exercises can reduce these adverse effects. In England, however, socioeconomic status (SES) is a much stronger predictor of academic success than is ethnic background. Aims: This study investigates whether self‐affirmation writing exercises can help close the SES attainment gap in England by increasing the academic performance of low‐SES (but not higher‐SES) school students. Sample: Our sample consisted of students aged 11–14 in a secondary school in southern England (N = 562); of these, 128 were eligible for free school meals, a proxy for low SES. Methods: Students completed three short writing exercises throughout one academic year: those randomly assigned to an affirmed condition wrote about values that were important to them, and those assigned to a control condition wrote about a neutral topic. Results: On average, the low‐SES students had lower academic performance and reported experiencing more stereotype threat than their higher‐SES peers. The self‐affirmation raised the academic performance of the low‐SES students by 0.38 standard deviations but did not significantly affect the performance of the higher‐SES students, thus reducing the SES performance gap by 62%. The self‐affirmation also reduced the level of stress reported by the low‐SES students. Conclusions: The benefits of this virtually zero‐cost intervention compare favourably with those of other interventions targeting the SES academic attainment gap. [ABSTRACT FROM AUTHOR]

Objectives Retirement could be a stressor or a relief. We stratify according to previous psychosocial working conditions to identify short-term and long-term changes in mental health. Method Using data from the Whitehall II study on British civil servants who retired during follow-up (n = 4,751), we observe mental health (General Health Questionnaire [GHQ] score) on average 8.2 times per participant, spanning up 37 years. We differentiate short-term (0–3 years) and long-term (4+ years) changes in mental health according to retirement and investigate whether trajectories differ by psychosocial job demands, work social support, decision authority, and skill discretion. Results Each year, mental health slightly improved before retirement (−0.070; 95% CI [−0.080, −0.059]; higher values on the GHQ score are indicative of worse mental health), and retirees experienced a steep short-term improvement in mental health after retirement (−0.253; 95% CI [−0.302, −0.205]), but no further significant long-term changes (0.017; 95% CI [−0.001, 0.035]). Changes in mental health were more explicit when retiring from poorer working conditions; this is higher psychosocial job demands, lower decision authority, or lower work social support. Discussion Retirement was generally beneficial for health. The association between retirement and mental health was dependent on the context individuals retire from. [ABSTRACT FROM AUTHOR]

Understanding our learning needs is fundamental for safe, effective and knowledge-based medical practice and facilitates life-long learning. A mixed methods study investigated fourth-year medical students' self-perceived understanding of their learning needs using 1] a visual scale, before and after a four-week module in Ageing and Health (A&H) and 2] through focus group discussions. During 2013–14 academic year, all students (252) were invited to use a Visual Analogue Scale (VAS) tool to self-assess their learning needs that were linked to Ageing and Health curriculum learning outcomes. Assenting students (197 at pre-self-assessment, 201 at post-assessment) returned anonymous Visual Analogue Scales, self-assessing history-taking skills, examination skills, knowledge of medication use, co-morbidity, nutritional and swallowing assessment responses, before and after the A&H module. Three student focus groups explored whether completion of the VAS self-assessment had prompted improved self-awareness of their learning needs. The VAS responses increased for each curriculum domain with significant differences between the pre-and post responses – for the student-year-group. Nutritional and swallowing knowledge showed the greatest improvement from a self-assessed low baseline at entry. Focus-group students generally viewed the VAS tool positively, and as an aid for prompting consideration of current and future clinical practice. Some students recognised that 'a need to be ready-for-work' focused engaged learning; others demonstrated self-regulated learning through self-motivation and an action plan. The Visual Analogue Scale quantitative responses showed increased student-self-perceived learning for each curriculum domain at fourth-year completion of the A&H module, suggesting that prompting self-assessment had increased students' knowledge and skills. Focus group students saw the VAS tool as useful for prompting awareness of their current and future learning needs. Additional educational strategies should be explored to enable all students to self-reflect and engage effectively on their learning needs, to gain the skills for the maintenance of professional medical competence. Abbreviations: A&H: Ageing and Health Module; e-portfolio: an electronic version of an evidence portfolio, which allows medical students and graduates to reflect and document learning and competencies; F1: year1 of post-graduate medical clinical training; GMC: General Medical Council-the regulation organisation for maintaining standards for doctors in UK; Logbook: usually a written document which can be used to record procedures and attendance at clinics or case-based discussions and can be used to set learning outcomes and to structure teaching in clinical settings for medical students and doctors; PDP: personal development plan is used to plan future learning and skills needs for work and education with an plan for action/s outcome; SPSS: Statistical Package for the Social Sciences; VAS: Visual Analogue Scale is a visual method of describing an experience. [ABSTRACT FROM AUTHOR]

This article draws on findings from the first cross-national study of school exclusions in the four jurisdictions of the UK. It sketches factors associated with the past research with reductions in exclusions. It then reports interview data gathered in England in 2018 from five specialist officers working in two Local Authorities and a senior officer working for a national voluntary organisation. The officers describe good practice but also national, local and school level developments contributing to a deteriorating situation. These developments include unhelpful government guidance and regulations; school accountability frameworks affecting curriculum and leading to the neglect of Special Educational Needs; loss of Local Authority powers and funding resulting in reductions in support services. Data gathered for this study in other UK jurisdictions suggests that in Scotland and Northern Ireland, and to a lesser extent in Wales, a practice that avoids school exclusions has persisted more than in England. [ABSTRACT FROM AUTHOR]

Young people whose behaviour does not conform to our expectations of how pupils should behave within an educational context have had a variety of labels attached to them including: Social, Emotional and Behavioural Difficulties (SEBD), and Attention Deficit Hyperactivity Disorder (ADHD). The employment of such labels will shape how the young person is perceived by the adults surrounding them. This will not only have an impact on the relationships that are developed between the pupil and the educator but also how the young people see themselves in terms of their own identity. This paper seeks to give voice and explore the position of young people within the confines of their educational experiences. The paper draws on 13 in-depth case studies to reflect on how young people experience the SEBD labels attached to them by others and what pupils consider to be the main antecedents leading them to display behaviour which is deemed unacceptable in the classroom. The paper highlights the importance of providing opportunities for young people to have their voice heard to fill the gap between professional perceptions and those of the pupil. In order to truly understand why young people display behaviour that is considered difficult and how they experience the labels we attach to them we have to speak to young people themselves. [ABSTRACT FROM AUTHOR]

Background: Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. Aims: We used the 2000 Adult Psychiatry Morbidity Survey and an 18-month follow-up data to test hypotheses relating to the role of impulsivity, CSA and MI in the inception and persistence of self-harm. Methods: We assessed associations of impulsivity with (1) suicidal self-harm (SSH) and (2) non-SSH (NSSH) at baseline and follow-up, controlling for confounders including MI. Finally, we tested whether impulsivity mediated the relationship between CSA and self-harm. Results: A total of 8,580 respondents were assessed at baseline and 2,406 at follow-up as planned. Impulsivity significantly predicted emergence of new NSSH at 18-month follow-up even after adjustment for MI and other confounders. Impulsivity did not significantly predict repetition of NSSH, or repetition or new inception of SSH, even before inclusion of MI in the model. However, the absolute numbers involved were small. Cross-sectionally, impulsivity was a stronger mediator of the link between CSA and SSH (13.1%) than that between CSA and NSSH (4.8%). Conclusion: Impulsivity may increase the risk of future development of NSSH independently of MI, which is clinically important for risk assessment. The involvement of impulsivity in the repetition of self-harm generally appears less certain. However, impulsivity may have a role in SSH in the context of previous CSA. [ABSTRACT FROM AUTHOR]

Introduction: The study describes the development of the first UK national framework to guide undergraduate education in anesthesia, perioperative medicine, critical care, and pain medicine. Methods: We followed an inclusive process of curriculum design aiming to promote high-level learning amongst students. We conducted telephone interviews with senior anesthetic educators at 33 UK medical schools to establish current provision and practice. We then held a consultative national workshop for educators, using focus group interviews to set broad aims for the final framework and gather information. Result: Anesthesia undergraduate educators demonstrated a conceptual focus that moves beyond simple acquisition of knowledge to one geared to encouraging clinical behavioral change in learners to equip them for practice as new doctors. Respondents also highlighted the opportunities for promoting spiral, integrated, and longitudinal learning within the undergraduate curriculum. We also formulated eight key domains of practice in anesthesia and critical care and mapped 63 of the 106 General Medical Council's Outcomes for Graduates against these domains, and created a brief suggested syllabus. Conclusions: The framework aims to provide support and guidance for medical schools in the development of competent, well-rounded doctors who are able to provide safe, patient-centered care in all areas of medical practice. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated the patterns of care and health care resource use (HCRU) in patients with metastatic squamous cell carcinoma of the head and neck (SCCHN) who received ≥3 lines of systemic therapy in the United Kingdom (UK). Oncologists (n = 40) abstracted medical records for patients with metastatic SCCHN who initiated third‐line systemic therapy during 1 January 2011–30 August 2014 (n = 220). Patient characteristics, treatment patterns and SCCHN‐related HCRU were summarised descriptively for the metastatic period; exploratory multivariable regression analyses were conducted on select HCRU outcomes. At metastatic diagnosis, most patients had an Eastern Cooperative Oncology Group performance status (PS) of 0/1 (95%). For patients with PS 0/1, the most common first‐line treatment was cisplatin+5‐fluorouracil (5‐FU); docetaxel was the most common second‐ and third‐line treatment. For patients with PS ≥ 2, the most common first‐, second‐, and third‐line treatments were carboplatin+5‐FU, cetuximab, and methotrexate, respectively. Most patients received supportive care during (85%) and after (89%) therapy. This study provides useful information, prior to the availability of immunotherapy, on patient characteristics, treatment patterns, HCRU, and survival in a real‐world UK population with metastatic SCCHN receiving ≥3 lines of systemic therapy. Patterns of care and HCRU varied among patients with metastatic SCCHN; specific systemic therapies varied by patient PS. [ABSTRACT FROM AUTHOR]