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This article traces the leisure travel of British homosexual men in continental Europe between 1950 and 1975. The aim of this article is to challenge narratives of British post-war sexual rights discourses as isolated from continental Europe. Taking a transnational approach, which examines the ways in which Britain was embedded in processes of social and cultural change across Europe, it charts informal encounters and networks of cultural communication forged by homosexual men themselves during the post-war tourist boom. Using Oral Histories deposited at the British Library Sound Archive, I emphasize the role of homosocial spaces in the production and performance of the sexual self and establish how affluence provided access to spaces for sexual self-development during a period when homosexuality remained criminalized in Britain. It explores two distinct types of holidays taken by homosexual travellers, examined via a life writing approach—the Amsterdam city break and the southern European beach holiday—and shows how these experiences shaped their self-conception and hopes for a more tolerant society at home. In revealing how foreign forms of homosexual sociability influenced domestic politics, I argue for a stronger emphasis on British entanglements with continental Europe when tracing political and social transformations during the post-war period. [ABSTRACT FROM AUTHOR]

Learning is a developmental journey, and geography curriculum plays a key role in supporting student progression. In this article, we argue that the concept of "self-authorship" is a useful guiding principle in supporting curriculum revision and reform. A series of international case studies illustrate how self-authorship can be enacted in different ways within geography curricula in a range of contexts. The role of a range of collaborators and the co-curriculum in supporting the student journey are highlighted. The article concludes by suggesting that the key strength of the concept is its non-prescriptive nature. (Contains 3 tables and 5 figures.)

Doctors are increasingly expected to demonstrate medical leadership and management (MLM) skills. The Faculty of Medical Leadership and Management (FMLM) has published an indicative undergraduate curriculum to guide the development of MLM content at UK medical schools. Students from 30 medical schools were surveyed to determine their understanding of MLM teaching at their school. Timetables for 21 schools were searched for MLM-related keywords. Student-reported teaching and timetabled teaching were coded according to predefined themes. Aggregated demographic and postgraduate performance data were obtained through collaboration with the Medical Student Investigators Collaborative (msico.org). Whilst 88% of medical students see MLM teaching as relevant, only 18% believe it is well integrated into their curriculum. MLM content represented ∼2% of timetabled teaching in each 5-year undergraduate medical course. Most of this teaching was dedicated to teamwork, performance/reflection and communication skills. There was minimal association between how much of a topic students believed they were taught, and how much they were actually taught. We found no association between the volume of MLM teaching and performance in postgraduate examinations, trainee career destinations or fitness to practice referrals. Our findings demonstrate limited and variable teaching of MLM content. Delivery was independent of broader teaching and assessment factors. [ABSTRACT FROM AUTHOR]

An imbalance in the renin-angiotensin system (RAS) is associated with cognitive decline and disease pathology in Alzheimer's disease (AD). In this study, we have investigated changes in the brain angiotensin-converting enzyme-1 (ACE-1) and angiotensin-II (Ang-II), and the counter-regulatory angiotensin-converting enzyme-2 (ACE-2), in the frontal and temporal cortex during normal aging and in the early stages of AD. We studied a cohort of normal aging (n = 121; 19-95 years age-at-death) from the Sudden Death Brain Bank, University of Edinburgh, United Kingdom, and AD and age-matched controls (n = 60) from the South West Dementia Brain Bank, University of Bristol, United Kingdom, stratified according to Braak tangle stage (BS): 0-II, III-IV (intermediate disease), and V-VI (end-stage disease). ACE-1 and ACE-2 enzyme activity were measured using fluorogenic peptide activity assays. ACE-1, ACE-2, and Ang-II protein level were measured by enzyme-linked immunosorbent assay (ELISA). In both regions, ACE-1 protein and Ang-II levels correlated positively with age whereas ACE-1 enzyme activity was inversely related to age. ACE-1 protein correlated positively with Ang-II, whilst ACE-1 activity correlated inversely with Ang-II in normal aging. ACE-1 enzyme activity was elevated at an early/intermediate stage, BS III-IV compared to BS 0-II in the temporal cortex in AD. ACE-2 protein and enzyme activity were unchanged with aging and in AD. In conclusion, ACE-1 activity is induced in the early stages of AD independently from normal physiological age-related changes in ACE-1 protein. [ABSTRACT FROM AUTHOR]

Tedizolid is a new oxazolidinone antibiotic with little real-life data on use outside of skin and soft tissue infections. There is a paucity of safety evidence in courses greater than 6 days. Our centre uses tedizolid predominantly when linezolid-associated adverse events have occurred. This service evaluation describes our experience to date. We performed a retrospective service evaluation by reviewing case notes, prescription charts, and laboratory system results for each patient prescribed tedizolid at our hospital and recording patient demographics, clinical details, and outcomes. Sixty patients received tedizolid between May 2016 and November 2018. Most were treated for bone or joint infections and had stopped linezolid prior to tedizolid prescription. Mean length of tedizolid therapy was 27 days. Haematological adverse effects were infrequent. Most patients (72%) finished the course and their clinical condition improved during treatment (72%). Adverse events were common, but often not thought to be tedizolid related. Tedizolid appears to be safe in prolonged courses within this context. It may be suitable for longer-term antibiotic therapy within a complex oral and parenteral outpatient antibiotic therapy (COPAT) service. Patients who do not tolerate linezolid can be safely switched to tedizolid if appropriate. [ABSTRACT FROM AUTHOR]

Background: We evaluated the incremental contribution of chronic kidney disease (CKD) to the risk of major adverse cardiovascular (CV) events (MACE), heart failure (HF), and all-cause mortality (ACM) in type 2 diabetes mellitus (T2DM) patients and its importance relative to the presence of other cardio-renal-metabolic (CaReMe) comorbidities.Methods: Patients (≥40 years) were identified at the time of T2DM diagnosis from US (Humedica/Optum) and UK (Clinical Practice Research Datalink) databases. Patients were monitored post-diagnosis for modified MACE (myocardial infarction, stroke, ACM), HF, and ACM. Adjusted hazard ratios were obtained using Cox proportional-hazards regression to evaluate the relative risk of modified MACE, HF, and ACM due to CKD. Patients were stratified by the presence or absence of atherosclerotic CV disease (ASCVD) and age.Results: Between 2011 and 2015, of 227,224 patients identified with incident T2DM, 40,063 (17.64%) had CKD. Regardless of prior ASCVD, CKD was associated with higher risk of modified MACE, HF, and ACM; this excess hazard was more pronounced in older patients with prior ASCVD. In time-to-event analyses in the overall cohort, patients with T2DM + CKD or T2DM + CKD + hypertension + hyperlipidemia had increased risks for modified MACE, HF, and ACM versus patients with T2DM and no CaReMe comorbidities. Patients with CKD had higher risks for and shorter times to modified MACE, HF, and ACM than those without CKD.Conclusion: In T2DM patients, CKD presence was associated with higher risk of modified MACE, HF, and ACM. This may have risk-stratification implications for T2DM patients based on background CKD and highlights the potential importance of novel renoprotective strategies. [ABSTRACT FROM AUTHOR]

Heavy menstrual bleeding (HMB) is often undiagnosed in women and can cause discomfort and distress. A haemostatic cause for excessive bleeding is often not routinely investigated and can lead to hysterectomy at an early age. A prospective cohort study was carried out to determine whether certain patients with unexplained HMB have an underlying platelet function defect (PFD). The Genotyping and Phenotyping of Platelets (GAPP) study recruited 175 women with HMB and 44 unrelated volunteers from 25 Haemophilia Centres across the UK, and a tertiary gynaecology service. Bleeding history was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Platelet count, platelet size, haemoglobin and mean corpuscular volume were measured in whole blood using the Sysmex XN-1000 Haematology Analyzer. Platelet function testing using lumiaggregometry and flow cytometry was performed in patients included in this study. A PFD was identified in 47% (82/175) of patients with HMB. Cutaneous bleeding was the most frequent additional bleeding symptom (89% in PFD and 83% with no PFD). Whole blood platelet count was significantly lower (P < 0.0001) between the PFD group and no PFD group. The prevalence of anaemia did not differ between patients and healthy volunteers. Clinical evaluation alone is insufficient to determine presence of an underlying PFD in patients with HMB. Platelet function tests may be considered and clinical guidelines may include them in their algorithms. An appropriate diagnosis and subsequent tailored management of HMB may prevent unnecessary surgery and help manage future haemostatic challenges. [ABSTRACT FROM AUTHOR]

Describes problems resulting from the use of immigrant industrial workers with poor language understanding and the method used to assess functional oral English for occupational purposes. While the form of assessment provides authentic data for company training and communication needs, further research is needed to resolve some problems. (MF)

Introduction: Increasing emphasis is being placed on insulin use among patients with type 2 diabetes mellitus (T2DM). Basal-bolus (BB) therapy is regarded as the gold standard, but a high frequency of injections and the general complexity of this therapy are seen as barriers in real-world practice. Here we describe the characteristics and treatment patterns of patients with T2DM receiving BB in the UK, with specific focus on those switching to a simplified regimen of premixed insulin. Methods: Patients with T2DM receiving BB from 1 January 2005 were identified from the Clinical Practice Research Datalink. Characteristics were described at treatment initiation or on 1 January 2005, and treatment patterns were assessed at 12 months of follow-up. Clinical factors were compared in two groups of patients who while receiving BB had one haemoglobin A1c (HbA1c) measurement of ≥53 mmol/mol (7.0%) and remained either on BB or switched to a premixed insulin regimen. Results: Study criteria were met by 12,060 subjects (mean age 59 years; duration diabetes 12.4 years). The mean HbA1c concentration was 76 mmol/mol (9.1% of patients), and 84.0% of patients were overweight. At 12 months of follow-up, 74.5% of the patients who had started BB remained on it. While on BB, 8835 patients had a HbA1c measurement of ≥53 mmol/mol (7.0% of all patients); of these, 95.9% remained on BB and 4.1% switched to premixed insulin. Mean HbA1c levels were consistently higher for patients who switched to premixed insulin than for those who remained on BB, but the levels remained relatively unchanged over time. Conclusion: A large proportion of patients receiving insulin did not achieve good glycaemic control in clinical practice. A small subset with higher comorbidities and HbA1c levels switched to a simplified regimen. Little evidence was found that type of insulin therapy was associated with meaningful changes in key clinical factors over time. Funding: Eli Lilly and company. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors considered to be important in the adjustment to amputation and the wearing of a prosthetic limb from the perspective of the person who has had a lower limb amputation. Hence, focus group methodology was employed as a means of acquiring perspectives within a population of young adults who had a lower limb amputation. Preliminary thematic analysis revealed that factors such as self-image, social, physical and practical concerns, the meaning attributed to and the acceptance of the amputation and support among others were important in the adjustment process. These findings have substantial implications for directing future research. [ABSTRACT FROM AUTHOR]

Objective To evaluate the management of pregnancies where the fetus was found to have one or more sonographic markers of possible fetal chromosomal abnormality. Design Prospective anonymous postal survey of UK obstetric ultrasound units. Main outcome measures The management of pregnancies where the fetus is found to have a sonographic marker of aneuploidy. Population All 252 maternity ultrasound units in the United Kingdom. Methods Postal questionnaire to the superintendent sonographer in routine maternal ultrasound departments. Results Questionnaires were returned from 179 maternity units (71%). Of the respondents 94% offered a fetal anomaly scan at 16–20 weeks' gestation and 59% performed a dating scan at 10–14 weeks. Screening for Down syndrome was available in 99% of all maternity units.The recognition of sonographic ‘soft signs’ for possible fetal chromosomal abnormality varied considerably between the units. When sonographers were asked about their unit's policy regarding offering amniocentesis to women with sonographic markers, 8–78% discussed amniocentesis when the marker was isolated and 53–88% when another abnormality was found.Eighty nine percent of units documented the abnormal ultrasound findings in the hospital notes and 88% of the women were informed of the findings regardless of the intention to offer amniocentesis. Conclusion The practice of routine ultrasound examination is well established in UK, though precise policies vary. The existing wide variations in management policies possibly reflect a lack of data derived from low risk populations. There is a need to collect such data from low risk populations with known screening practices so that national guidelines to standardize practice can be formulated. [ABSTRACT FROM AUTHOR]

This article tests the Managerial and Professional Profiler (MAPP), a personality questionnaire developed in Great Britain for use in occupational settings, among a group of managers from Malawi. Personality tests are becoming increasingly popular. It is now well recognized that using psychometric instruments developed within one cultural context to assess human attributes in another cultural context is fraught with difficulties. One aspect of psychometric acceptability across cultures that has been largely ignored is face validity. In the very broadest sense, this concept may refer to whether the instrument appears acceptable to respondents in terms of what it sets out to achieve. Although the sample size was small, the present results suggest that, regardless of the psychometric properties of the MAPP in Malawi, the potential consumers of this personality questionnaire were, on average, equivocal about it. Authors believe that the way in which people perceive a psychometric instrument is likely to influence not only their enthusiasm for it but also the more conventional psychometric properties of the instrument. Authors suggest that all instruments could benefit from an analysis of their consumers' views, especially when the instruments are applied in a cultural context different from the one in which they were developed.

The British Ocean Sediment Core Research Facility (BOSCORF) provides long-term curation and archiving of sediment cores collected by the UK's geoscience community. The collection consists of 8,900 m of core composed of 2,400 individual marine sediment cores and is stored at a dedicated facility at the National Oceanography Centre (NOC). BOSCORF has taken an increasingly active role in geoscience outreach at a multitude of scales. The repository forms an essential component of formal visitor tours to the NOC. Annually hosting educational sessions for high-school students, engages with regionally active geological interest groups and recently, participating in large scale public science events. BOSCORF has utilised the recent NERC funded project: the Arctic Landslide Tsunami Project, and developed an activity that can be adapted to the needs of specific audiences. The activity focusses on the Storegga Slides, and the history of tsunamis and volcanic eruptions to have affected the UK. To appeal to a wide range of audiences, this outreach activity places emphasis on constructivist learning, relating complex scientific concepts such as sedimentation rates, tephrochronology and turbidites to recent examples of volcanic eruptions and tsunamis. Using a sediment core as a visual guide, participants are guided through a history of geohazards, and given a range of statistics and facts relating to the visible event in the sediment core (e.g. Holocene tephra). This information is then compared with a similar event occurring today (e.g. 48 x the size of the Eyjafjallajökull eruption). The focus is on risk to UK populations which leads a targeted discussion on hazard mitigation, policy and future research, and the role that BOSCORF has in achieving these goals. In addition, a range of unique and varied peripheral activities have been included to interest stakeholders from varied backgrounds. These have included 3D printed foraminifera, peat cores containing tsunami deposits and a "tsunami" generator in a paddling pool. The use of a currently research-active scientific resource does present some challenges for BOSCORF, but through collaboration with the NOC Communications department, these issues have been managed, and this resource should be available for several years.The "storytelling" approach, using a deep marine sediment core as a timeline to frame a complex problem, captures the imagination of those who engage with the activity. A focus on training staff to encourage the participant to reflect on their new knowledge (tsunamis in the UK) and develop this interest through guided questioning (where could this happen, why could this happen, how can you tell this happened), is essential to avoiding the feeling of being "lectured at" by a scientist. This approach helps to make participants feel involved, and to understand why facilities such as BOSCORF exist, why they are tax-payer funded and the relevance of the science. It is also essential to ensure an understanding of the limitations of the science is effectively communicated, and that they will encounter research similar to this in the press, and to think critically about how it is reported. [ABSTRACT FROM AUTHOR]