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Background: Objective Structured Clinical Examinations (OSCEs) are a simulation-based assessment tool used extensively in medical education for evaluating clinical competence. OSCEs are widely regarded as more valid, reliable, and valuable compared to traditional assessment measures, and are now emerging within professional psychology training programs. While there is a lack of findings related to the quality of OSCEs in published psychology literature, psychometric properties can be inferred by investigating implementation. Accordingly, the current review assessed implementation of OSCEs within psychology programs against a set of Quality Assurance Guidelines (QAGs). Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. Electronic databases including ProQuest Psychology, PsycArticles, Psychology and Behavioural Sciences Collection, PsycInfo and key indexing databases such as Scopus, ProQuest, and Web of Science were used to identify relevant articles. Twelve full-text articles met all inclusion criteria and were included in the review. Results: There was considerable heterogeneity in the quality of studies and reporting of OSCE data. Implementation of OSCEs against QAGs revealed overall adherence to be "Fair." Conclusion: The current review consolidated what is known on psychometric quality of OSCEs within psychology programs. A further need for quantitative evidence on psychometric soundness of OSCEs within psychology training is highlighted. Furthermore, it is recommended that future training programs implement and report OSCEs in accordance with standardized guidelines.

Purpose: The purpose of this paper is to focus on a designed research methodology to distil existing research findings from an esrc/ahrc funded japan/uk network on location-based virtual reality experiences for children in order to generate new knowledge. Design/methodology/approach: The structured co-production methodology was undertaken in three stages. These were: (1) a collaborative workshop which produced a series of collage narratives, (2) collaborating with a non-human entity in the form of a digital coded tool to reconfigure the workshop responses and mediate the hierarchy of roles, (3) the co-production of a zine as a collaborative reflection method, which shared via postal service enabled a dialogue and exchange of round Robin interventions by the network members. Findings: The analysis of the data collected in this study highlighted five themes that could be used by other researchers on a wide range of projects. These were: (1) knowing through making, (2) the importance of process, (3) beyond linear representations, (4) agency of physical materials and (5) agency of digital code. Research limitations/implications: The context of the study being undertaken during the first phase of the global pandemic, revealed insight into a method of co-production that was undertaken under emergency remote working conditions. The knowledge generated from this can be applied to other research contexts such as working with researchers or participants across global borders without the need to travel. Originality/value: The research provides an innovative rethinking of co-production methods in order to generate new knowledge from multidisciplinary and multimodal research.

This paper outlines the findings from a study that examined the tablet and app use of children aged from birth to three. The aim of the study was to examine how far use of tablets and apps promoted play and creativity. A total of 954 UK parents of children aged from birth to three who had access to a tablet in the home completed an online survey that explored the children's use of apps. Ethnographic case studies of four children aged from birth to three were undertaken in homes in order to explore in greater depth issues that emerged in the survey. The paper reports on the way in which the use of tablets promoted play and creativity across cognitive, physical social and cultural domains. The implications for policy and research are outlined.

Background: Social connections between medical students provide a key basis for learning and support. These connections, and associated social identity, may be patterned by ethnicity, and students often perform similarly academically to those they connect with. The mechanisms that underpin the formation of these connections and the role that they play are not fully understood. This study explored how medical students connect with each other, and the potential impact of this on their academic attainment and well‐being, with a focus on students with minoritised ethnic identities. Methods: A mixed methods study combining (1) a survey to establish the number and strength of connections formed by Years 1 and 2 medical students with both minoritised and non‐minoritised ethnicities and (2) semi‐structured interviews to understand how connections were formed, whether this was shaped by ethnicity and the role of connections in supporting students with their learning and well‐being. Results: One hundred fifty‐one students (15.5% response rate) completed the survey. Students connected regularly with three to four peers with the goal of supporting learning and 71.9% of students reported a sense of social identification with this group. There was no statistical difference between ethnically minoritised and White students on either of these measures (t = 0.1, p = 0.92, χ2 = 2.9, p = 0.56). Interviews with 19 students found that social connections were shaped by perceptions of their self‐identity and the need to find 'equilibrium' by forming relationships with compatible others. The education environment, including its ethnic diversity, impacted on the opportunities to make connections. Students who were ethnically minoritised reported encountering challenges, especially in the clinical environment, and described the burden of these for them. Discussion: Curriculum designers should consider the time and space that is afforded to student interaction during course development, as finding compatible others with whom students can socially connect is important to balancing well‐being with academic performance. Bull et al. analyze students' experiences to show that they seek individuals with whom they feel compatible to maintain 'equilibrium' and support both academic performance and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Friendships have been linked to mental health and school attainment in children. The effects of friendlessness and friendship quality have been well researched, but less is known about the role of friendship stability (i.e., maintaining the same friend over time), an aspect of friendship which is often interrupted by the transition between phases of schooling. Many children report concerns about the secondary school transition which introduces a number of new social and academic challenges for children. Aims: To explore rates of friendship stability and whether maintaining a stable best friend across the primary to secondary school transition provided benefits to children's adjustment during this period. Sample: Data were from 593 children (M age = 11 years 2 months). Methods: This study used longitudinal data from children transitioning into 10 UK secondary schools and explored the association between self-reported friendship stability and three outcomes: academic attainment, emotional problems and conduct problems. Analyses controlled for friendship quality and pre-transition psychological adjustment or attainment as appropriate. Results: Rates of friendship stability were relatively low during this period. Children who kept the same best friend had higher academic attainment and lower levels of conduct problems. Exploratory analyses indicated that secondary school policies that group children based on friendships may support friendship stability. Conclusions: Helping maintain children's best friendships during the transition to secondary school may contribute to higher academic performance and better mental health.

Background and aims: Xylazine is a non‐opioid sedative which has spread rapidly throughout the US illicit drug supply. This study aimed to describe the spread of xylazine throughout the UK illicit drug supply. Methods: Xylazine detections in human biological samples were collated from toxicology laboratories operating in the United Kingdom with the date, location, case type, xylazine concentration and co‐detected drugs (with quantifications where performed) detailed, where permitted, by the corresponding coroner. Drug‐testing cases positive for xylazine were collated from the Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) drug‐testing postal service with the date, location, purchase intent and co‐detected drugs detailed. Drug seizures made by UK law enforcement were communicated by the Office for Health Improvement and Disparities with the date and location detailed. Results: By the end of August 2023, xylazine was detected in 35 cases from throughout toxicology, drug‐testing and drug seizure sources covering England, Scotland and Wales. There were no cases reported from Northern Ireland. Xylazine was detected in biological samples from 16 people. In most cases where full toxicology results were provided, xylazine was detected with heroin and/or a strong opioid (n = nine of 11), but this polydrug use pattern was not evident in all cases (n = two of 11), suggesting a wider circulation of xylazine in the UK illicit drug market beyond heroin supplies. Evidence from WEDINOS supports this claim, as all 14 drug samples (100%) submitted from across the UK contained xylazine; however, in none of these cases was heroin the purchase intent but rather counterfeit prescription medication tablets (n = 11 of 14), tetrahydrocannabinol (THC) vapes (n = two of 14) or white powder (n = one of 14). Additional evidence for the spread of illicit xylazine comes from five drug seizures made by law enforcement. Conclusions: Xylazine has penetrated the UK illicit drug market and is not limited to heroin supplies. [ABSTRACT FROM AUTHOR]

This study is the first to systematically investigate the extent to which apps for children aged 0-5 foster play and creativity. There is growing evidence of children's use of tablets, but limited knowledge of the use of apps by children of children of this age. This ESRC-funded study undertook research that identified how UK children aged from 0 to 5 use apps, and how far the use of apps promotes play and creativity, given the importance of these for learning and development. A survey was conducted with 2000 parents of under 5s in the UK, using a random, stratified sample, and ethnographic case studies of children in six families were undertaken. Over 17 hours of video films of children using apps were analysed. Findings indicate that children of this age are using a variety of apps, some of which are not aimed at their age range. The design features of such apps can lead to the support or inhibition of play and creativity. The study makes an original contribution to the field in that it offers an account of how apps contribute to the play and creativity of children aged five and under.

This article looks at the way in which changes in technology, as well as wider social and cultural patterns, bring about new materials in the landscape of young children's communication practices and play. This is done in relation to a new form of screen-less digital toy known as Avakai. Avakai are a set of digitally interactive wooden dolls that combine set movements and sounds. The study had two parts that focused first on the toy's design and second on how it was used in combined play and communication practices by seven 4- to 6-year-olds. This was to ascertain the extent to which the design and children's use aligned. Data were gathered through conversations and email exchanges with the toy designers and observations of the children's play and communication practices with the toy. All data were transcribed and analysed using thematic analysis. Three key findings are discussed in relation to the alignment of these two areas: (1) children's customisation of the toy design, (2) designing to produce emotional narratives in play and (3) the use of a compartment in the toy's base. Each finding is described in relation to the designers' backgrounds and intentions for the toy, and then the children's use in terms of play and communication. In doing so, the extent to which the child and the toy's design influenced play and communication practices is shown. These findings make a contribution to the field of materialities in young children's communication practices when playing. This is ever important given the evolving speed of new materials and technologies for play and communication. In particular to how non-visual modes of communication are foregrounded in the absence of screens. In addition, it adds to prior research that has taken an object ethnographic approach by uniquely considering the toy in relation to primary data about the toy designers' backgrounds and design decisions rather than from what can be inferred from the object.

Purpose: There is a need for well-defined language phenotypes suitable for adolescents in twin studies and other large-scale research projects. Rice, Hoffman, and Wexler (2009) have developed a grammatical judgment measure as a clinical marker of language impairment, which has an extended developmental range to adolescence. Method: We conducted the first twin analysis, along with associated phenotypic analyses of validity, of an abridged, 20-item version of this grammatical judgment measure (GJ-20), based on telephone administration using prerecorded stimuli to 405 pairs of 16-year-olds (148 monozygotic and 257 dizygotic) drawn from the Twins Early Development Study (Haworth, Davis, & Plomin, 2012). Results: The distribution of scores is markedly skewed negatively, as expected for a potential clinical marker. Low performance on GJ-20 is associated with lower maternal education, reported learning disability (age 7 years), and low scores on language tests administered via the Twins Early Development Study (age 16 years) as well as General Certificate of Secondary Education English and Math examination performance (age 16 years). Liability threshold estimates for the genetic influence on low performance on GJ-20 are substantial, ranging from 36% with a lowest 10% criterion to 74% for a lowest 5% criterion. Conclusions: The heritability of GJ-20 scores, especially at more extreme cutoffs, along with the score distribution and association with other indicators of language impairments, provides additional evidence for the potential value of this measure as a clinical marker of specific language impairment.

This paper explores the changing roles of families in children's developing literacy in the UK in the last century. It discusses how, during this time, understandings of reading and writing have evolved into the more nuanced notion of "literacy." Further, in acknowledging changes in written communication practices, and shifting attitudes to reading and writing, the paper sketches out how families have always played some part in the literacy of younger generations; though reading was frequently integral to the lives of many families throughout the past century, we consider in particular the more recent enhancement of children's literacy through targeted family programmes. The paper considers policy implications for promoting young children's literacy through work with families.

Background: Depression and anxiety are the most common mental health problems in young people. Currently, clinicians are advised to wait before initiating treatment for young people with these disorders as many spontaneously remit. However, others develop recurrent disorder but this subgroup cannot be identified at the outset. We examined whether psychiatric polygenic scores (PGS) could help inform stratification efforts to predict those at higher risk of recurrence. Methods: Probable emotional disorder was examined in two UK population cohorts using the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ). Those with emotional disorder at two or more time points between ages 5 and 25 years were classed as 'recurrent emotional disorder' (n = 1,643) and those with emotional disorder at one time point as having 'single episode emotional disorder' (n = 1,435, controls n = 8,715). We first examined the relationship between psychiatric PGS and emotional disorders in childhood and adolescence. Second, we tested whether psychiatric PGS added to predictor variables of known association with emotional disorder (neurodevelopmental comorbidity, special educational needs, family history of depression and socioeconomic status) when discriminating between single‐episode and recurrent emotional disorder. Analyses were conducted separately in individuals of European and South Asian ancestry. Results: Probable emotional disorder was associated with higher PGS for major depressive disorder (MDD), anxiety, broad depression, ADHD and autism spectrum disorder (ASD) in those of European ancestry. Higher MDD and broad depression PGS were associated with emotional disorder in people of South Asian ancestry. Recurrent, compared to single‐episode, emotional disorder was associated with ASD and parental psychiatric history. PGS were not associated with episode recurrence, and PGS did not improve discrimination of recurrence when combined with clinical predictors. Conclusions: Our findings do not support the use of PGS as a tool to assess the likelihood of recurrence in young people experiencing their first episode of emotional disorder. [ABSTRACT FROM AUTHOR]

This paper draws on an ESRC-funded study of play and creativity in preschool-aged children's use of apps in the UK. The main objectives of the study were to collect information about access to and use of apps in the home, establish the most popular apps and identify the features of those apps that are successful in promoting play and creativity. A mixed-method approach was used to collect data, including video filming of children using the most popular apps. In identifying play types that emerged in the analysis of data, the team utilised an established taxonomy, which outlines sixteen play types. This taxonomy was reviewed and adapted to analyse data from the project relating to digital play. Through this process, an additional type of play, transgressive play, was identified and added to the taxonomy. The paper outlines the implications of the revised taxonomy for future studies of play.

The mass media has a fundamental role to sustain an informed citizenry as a prerequisite for democratic politics. It is, therefore, vital that an evidence-based approach is used when reporting on climate change. Yet, multiple and arguably irreconcilable tensions exist between science and mass media. For example, as media workers are trained to provide a "balanced" approach, this can result in bias in climate change reporting. Additionally, various industry-related pressures mean that mainstream journalists often have limited resources and time to check the accuracy of their climate news stories with researchers. Such tensions and media coverage of alleged climate research misconduct formed the basis of a survey we have developed for an interface group of researchers and journalists who have a vested interest in climate science. The aim of this survey is to compare their attitudes on the performance of the media as a channel of climate change information. The survey was conducted in mid-2010, with responses from journalists and researchers who attended international fora for science-media interface and research integrity discussions, or accessed the survey via an international climate research programme website. Survey findings reveal, contrary to tensions described in the existing literature, a mutual intelligibility and general trust between this core group of journalists and researchers, who have a vested interest in evidence-based climate science reporting. We argue that scientifically informed interface journalists, by collaborating with scientists, can help influence mainstream journalists to better inform the public about the urgency for society to overcome the diabolical climate challenge.

A substantial body of evidence points to the heritability of dietary preferences. While vegetarianism has been practiced for millennia in various societies, its practitioners remain a small minority of people worldwide, and the role of genetics in choosing a vegetarian diet is not well understood. Dietary choices involve an interplay between the physiologic effects of dietary items, their metabolism, and taste perception, all of which are strongly influenced by genetics. In this study, we used a genome-wide association study (GWAS) to identify loci associated with strict vegetarianism in UK Biobank participants. Comparing 5,324 strict vegetarians to 329,455 controls, we identified one SNP on chromosome 18 that is associated with vegetarianism at the genome-wide significant level (rs72884519, β = -0.11, P = 4.997 x 10−8), and an additional 201 suggestively significant variants. Four genes are associated with rs72884519: TMEM241, RIOK3, NPC1, and RMC1. Using the Functional Mapping and Annotation (FUMA) platform and the Multi-marker Analysis of GenoMic Annotation (MAGMA) tool, we identified 34 genes with a possible role in vegetarianism, 3 of which are GWAS-significant based on gene-level analysis: RIOK3, RMC1, and NPC1. Several of the genes associated with vegetarianism, including TMEM241, NPC1, and RMC1, have important functions in lipid metabolism and brain function, raising the possibility that differences in lipid metabolism and their effects on the brain may underlie the ability to subsist on a vegetarian diet. These results support a role for genetics in choosing a vegetarian diet and open the door to future studies aimed at further elucidating the physiologic pathways involved in vegetarianism. [ABSTRACT FROM AUTHOR]

Cognitive impairment and chronic pain are amongst the most prevalent neurological sequelae of HIV infection, yet little is understood about the potential bidirectional relationship between the two conditions. Cognitive dysfunction can occur in chronic pain populations whilst those with cognitive impairment can display modified responses to experimentally induced painful stimuli. To date, this has not been explored in HIV cohorts. This study aimed to identify any contribution of chronic pain to cognitive impairment in HIV and to determine differences in pain characteristics between those with and without cognitive dysfunction. This was an observational cohort study involving people living with HIV (n = 148) in the United Kingdom. Participants underwent validated questionnaire-based measurement of pain severity, interference and symptom quality as well as conditioned pain modulation and quantitative sensory testing. All participants completed a computer-based cognitive function assessment. Fifty-seven participants met the criteria for cognitive impairment and 73 for chronic pain. The cognitive impairment group had a higher prevalence of chronic pain (p = 0.004) and reported more neuropathic symptoms (p = 0.001). Those with chronic pain performed less well in emotional recognition and verbal learning domains. The interaction identified between chronic pain and cognitive dysfunction warrants further exploration to identify causal links or shared pathology. [ABSTRACT FROM AUTHOR]

Emotional disorders are common in childhood, and their prevalence sharply increases during adolescence. The Strengths and Difficulties Questionnaire (SDQ) is widely used for screening emotional and behavioural difficulties in children and young people, but little is known about the accuracy of the emotional subscale (SDQ-E) in detecting emotional disorders, and whether this changes over development. Such knowledge is important in determining whether symptom changes across age are due to developmental or measurement differences. This study assessed the validity of the SDQ-E and two individual items (low mood and general worry) in differentiating between cases and non-cases of Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), and other anxiety disorders across ages 7, 10, 13, 15, and 25 years in a UK population cohort. Analyses showed moderate accuracy of the subscale in discriminating cases of MDD (AUC = 0.67–0.85), and high accuracy for discriminating cases of GAD (AUC = 0.80–0.93) and any anxiety disorder (AUC = 0.74–0.83) compared to non-cases. The SDQ-E performed well across ages and sex, and generally performed better than the two individual items. Together our findings validate the SDQ-E as a screen for emotional disorders during childhood, adolescence, and early adulthood, and as a tool for longitudinal research on depression and anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. Methods: Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. Results: A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals' roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). Conclusion: This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change. [ABSTRACT FROM AUTHOR]

Background: The primary-secondary transition can negatively affect pupils' emotional and psychological adjustment. However, methods for assessing concerns regarding secondary school are limited. A reliable and valid measure of transition-related concerns would be useful both in evaluating and shaping the content and delivery of universal and targeted transition support programmes. Aims: To assess the validity of a quantitative self-report measure of school concerns as an assessment tool during the primary-secondary school transition. Sample: A UK sample of 147 Year 6 primary school pupils and 263 Year 7 secondary school pupils. Method: Self-reports of school concerns and school liking as well as self-reported and peer assessments on a range of psychological adjustment measures were collected. Results: The School Concerns Questionnaire (SCQ) showed good reliability at primary and secondary school. Secondary concerns reduced significantly post-transition. Three factors emerged from an exploratory factor analysis of the SCQ and the pattern of results was replicated for post-transition concerns. Pupils with higher school concerns at secondary school reported reduced liking of school and reduced trust and respect for teachers. The SCQ was associated with generalized anxiety and female gender both pre-and post-transition. Peer problems and depression were associated with pre- and post-transition concerns, respectively. Conclusions: The SCQ is a simple to complete, reliable, and valid tool for assessing primary-secondary transition concerns. It could serve a valuable role in the evaluation and development of universal and targeted school-based initiatives that aim to promote positive secondary transition.

The aim of this study was to examine whether there was variation in levels of psychological adjustment among children conceived through Assisted Reproductive Technologies using the parents' gametes (homologous), sperm donation, egg donation, embryo donation and surrogacy. Information was provided by parents about the psychological functioning of 769 children aged 5 to 9 years who had been born using ART (from the five groups described). Comparisons were made between the different conception groups, to UK national norms and, for a sub-sample of multiple births, to an age-matched twin sample. No differences were found between the conception groups except that fathers from the egg donation group rated children higher in conduct problems compared to other ART groups. No effects were observed by ART treatment type (ICSI vs. IVF, GIFT and IUI). There was some evidence of lower conduct problems and prosocial behaviour among children conceived through homologous IVF compared to national norms. Taken together, however, consistent differences between groups and in comparison to naturally conceived children were not apparent for mother- or father-rated adjustment problems. Children conceived with assisted reproductive technologies, regardless of whether they are genetically related or unrelated to their parents or born by gestational surrogacy do not differ in their levels of psychological adjustment. Nor do they appear to be at greater risk of psychological adjustment problems in middle childhood compared to naturally conceived children. (Contains 3 tables.)

Objective: To assess the value of maternal and self-ratings of adolescent depression by investigating the extent to which these reports predicted a range of mental health and functional outcomes 4 years later. The potential influence of mother's own depressed mood on her ratings of adolescent depression and suicidal ideation on adolescent outcome was also tested. Method: A longitudinal population-based study of 842 adolescents ages 11 to 16 at the baseline assessment and 15 to 20 at follow-up (62% retention). Results: Both mother- and adolescent-rated depressive symptoms predicted future depression, antisocial behavior, impairment, health service use, and regular tobacco use in the adolescent. The odds ratios obtained for maternal and adolescent ratings of depressive symptoms as predictors of future psychopathology were not significantly different. Mothers' own depressive symptoms were not significantly associated with adolescent depression, health service use, or substance use at follow-up. Depression that was accompanied by adolescent-rated suicidal thoughts was significantly more strongly associated with impairment at follow-up than depression alone. Conclusions: It is possible to obtain clinically useful information on adolescent depression from the child's mother. However, information on suicidal ideation was rarely endorsed by mothers, suggesting that maternal report of adolescent suicidal thoughts shows less sensitivity than adolescent report. (Contains 4 tables.) [Funding for this study was provided in part by the Medical Research Council UK, the PPP Foundation, and the European Research Advisory Panel.]

Purpose: Care leavers are identified as a vulnerable group within UK society and, unsurprisingly, are more susceptible to mental health problems. Research highlights inadequacies among UK Government provisions combined with poorer outcomes for care leavers. This paper aims to measure the effectiveness of provisions on mental health when transitioning from the care system to adulthood. Design/methodology/approach: A systematic review was conducted to identify and highlight the inadequacies of provisions in place to aid a care leaver's transition and the effects on their mental health. Of the 211 studies identified from the search, six studies met the eligibility criteria and were deemed eligible by the researcher for further exploration of themes. Findings: The findings identified feeling isolated, training given to care professionals and caregivers, collaboration, lack of preparation and support and access and gaps in provisions as the five key themes. The overarching theme of interconnectedness and interplay between subthemes, mental health and a care leaver's transition, is strongly presented throughout. Many participants within the individual studies reported negative findings illustrating the weaknesses of provisions and the negative effect on their mental health. Furthermore, the findings emphasise the unique nature of everyone's experience transitioning out of the care system. Research limitations/implications: A limitation of the review is the selection of key words, which may have restricted the results produced during the main search, subsequently affecting the amount of relevant data extracted and synthesised. Finally, less emphasis on grey literature and more on empirical studies reduces the probability of discovering null or negative findings, therefore increasing the chances of publication bias (Paez, 2017). A small number of eligible studies increase the risk of not making important comparisons, prompting a wider search to be conducted in the future. An unequal ratio between national and international research in the systematic review restricts fresh perspectives and strategies concerning the mental health of care leavers. Practical implications: Care leavers are identified as a vulnerable group within society and, unsurprisingly, are more susceptible to mental health problems. The UK Government enforces national and local policies to support young adults leaving the care system and transitioning to independence. However, previous research highlights inadequacies among provisions, combined with poorer mental health outcomes for care leavers. Social implications: Following on from gaps in the current findings, an investigation into regional disparities across provisions aimed at assisting care leavers transitioning to independence would produce useful information for the field and policymakers. Although current research addresses the essence of interplay between mental health and transitioning, further research is required to help build a supporting argument for adaptations and improvements in policies and practice. Originality/value: This study supports the argument for an increase in attention from the UK Government and policymakers to improve the quality and quantity of support for a population often underserved and marginalised, especially in terms of reducing poorer mental health outcomes. [ABSTRACT FROM AUTHOR]

A survey of 100 securities analysts at investment banking firms in the United States and United Kingdom showed that individual characteristics have little influence on the information sources and communication channels used by analysts, but institutional resources significantly influence the information and communication channels used, and also directly influence outcomes. (Author/AEF)

To identify genetic determinants of airway dysfunction, we performed a transcriptome-wide association study for asthma by combining RNA-seq data from the nasal airway epithelium of 681 children, with UK Biobank genetic association data. Our airway analysis identified 102 asthma genes, 58 of which were not identified by transcriptome-wide association analyses using other asthma-relevant tissues. Among these genes were MUC5AC, an airway mucin, and FOXA3, a transcriptional driver of mucus metaplasia. Muco-ciliary epithelial cultures from genotyped donors revealed that the MUC5AC risk variant increases MUC5AC protein secretion and mucus secretory cell frequency. Airway transcriptome-wide association analyses for mucus production and chronic cough also identified MUC5AC. These cis-expression variants were associated with trans effects on expression; the MUC5AC variant was associated with upregulation of non-inflammatory mucus secretory network genes, while the FOXA3 variant was associated with upregulation of type-2 inflammation-induced mucus-metaplasia pathway genes. Our results reveal genetic mechanisms of airway mucus pathobiology. Understanding regulation of genes associated to disease can reveal insights into disease mechanisms. Here, the authors perform an airway epithelial transcriptome-wide association analysis to elucidate genetic determinants of airway dysfunction in asthma, identifying genetic mechanisms of mucus pathobiology. [ABSTRACT FROM AUTHOR]

Background: Weight loss, hyperglycaemia and diabetes are known features of pancreatic cancer. We quantified the timing and the amount of changes in body mass index (BMI) and glycated haemoglobin (HbA1c), and their association with pancreatic cancer from five years before diagnosis. Methods: A matched case-control study was undertaken within 590 primary care practices in England, United Kingdom. 8,777 patients diagnosed with pancreatic cancer (cases) between 1st January 2007 and 31st August 2020 were matched to 34,979 controls by age, gender and diabetes. Longitudinal trends in BMI and HbA1c were visualised. Odds ratios adjusted for demographic and lifestyle factors (aOR) and 95% confidence intervals (CI) were calculated with conditional logistic regression. Subgroup analyses were undertaken according to the diabetes status. Results: Changes in BMI and HbA1c observed for cases on longitudinal plots started one and two years (respectively) before diagnosis. In the year before diagnosis, a 1 kg/m2 decrease in BMI between cases and controls was associated with aOR for pancreatic cancer of 1.05 (95% CI 1.05 to 1.06), and a 1 mmol/mol increase in HbA1c was associated with aOR of 1.06 (1.06 to 1.07). ORs remained statistically significant (p < 0.001) for 2 years before pancreatic cancer diagnosis for BMI and 3 years for HbA1c. Subgroup analysis revealed that the decrease in BMI was associated with a higher pancreatic cancer risk for people with diabetes than for people without (aORs 1.08, 1.06 to 1.09 versus 1.04, 1.03 to 1.05), but the increase in HbA1c was associated with a higher risk for people without diabetes than for people with diabetes (aORs 1.09, 1.07 to 1.11 versus 1.04, 1.03 to 1.04). Conclusions: The statistically significant changes in weight and glycaemic control started three years before pancreatic cancer diagnosis but varied according to the diabetes status. The information from this study could be used to detect pancreatic cancer earlier than is currently achieved. However, regular BMI and HbA1c measurements are required to facilitate future research and implementation in clinical practice. [ABSTRACT FROM AUTHOR]

The current paper is motivated by longitudinal progress tests given to medical students in the United Kingdom, which are used to assess students' applied medical knowledge during their learning programme. The main analytic interest is the maximum competency each student achieves on the assessment and the point in the programme at which each student attains this competency. Direct estimates of maximum competency and the time at which students realised this competency are useful for optimising allocation of classroom and hands‐on experiences, as well as to inform curriculum development. Models have been developed for estimating the timing of a threshold or cut‐off common across people or for estimating different rates of change that occur for different phases of time. However, less attention has been paid to models interested in the timing of a value that can change across people—such as maximum competency—and where growth is flat in some phases of time. In this paper, we build a model that borrows pieces from various existing methods such as reparameterisations of polynomial models, splines for ceiling effects, time‐to‐criterion models, dynamic measurement and non‐linear mixed‐effect models to allow the motivating questions to be addressed from these data. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health problems are prevalent, affecting up to 20% of women However, only 17-25% receive formal support during the perinatal period. In this qualitative study, we sought to examine women's experiences with peer support for mental health problems during the perinatal period.Methods: Semi-structured interviews and focus groups were conducted with twenty-five mothers from the UK who had utilised peer support for a perinatal mental health problem. Data was analysed using thematic analysis.Results: Seven major themes were identified in women's help seeking process and experience of peer support. These included; perinatal specific precipitating factors that contributed to their mental health problems, barriers in the form of unhelpful professional responses, feelings of isolation, acceptance of the problem and need to actively re-seek support, finding support either through luck or peer assistance.Conclusion: Peer support showed promise as an effective means to reduce perinatal mental health difficulties; either as a form of formal support or as an adjunct to formal support. The results highlight ways to improve perinatal women's access to mental health support through peer-based mechanisms. [ABSTRACT FROM AUTHOR]

Unique challenges arise when conducting trials to evaluate therapies already in common clinical use, including difficulty enrolling patients owing to widespread open-label use of trial therapies and the need for large sample sizes to detect small but clinically meaningful treatment effects. Despite numerous successes in trials evaluating novel interventions such as vaccines, traditional explanatory trials have struggled to provide definitive answers to time-sensitive questions for acutely ill patients with COVID-19. Pragmatic trials, which can increase efficiency by allowing some or all trial procedures to be embedded into clinical care, are increasingly proposed as a means to evaluate therapies that are in common clinical use. In this Personal View, we use two concurrently conducted COVID-19 trials of hydroxychloroquine (the US ORCHID trial and the UK RECOVERY trial) to contrast the effects of explanatory and pragmatic trial designs on trial conduct, trial results, and the care of patients managed outside of clinical trials. In view of the potential advantages and disadvantages of explanatory and pragmatic trial designs, we make recommendations for their optimal use in the evaluation of therapies in the acute care setting. [ABSTRACT FROM AUTHOR]

Over the course of a playing career that spanned roughly fifty years, John Mahon (pronoucned M'hone) introduced and popularized the clarinet as a solo and chamber instrument throughout Britain. He performed extensively in London and in many provincial towns. This article presents biographies of John and William Mahon, illustrations of contemporary clarinets and a basset horn, Mahon as a teacher, his music, and his influence and legacy. William Mahon's concerts and reviews and a conclusion end the article. [ABSTRACT FROM AUTHOR]

Coastal vulnerability and its physical, economic and social consequences at national and international scales is of high scientific, political and policy interest. Anthropogenic climate change and coastal erosion threaten the very fabric of a society. Indications, that coastal hazards are impacting diverse coastal areas severely across the world, and it is no longer a vague future threat that can't be ignored. Rising eustatic sea levels synthesized by the growing frequency and scale of coastal hazards like storm surges, coastal erosion and coastal landslides threaten low-lying and unprotected coastal areas in the United Kingdom even if they have coastal defenses. However, there is still significant uncertainty about the degree of vulnerability along different coastal stretches, particularly in England. To fill this uncertainty, the current study estimated the coastal vulnerability of the coastal erosion hotspot Camber, England, by establishing a coastal vulnerability index. This index was developed by compounding various existing parameters and termed as Erosion Coastal Vulnerability Index (ECVI). Results illustrate that 67% of coastal area fall between high and very high vulnerability categories, and current coastal defenses are not strong enough to tackle the severe coastal erosion in Camber. Within the evaluation, thematic maps were generated to enable the intensity of the vulnerability for different coastal stretches to be identified. The evaluated vulnerable hotspot should be treated urgently by regional and national policy organizations to ameliorate the impacts of coastal erosion and other associated risks. Without action, the hotspot is likely to encounter unprecedented new vulnerabilities, disasters and humanitarian catastrophes. The current study results allow for a local, regional and national comparison that may help to evaluate changes in coastal erosion vulnerability. [ABSTRACT FROM AUTHOR]

The first edition of the Daily Mail on May 4, 1896, included an advertisement for the "latest scientific marvel," the Lumiere Cinematograph. While historians have acknowledged the concurrent rise of film and the popular press, this article explores the varied and often-innovative ways in which British newspapers produced film and visual media. From the use of Daily Mail screens to relay election results, to the production and promotion of the newspaper's own film in 1910, these early interactions allow us to understand better the emergence, evolution, and endurance of Britain's modern media system. [ABSTRACT FROM AUTHOR]

The scarcity of public sector healthcare resources and the vulnerability of service users make the conduct of health professionals critically important. Health regulators, in delivering their core objective of patient protection, use empirical evidence to identify professionals' misconduct, improve their understanding of why misconduct occurs, and to maximize the effectiveness of regulatory actions that safeguard public trust in the healthcare system. This paper outlines the contribution of comparative academic analysis of three professions in the UK (doctors, nurses & midwives, and allied health professions) based on 6714 individual cases of professional misconduct. Three dynamic strands of ongoing impact are identified: "dialogue", that creates an international multi-stakeholder community of interest; "knowledge generation", which advances conceptual and empirical understanding of counterproductive work behaviour through sequential quantitative and qualitative study; and "dissemination", where practical learning is utilized by regulators, employers and other academics. [ABSTRACT FROM AUTHOR]

Burrowing into riverbanks by animals transfers sediment directly into river channels and has been hypothesised to accelerate bank erosion and promote mass failure. A field monitoring study on two UK rivers invaded by signal crayfish (Pacifastacus leniusculus) assessed the impact of burrowing on bank erosion processes. Erosion pins were installed in 17 riverbanks across a gradient of crayfish burrow densities and monitored for 22 months. Bank retreat increased significantly with crayfish burrow density. At the bank scale (<6 m river length), high crayfish burrow densities were associated with accelerated bank retreat of up to 253% and more than a doubling of the area of bank collapse compared with banks without burrows. Direct sediment supply by burrowing activity contributed 0.2% and 0.6% of total sediment at the reach (1.1 km) and local bank (<6 m) scales. However, accelerated bank retreat caused by burrows contributed 12.2% and 29.8% of the total sediment supply at the reach and bank scales. Together, burrowing and the associated acceleration of retreat and collapse supplied an additional 25.4 t km−1 a−1 of floodplain sediments at one site, demonstrating the substantial impact that signal crayfish can have on fine sediment supply. For the first time, an empirical relation linking animal burrow characteristics to riverbank retreat is presented. The study adds to a small number of sediment budget studies that compare sediment fluxes driven by biotic and abiotic energy but is unique in isolating and measuring the substantial interactive effect of the acceleration of abiotic bank erosion facilitated by biotic activity. Biotic energy expended through burrowing represents an energy surcharge to the river system that can augment sediment erosion by geophysical mechanisms. [ABSTRACT FROM AUTHOR]

The economic shocks experienced by the UK economy in the 1970s brought major changes in the spatial distribution of employment rates in the UK. This paper traces the long-run implications of these changes, suggesting that they were highly persistent and to a large extent shape current UK regional disparities. Most of the Local Authority Districts that experienced large negative shocks in the 1970s had high deprivation rates in 2015, and they constitute two-thirds of all districts with the highest deprivation rates. We conclude that neither economic adjustment processes nor policy measures have acted to reverse the effect of negative shocks incurred nearly half a century ago. [ABSTRACT FROM AUTHOR]

There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates risk of later depression, but the mechanisms behind this association are unclear. We investigated the relationship between childhood ADHD symptoms and late-adolescent depressive symptoms in a population cohort, and examined whether academic attainment and peer problems mediated this association. ALSPAC (Avon Longitudinal Study of Parents and Children) is an ongoing prospective longitudinal population-based UK cohort that has collected data since September 1990. 2950 individuals with data on parent-reported ADHD symptoms in childhood (7.5 years) and self-reported depressive symptoms in late adolescence (17.5 years) were included in analyses. 2161 individuals with additional data at age 16 years on parent-reported peer problems as an indicator of peer relationships and formal examination results (General Certificate of Secondary Education; GCSE) as an indicator of academic attainment were included in mediation analyses. Childhood ADHD symptoms were associated with higher depressive symptoms (b = 0.49, SE = 0.11, p < 0.001) and an increased odds of clinically significant depressive symptoms in adolescence (OR = 1.27, 95% CI 1.15–1.41, p < 0.001). The association with depressive symptoms was mediated in part by peer problems and academic attainment which accounted for 14.68% and 20.13% of the total effect, respectively. Childhood ADHD is associated with increased risk of later depression. The relationship is mediated in part by peer relationships and academic attainment. This highlights peer relationships and academic attainment as potential targets of depression prevention and intervention in those with ADHD. Future research should investigate which aspects of peer relationships are important in conferring later risk for depression. [ABSTRACT FROM AUTHOR]

Background: Retrospectively recalled adverse childhood experiences (ACEs) are associated with adult mood problems, but evidence from prospective population cohorts is limited. The aims of this study were to test links between prospectively ascertained ACEs and adult mood problems up to age 50, to examine the role of child mental health in accounting for observed associations, and to test gender differences in associations. Methods: The National Child Development Study is a UK population cohort of children born in 1958. ACEs were defined using parent or teacher reports of family adversity (parental separation, child taken into care, parental neglect, family mental health service use, alcoholism and criminality) at ages 7–16. Children with no known (n = 9168), single (n = 2488) and multiple (n = 897) ACEs were identified in childhood. Adult mood problems were assessed using the Malaise inventory at ages 23, 33, 42 and 50 years. Associations were examined separately for males and females. Results: Experiencing single or multiple ACEs was associated with increased rates of adult mood problems after adjustment for childhood psychopathology and confounders at birth [2+ v. 0 ACEs – men: age 23: odds ratio (OR) 2.36 (95% confidence interval (CI) 1.7–3.3); age 33: OR 2.40 (1.7–3.4); age 42: OR 1.85 (1.4–2.4); age 50: OR 2.63 (2.0–3.5); women: age 23: OR 2.00 (95% CI 1.5–2.6); age 33: OR 1.81 (1.3–2.5); age 42: OR 1.59 (1.2–2.1); age 50: OR 1.32 (1.0–1.7)]. Conclusions: Children exposed to ACEs are at elevated risk for adult mood problems and a priority for early prevention irrespective of the presence of psychopathology in childhood. [ABSTRACT FROM AUTHOR]

Background: We aimed to estimate the causal effect of health conditions and risk factors on social and socioeconomic outcomes in UK Biobank. Evidence on socioeconomic impacts is important to understand because it can help governments, policy makers and decision makers allocate resources efficiently and effectively.Methods: We used Mendelian randomization to estimate the causal effects of eight health conditions (asthma, breast cancer, coronary heart disease, depression, eczema, migraine, osteoarthritis, type 2 diabetes) and five health risk factors [alcohol intake, body mass index (BMI), cholesterol, systolic blood pressure, smoking] on 19 social and socioeconomic outcomes in 336 997 men and women of White British ancestry in UK Biobank, aged between 39 and 72 years. Outcomes included annual household income, employment, deprivation [measured by the Townsend deprivation index (TDI)], degree-level education, happiness, loneliness and 13 other social and socioeconomic outcomes.Results: Results suggested that BMI, smoking and alcohol intake affect many socioeconomic outcomes. For example, smoking was estimated to reduce household income [mean difference = -£22 838, 95% confidence interval (CI): -£31 354 to -£14 321] and the chance of owning accommodation [absolute percentage change (APC) = -20.8%, 95% CI: -28.2% to -13.4%], of being satisfied with health (APC = -35.4%, 95% CI: -51.2% to -19.5%) and of obtaining a university degree (APC = -65.9%, 95% CI: -81.4% to -50.4%), while also increasing deprivation (mean difference in TDI = 1.73, 95% CI: 1.02 to 2.44, approximately 216% of a decile of TDI). There was evidence that asthma decreased household income, the chance of obtaining a university degree and the chance of cohabiting, and migraine reduced the chance of having a weekly leisure or social activity, especially in men. For other associations, estimates were null.Conclusions: Higher BMI, alcohol intake and smoking were all estimated to adversely affect multiple social and socioeconomic outcomes. Effects were not detected between health conditions and socioeconomic outcomes using Mendelian randomization, with the exceptions of depression, asthma and migraines. This may reflect true null associations, selection bias given the relative health and age of participants in UK Biobank, and/or lack of power to detect effects. [ABSTRACT FROM AUTHOR]

Transplacental antibody transfer from mother to fetus provides protection from infection in the first weeks of life, and the four different subclasses of IgG (IgG1, IgG2, IgG3, and IgG4) have diverse roles in protection against infection. In this study, we evaluated concentrations and transplacental transfer ratios of the IgG subclasses in a healthy UK-based cohort of mother-cord pairs, and investigated associations with maternal, obstetric, and fetal factors. In agreement with previous studies, we found a strong association between maternal and cord IgG for all subclasses. We report a transfer efficiency hierarchy of IgG1>IgG3>IgG4=IgG2 in our study population, and our review of the literature demonstrates that there is no consensus in the hierarchy of subclass transfer, despite the commonly made statement that the order is IgG1>IgG4>IgG3>IgG2. We report additional data regarding negative associations between elevated maternal IgG concentrations and maternal/cord transfer ratios, finding an effect on IgG1, IgG2, and IgG3 subclasses. Levels of IgG subclasses were the same between venous and arterial blood samples from the umbilical cord, but there was a significantly higher level of total IgG in arterial blood. We found no correlation between placental FcRn protein levels and IgG transfer in our cohort, suggesting that IgG is the main determinant of observed differences in transplacental transfer ratios at term. Neonatal IgG1 and IgG4 levels were increased with later gestation at delivery, independent of any increase in transplacental transfer, indicating that the benefit of later gestation is through accumulation of these subclasses in the fetus. Neonatal IgG2 levels and transfer ratios were reduced in rhesus-negative pregnancies, suggesting that administered anti-D antibodies may compete for transplacental transfer of this subclass. Maternal influenza vaccination resulted in elevated maternal and neonatal levels of IgG4, whereas maternal Tdap vaccination had no impact on neonatal levels of the subclasses, nor transfer. However, within Tdap vaccinated pregnancies, later gestation at Tdap vaccination was associated with higher transplacental transfer. Our study provides information regarding levels and transfer of IgG subclasses in healthy term pregnancies and demonstrates the importance of recording detailed clinical information in studies of antibody transfer, including parity, ethnicity, and timing of maternal vaccine delivery. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking in pregnancy is associated with low birth weight (LBW), child conduct problems, hyperactivity and lower cognitive attainment, but associations may reflect measured and unmeasured confounding. Cross-cohort designs can aid causal inference through comparison of associations across populations with different confounding structures. We compared associations between maternal smoking in pregnancy and child conduct and hyperactivity problems, cognition and LBW across two cohorts born four decades apart.Methods: Two national UK cohorts born in 1958 (n = 12 415) and 2000/01 (n = 11 800) were compared. Maternal smoking in pregnancy and child birth weight was assessed at or shortly after birth. Parents rated children's conduct problems and hyperactivity, and children completed standardized tests of reading and mathematics.Results: Maternal smoking in pregnancy was less common and more strongly associated with social disadvantage in 2000/01 compared with 1958 (interactions P < 0.001). Maternal smoking in pregnancy was robustly and equivalently associated with infant LBW in both cohorts [interactions: boys odds ratio (OR) = 1.01 (0.89, 1.16), P = 0.838; girls OR = 1.01 (0.91, 1.17), P = 0.633]. Maternal smoking was more strongly associated with conduct problems, hyperactivity and reading in the 2000/01 cohort (interactions P < 0.001).Conclusions: Marked cross-cohort change in associations between maternal smoking and child conduct problems, hyperactivity and reading highlights the likely role of confounding factors. In contrast, association with LBW was unaffected by change in prevalence of maternal smoking and patterns of confounding. The study highlights the utility of cross-cohort designs in helping triangulate conclusions about the role of putative causal risk factors in observational epidemiology. [ABSTRACT FROM AUTHOR]

An impaction of the foetal head at caesarean section is a topical concern in modern obstetric practice. The management options for this problem are well described but the incidence or even definition of impaction, is unknown. The primary aim of this study was to ascertain the incidence of impacted foetal head at CS in labour. This prospective study used data from all women undergoing CS during a 12-month period in a single unit. Following completion of all CS, the surgeon completed a questionnaire covering: cervical dilation at time of CS; if the surgeon felt there was a difficulty in delivering the foetal head as an indicator of impaction, as well as the other techniques utilised. Of 440 EMCS in labour, 18% (n = 81) reported a difficulty delivering the head, which was most common at cervical dilation ≥8 cm (n = 124, 48%). A difficulty with the delivery of the foetal head was associated with 36% increased measured blood loss. Impact statement What is already known on this subject? Impaction of the foetal head at a caesarean section is a recognised complication of CS in late labour but there are no reliable data on the incidence of the problem. It is poorly defined and yet many techniques and devices have been described to overcome this problem, however, optimal management remains uncertain. What do the results of this study add? The primary aim of this study was to determine the incidence of the impacted foetal head during CS in labour as determined by whether the surgeon experienced difficulty with delivery of the head. We report that at least some difficulty in delivering the foetal head at CS is common, and most often encountered when cervical dilation is ≥8 cm. When additional manoeuvres were required, the 'push' technique was exclusively adopted with implications for training. A difficulty in delivering the foetal head was associated with a 36% increase in the measured maternal blood loss. What are the implications of these findings for clinical practice and/or further research? Further multi-centre investigation is required to ascertain incidence of this obstetric problem with predicting factors determined. This work will inform decisions about the optimal management. [ABSTRACT FROM AUTHOR]

Objective: Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice. However, empirical evidence on its effectiveness is scarce. Therefore, the authors estimated the effectiveness of antipsychotic polypharmacy relative to monotherapy in terms of health care utilization and mortality.Methods: Primary care data from Clinical Practice Research Datalink, hospital data from Hospital Episode Statistics, and mortality data from the Office of National Statistics were linked to compile a cohort of patients with serious mental illness in England from 2000 to 2014. The antipsychotic prescribing profile of 17,255 adults who had at least one antipsychotic drug record during the period of observation was constructed from primary care medication records. Survival analysis models were estimated to identify the effect of antipsychotic polypharmacy on the time to first occurrence of each of three outcomes: unplanned hospital admissions (all cause), emergency department (ED) visits, and mortality.Results: Relative to monotherapy, antipsychotic polypharmacy was not associated with increased risk of unplanned hospital admission (hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.98-1.32), ED visit (HR=0.95; 95% CI=0.80-1.14), or death (HR=1.02; 95% CI=0.76-1.37). Relative to not receiving antipsychotic medication, monotherapy was associated with a reduced hazard of unplanned admissions to the hospital and ED visits, but it had no effect on mortality.Conclusions: The study results support current guidelines for antipsychotic monotherapy in routine clinical practice. However, they also suggest that when clinicians have deemed antipsychotic polypharmacy necessary, health care utilization and mortality are not affected. [ABSTRACT FROM AUTHOR]

Summary: The maternal Tdap (tetanus, diphtheria and acellular pertussis) vaccination programme in the United Kingdom has successfully reduced cases of pertussis in young infants. In addition to prevention of pertussis cases, it is also important to investigate the persistence of maternal antibodies during infancy and the possible interference of maternal antibodies with infant responses to vaccines. We recruited mother–infant pairs from vaccinated and unvaccinated pregnancies and measured concentrations of immunoglobulin (Ig)G against pertussis toxin (PTx), filamentous haemagglutinin (FHA), pertactin (Prn), diphtheria toxin (DTx), tetanus toxoid (TTx) Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in mothers and infants at birth, and in infants at 7 weeks and at 5 months. Thirty‐one mother–infant pairs were tested. Tdap‐vaccinated women had significantly higher antibody against Tdap antigens, compared to unvaccinated women (DTx, P = 0·01; PTx, FHA, Prn and TTx, P < 0·001). All antibodies were actively transferred to the infants (transfer ratio  > 1) with higher transfer of DTx (P = 0·04) and TTx (P = 0·02) antibody in Tdap‐vaccinated pregnancies compared to unvaccinated pregnancies. Infants from Tdap‐vaccinated pregnancies had significantly elevated antibodies to all antigens at birth (P < 0.001) and at 7 weeks (FHA, Prn, TTx, P < 0·001; DTx, P = 0.01; PTx, P = 0·004) compared to infants from unvaccinated pregnancies. Infants from Tdap‐vaccinated and ‐unvaccinated pregnancies had comparable antibody concentrations following primary pertussis immunization (PTx, P = 0·77; FHA, P = 0·58; Prn, P = 0·60; DTx, P = 0·09; TTx, P = 0·88). These results support maternal immunization as a method of protecting vulnerable infants during their first weeks of life. [ABSTRACT FROM AUTHOR]

Background: Previous studies find that both schizophrenia and mood disorder risk alleles contribute to adult depression and anxiety. Emotional problems (depression or anxiety) begin in childhood and show strong continuities into adult life; this suggests that symptoms are the manifestation of the same underlying liability across different ages. However, other findings suggest that there are developmental differences in the etiology of emotional problems at different ages. To our knowledge, no study has prospectively examined the impact of psychiatric risk alleles on emotional problems at different ages in the same individuals. Methods: Data were analyzed using regression-based analyses in a prospective, population-based UK cohort (the National Child Development Study). Schizophrenia and major depressive disorder (MDD) polygenic risk scores (PRS) were derived from published Psychiatric Genomics Consortium genome-wide association studies. Emotional problems were assessed prospectively at six time points from age 7 to 42 years. Results: Schizophrenia PRS were associated with emotional problems from childhood [age 7, OR 1.09 (1.03–1.15), p = 0.003] to mid-life [age 42, OR 1.10 (1.05–1.17), p < 0.001], while MDD PRS were associated with emotional problems only in adulthood [age 42, OR 1.06 (1.00–1.11), p = 0.034; age 7, OR 1.03 (0.98–1.09), p = 0.228]. Conclusions: Our prospective investigation suggests that early (childhood) emotional problems in the general population share genetic risk with schizophrenia, while later (adult) emotional problems also share genetic risk with MDD. The results suggest that the genetic architecture of depression/anxiety is not static across development. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study investigated the effects of 3 different types of slide sheets upon hand forces while sliding a patient up in bed. METHODS: The sheets used included the reusable Arjo Maxislide, the McAuley disposable sheet, and a standard cotton sheet. Hand forces were measured from 38 male and female participants as they slid a 'patient' up in bed. A repeated measures ANOVA with 5 levels to the repeated factor (number of sheets and sheet type) was used, along with post-hoc repeated measures contrasts to compare differences between each condition. RESULTS: A significant reduction in required force occurred when using the friction reducing sheets as compared to the cotton sheets when used according to manufacturer recommendations, as well as a reduction in one of the single friction reducing sheet categories compared to the cotton. However, it is important to note that there was still substantial force being placed on the participants. CONCLUSIONS: This study illustrates the importance of using friction reducing slide sheets while engaging in manual patient handling. Future research should investigate the forces involved with other friction reducing materials and methods as well as the possibility of combining said materials and methods. [ABSTRACT FROM AUTHOR]

The Medical Research Council recommends strong theoretical underpinning in the design and evaluation of lifestyle intervention programmes ( LIPs). This qualitative study aimed to use Basic Needs Theory ( BNT) as a framework to explore participants' perspectives on a workplace dietitian-led LIP. Specifically, experiences with LIP engagement and initiation and maintenance of behaviour change were evaluated. Fifteen semi-structured face-to-face interviews were conducted with participants who had previously completed a workplace cardiovascular disease and type 2 diabetes prevention programme, which involved advice and motivational support with making dietary and lifestyle changes. Interviews were audio recorded and transcribed verbatim. To evaluate the narrative, interpretative phenomenological analyses were used with BNT as the theoretical framework. A total of 12 themes were identified in relation to the three concepts of BNT - autonomy, competence and relatedness - and organised into three domains: intervention engagement, behaviour change initiation and behaviour change maintenance. Line manager and colleague support to attend was reported to have a strong influence on intervention engagement, and the importance of dietitian and peer guidance in initiating behaviour changes was highlighted. Differences between participants who maintained behavioural changes compared to those who relapsed included autonomously seeking support (relatedness) through family, friends, healthcare professionals and commercial slimming organisations. BNT provided an insightful theoretical framework to evaluate factors that underpinned the effectiveness of a dietitian-led cardiovascular and type 2 diabetes prevention LIP. Attendance and retention in workplace LIPs can depend on participants' managerial and colleague support, so recruitment processes should consider targeting managers in marketing and promotional activities. Workplace LIPs may increase the likelihood of behaviour change maintenance by including methods that foster longer term participant relatedness and emotional support. [ABSTRACT FROM AUTHOR]

Health care in England is predominantly provided free at the point of service through the publicly-funded National Health Service (NHS). Total NHS expenditure, which has risen in real terms by an average of 3.7 per cent per annum since the inception of the NHS in 1948, constituted 7.9 per cent of GDP in 2012. This paper presents a summary of the trends in medical expenditure in England together with, using detailed administrative data, an analysis of the growth over 15 years of expenditure and activity in hospital inpatient health care, which represents around 20-25 per cent of all NHS expenditure. We document the coincidence of observed trends in expenditure with reported activity, morbidity and the proximity of individuals to death. We find that: (i) expenditure for both elective and emergency inpatient care broadly follows activity, so that expenditure is mostly driven by activity rather than unit costs; (ii) expenditure is concentrated in individuals with multiple diseases, so that the prevalence and identification of complex medical conditions are important drivers of expenditure; and (iii) health care activity rises substantially for individuals in the period before death, so that expenditure is driven substantially by mortality in the population. Taken together, these findings indicate that this element of health care expenditure in England has been substantially driven by the underlying morbidity and age of the population in conjunction with improving health care technology. [ABSTRACT FROM AUTHOR]

We report on measures used to monitor the response to the UK HIV epidemic. We present analyses of routine data on HIV testing, diagnosis and care, and of CD4 back-calculation models to estimate country of HIV acquisition and incidence. Over the past decade, HIV and AIDS diagnoses and deaths declined while HIV testing coverage increased. Linkage into care, retention in care, and viral suppression was high with few socio-demographic differences. However, in 2013, incidence among MSM, and undiagnosed infection, also remained high, and more than half of heterosexuals newly diagnosed with HIV (the majority of whom were born-abroad) probably acquired HIV in the UK and were diagnosed late. HIV care following diagnosis is excellent in the UK. Improvements in testing and prevention are required to reduce undiagnosed infection, incidence and late diagnoses. Routinely collected laboratory and clinic data is a low cost, robust and timely mechanism to monitor the public health response to national HIV epidemics. [ABSTRACT FROM AUTHOR]