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Different approaches to the use of "clickers" (also known as student response systems) were introduced to a cohort of 127 students over a two-year period with the aim of making students think more deeply in-class about their chemistry knowledge. Student performance was monitored, and individual, anonymous student feedback was frequently obtained using the clicker platform. This work, labeled Project Ponder, tracked the pedagogical benefit of clicker technology when applied to problem-based learning. In phase 1, multiple-choice questions (MCQs) were integrated into problem class sessions. All enrolled students received a clicker handset on a year-long loan, and their responses were anonymously recorded, with repolling and peer discussion where appropriate. Phase 2 adopted a team-based model using the same student cohort as they progressed into year 2 of their studies; however, only one handset was provided per team, which was programmed to score the team's final response to each question. More sophisticated handsets with an alphanumerical keypad were used to allow short-answer questions (SAQs) to be embedded alongside MCQs; additionally, this enabled individual free-text feedback using the handset's multiple response setting. Superior exam performance was taken as an indicator of clicker success. 94% and 100% of students agreed that clickers improved their learning experience, following phases 1 and 2, respectively, and 96-98% responded positively to expanding the project. The thoughtful way that phases 1 and 2 were developed was aided by frequently gauging the student view. The overwhelming preference for a team-based model over individual clicker use can be explained by greater peer instruction and discussion, and in this context helps address conflicting literature regarding the success of these two, very different, clicker approaches.

The transformation of talented youngsters into senior world-beaters is a topic of interest for practitioners and researchers alike. Unfortunately there is a dearth of research to guide the optimization of this process. Accordingly, this paper offers an overview of key themes apparent in the literature that have relevance to the effective development of talent. The five key generic features that emerge consistently include long-term aims and methods; wide ranging coherent messages and support; emphasis on appropriate development rather than early selection; individualized and ongoing development; and finally, integrated, holistic, and systematic development. In addition to the review, exemplars of current worldwide practice are used to further highlight both the need and direction for further research and more broad education of an effective talent development model. (Contains 1 figure.)

The Prader-Willi/Angelman Critical Region (PWACR; Chromosome 15q11-13) is of interest as a potential locus for genes conferring susceptibility to autism spectrum disorders (ASD). This report describes a female proband referred for evaluation of a possible ASD. Genetic analyses indicated that the proband, her father and one of her sisters, carried a paternally derived interstitial duplication involving 15q11-13. The proband showed evidence of ASD (PDD-NOS), borderline mental retardation, mild hypotonia and joint laxity. Her father and her sister were of normal intelligence and neither was thought to have an ASD, although speech/language difficulties and some autistic type behaviours were reported to have been present early in the development of the sister. This is one of the first reports of a child with a paternal duplication and an autism spectrum disorder. More research is required to determine whether paternally derived duplications that involve 15q11-13 are associated with developmental impairments.

Evaluated the effects of a brief isokinetic training program on quadriceps and hamstring peak torque (PT) and standing long-jump performance. Tests on 12 untrained men indicated that the brief training program was at least as effective in improving quadriceps isokinetic (but not hamstring) PT. PT gains subsequent to isokinetic resistance training did not influence functional jumping performance. (SM)

Marine litter is increasingly recognised as a vector for the spread of non-native species (NNS). However, our understanding of its role in the propagation of NNS in UK waters remains limited. As part of the Clean Seas Environmental Monitoring Programme, we opportunistically analysed seafloor macrolitter items trawled from various locations around the coast of England and Wales and examined each for the presence of NNS. Of the 41 litter items analysed, we identified a total of 133 taxa, including two non-native and four cryptogenic species. This confirms that NNS are settling on seafloor macrolitter in UK waters and that these can be detected using morphological taxonomic analysis. Furthermore, we propose a methodology to classify litter based on size, rugosity and polymer/material type to explore whether there were detectable patterns governing community composition and litter characteristics. This exploratory investigation provides evidence to inform future risk assessments of NNS vectors and pathways. • We analysed seafloor litter samples for the presence of non-native species • We found two non-native species on seafloor litter from around the UK • We found four cryptogenic species on seafloor litter from around the UK • We describe a methodology for analysing the litter, by looking at the material composition (e.g., polymers), surface texture and size • We discuss some of the major groups we have found on the litter and how it relates to previous studies [ABSTRACT FROM AUTHOR]

High rates of occupational training-related lower-limb musculoskeletal (MSK) overuse injuries are reported for British Army recruits during basic training. Foot drill is a repetitive impact loading occupational activity and involves striking the ground violently with an extended-knee (straight-leg) landing. Foot drill produces vertical ground reaction force (vGRF) equal to or greater than those reported for high-level plyometric exercises/activities. Shock absorbing footwear aid in the attenuation of the magnitude of vGRF, resulting in a reduced risk of lower-limb MSK overuse injury when running. The potential shock absorbing characteristics of standard issue British Army footwear on the magnitude of vGRF and temporal parameters of foot drill are scant. Therefore, this study sought to determine the magnitude of and examine changes in vGRF and temporal parameters of foot drill across 3 types of British Army footwear. Sampled at 1,000 Hz, the mean of 8 trials from 15 recreationally active men were collected from 4 foot drills; stand-at-ease, stand-at-attention, quick-march (QM), and halt. Analysis of a normal walk was included to act as a comparison with QM. Significant main effects (P ≤ 0.05) were observed between footwear and foot drill. The training shoe (TR) demonstrated significantly greater shock absorbing capabilities when compared with the combat boot and ammunition boot. Foot drill produced peak vGRF and peak vertical rate of force development in excess of 5 bw, and 350 bw·s, respectively. Time to peak vGRF ranged from 0.016 to 0.036 ms across foot drills, indicating that passive vGRF may not be under neuromuscular control. The marginal reductions in the magnitude of vGRF and temporal parameters in foot drill associated with the TR may act to reduce the accumulative impact loading forces experienced by recruits, subsequently minimizing the severity and rates of lower-limb MSK overuse injuries and recruit medical discharges during basic training. [ABSTRACT FROM AUTHOR]

Objective: Packable composites are a comparatively recent addition to the dentist's armamentarium, Solitaire-2 being an example of this type of material. This paper reports the performance of 100 restorations formed in Solitaire-2 in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems, in Class I and II cavity restorations in permanent teeth, placed in the practices of five members of the Product Research and Evaluation by Practitioners (PREP) Panel, a group of United Kingdom-based dental practitioners who are prepared to undertake research projects in their practices. Method and materials: Five members of the PREP Panel were each requested to place 20 Solitaire-2 restorations. These restorations were reviewed at 1 year by a trained and calibrated evaluator, and the PREP panel member who had placed the restorations. Results: A total of 88 restorations (33 Class I, 55 Class II in 49 patients (mean age 43 years) were reviewed at 1 year. One Class II restoration (a large mesio-occlusodistal restoration) had been replaced at 10 months after a fracture was detected across the distal box. The remaining 87 (99%) of the restorations were intact with no secondary caries detected. Conclusion: Ninety-nine percent of the Solitaire-2 restorations, placed in general dental practice conditions in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems, were found to be performing satisfactorily at 1 year. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess Pertac II restorations placed in general dental practice. Method and materials: A total of 86 restorations (14 Class 1, 10 Class II, 17 Class III, 5 Class IV, and 40 Class V) using a hybrid composite material (Pertac II) placed in 56 patients (mean age, 39 years) in 5 dental practices in the United Kingdom were assessed after 1 year by a trained evaluator and the dental practitioner who had placed the restoration. All the restorations were assessed for anatomic form, marginal adaptation, surface roughness, sensitivity or discomfort, gingival condition, and the presence or absence of secondary caries. Results: Thirty-five (43%) restorations were placed in load-bearing situations, 9% of which were assessed as being in "heavy" occlusion. Five (6%) of the restorations were lost (all Class V restorations), 4 from premolars and 1 from a molar. Four were in wedge-shaped cavities and 1 small restoration was actually dislodged during examination. The remaining 81 (94%) restorations were found to be intact, with no secondary caries detected. A high percentage of optimal scores were recorded for both anatomic form and surface roughness. Conclusion: It is concluded that the evaluation demonstrated satisfactory clinical performance of Pertac II restorations after 1 year of clinical service in the wide variety of clinical situations seen in general dental practice. However, the potential for failure of hybrid composite materials in Class V situations appears high. It may be argued that clinicians who wish to use a resin-based material in a Class V situation should use a compomer or microfilled composite. [ABSTRACT FROM AUTHOR]

Inadequate nutrition may contribute to poor health in homeless and vulnerable adults. Charitable meals are critical to this group’s nutrition. The nutrient content of charitable meals at 2 organizations was assessed. Ethnography investigated organizational practice; semistructured interviews explored influences on meal provision. Meals were adequate for energy and the majority of nutrients but exceeded thresholds of saturated fat, salt, and sugars and lacked vitamin D and selenium in both organizations. Organizations were constrained by budget, equipment, food donations, volunteer capabilities, and time. Organizational values influenced meal provision; strategies to reduce fat, salt, and sugar content may be resisted because of an ethos of hospitality and overprovision. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the working patterns and facilities of the consultant orthodontist service.Design: A cross-sectional survey.Setting: Consultant orthodontist departments in the UK.Subjects and Methods: All consultant orthodontists in the UK were sent a questionnaire that gathered information on the individual consultant, the facilities available, the new patients referred and patients under current treatment.Results: The consultant orthodontist service provided treatment to a high number of patients who were in definite need of orthodontic treatment. A marked reduction in the use of removable appliances suggests improving standards of care and provision of more complex treatment. The caseload was high and a fair proportion of patients were returned to their referring dentists with treatment plans. The consultant service has not completely evolved into a service that provides treatment at a super-specialist level alone.Conclusions: There has been little change in the consultant orthodontist service over the past ten years. Arguably, this is because of the wishes of the purchasers and the shortage of trained orthodontic manpower as a direct result of poor manpower planning and lack of funds for post-graduate training. [ABSTRACT FROM AUTHOR]

Background Homeless people in the UK and elsewhere have typically been found to consume a nutritionally inadequate diet. There is need for contemporary research to update our understanding within this field. The present study aimed to provide an insight into the nutrient intake and food choice of a sample of homeless adults. Methods In this mixed-methods study, 24 homeless individuals accessing two charitable meal services in Sheffield, UK, participated in up to four 24-h dietary recalls between April and August 2012. Twelve individuals took part in a semi-structured interview focusing on food choice. Results Energy intake was significantly lower than the estimated average requirement. Median intakes of vitamin A, zinc, magnesium, potassium and selenium were significantly lower than reference nutrient intakes. Contributions of saturated fat and nonmilk extrinsic sugars to total energy intake were significantly higher, whereas dietary fibre was significantly lower, than population average intakes. Charitable meals made an important contribution to intakes of energy and most micronutrients. Thematic analysis of interview transcripts revealed three major themes: food aspirations; constraints over food choice; and food representing survival. Conclusions The present study reveals risk of dietary inadequacies amongst homeless people alongside a lack of control over food choices. Charitable meal services are suggested as a vehicle for improving the dietary intake and nutritional health of homeless people. [ABSTRACT FROM AUTHOR]

Background The present study examined temporality in the representation of food in two popular British women's magazines between 1950 and 1998. Methods A quantitative content analysis of (i) prevalence of cooking, slimming, nutrition advice in articles; (ii) prevalence of food advertising by food type; and (iii) likelihood of various nutrition and consumer messages in advertising was performed on a sample comprising 200 magazines, with 3045 advertisements and 88 articles. Results The prevalence of food advertisements decreased ( P < 0.001), whereas food articles increased, across decades ( P < 0.001). Cooking tips dominated 1950s food writing (100%), contrasting with miniscule coverage in the 1990s (5%). Slimming advice was not represented in 1950s articles and was most common in 1970s articles (55% of articles). Food advertising for all food types decreased in the 1990s decade. There were greater bread and cereals ( P < 0.001), protein foods ( P = 0.001) and dairy ( P < 0.001) advertising in later decades; advertising for sugar- and fat-rich foods ( P < 0.001), condiments and baking ingredients ( P < 0.001) and beverages ( P < 0.001) was greater in earlier decades. Odds of advertising claims for energy, easy digestion, nourishment, general health, economy, good for family (all P < 0.01), pleased others ( P = 0.017) and convenience ( P = 0.031) were greater in the 1950s and decreased thereafter. Claims around taste and quality were highest in the 1960s (all P < 0.01). Mineral, additive-free, and protein claims were most likely to be invoked in 1970s advertising (all P < 0.01). Low-fat, low-calorie and fibre claims peaked in the 1980s (all P < 0.01), whereas the odds of specific fat claims was greatest in the 1990s ( P = 0.015). Conclusions Representation of food resonated with prevailing food culture but was not always congruent with nutrition policy. [ABSTRACT FROM AUTHOR]

Chronic kidney disease prevalence will continue to rise due to increased life expectancy and population ageing. It is likely that the decline in glomerular filtration rate with increasing age represents a renal manifestation of widespread vascular disease. In addition to its associated cardiovascular risk, chronic kidney disease in older people is associated with increased prevalence of geriatric syndromes such as functional and cognitive decline, which lead to disability and frailty. Competing risks for mortality, because of the co-existence of multiple co-morbidities in old age, means that the majority of older people with chronic kidney disease will not progress to end-stage renal disease. Management of chronic kidney disease in older people is complex and an individualized and holistic, rather than disease-orientated, approach is necessary, which takes into account patients’ priorities and wishes, especially frail and very elderly populations with multiple co-morbidities. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: A novel resin composite system, Filtek Silorane (3M ESPE) with reduced polymerization shrinkage has recently been introduced. The resin contains an oxygen-containing ring molecule (‘oxirane’) and cures via a cationic ring-opening reaction rather than a linear chain reaction associated with conventional methacrylates and results in a volumetric shrinkage of ∼1%. The purpose of this study was to review the literature on a recently introduced resin composite material, Filtek Silorane, and evaluate the clinical outcome of restorations formed in this material. Methods: Filtek Silorane restorations were placed where indicated in loadbearing situations in the posterior teeth of patients attending five UK dental practices. These were evaluated, after two years, using modified USPHS criteria. Results: A total of 100 restorations, of mean age 25.7 months, in 64 patients, were examined, comprised of 30 Class I and 70 Class II. All restorations were found to be present and intact, there was no secondary caries. Ninety-seven per cent of the restorations were rated optimal for anatomic form, 84% were rated optimal for marginal integrity, 77% were rated optimal for marginal discoloration, 99% were rated optimal for color match, and 93%% of the restorations were rated optimal for surface quality. No restoration was awarded a “fail” grade. No staining of the restoration surfaces was recorded and no patients complained of post-operative sensitivity. Significance: It is concluded that, within the limitations of the study, the two year assessment of 100 restorations placed in Filtek Silorane has indicated satisfactory clinical performance. [Copyright &y& Elsevier]

Background: Anterior knee pain (AKP) is the most common activity-related injury of the knee. The authors investigated the effect of an exercise intervention on the incidence of AKP in UK army recruits undergoing a 14-week physically arduous training program.Hypothesis: Modifying military training to include targeted preventative exercises may reduce the incidence of AKP in a young recruit population.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A single-blind cluster randomized controlled trial was performed in 39 male and 11 female training groups (median age: 19.7 years; interquartile range, 17-25) undergoing phase 1 of army recruit training. Each group was randomly assigned to either an intervention (n = 759) or control (n = 743) protocol. The intervention consisted of 4 strengthening and 4 stretching exercises completed during supervised physical training lessons (7 per week). The control group followed the existing training syllabus warm-up exercises. The primary outcome was a diagnosis of AKP during the 14-week training program.Results: Forty-six participants (3.1%; 95% confidence interval [CI], 2.3-4.1) were diagnosed with AKP. There were 36 (4.8%; 95%CI, 3.5-6.7) new cases of AKP in the control group and 10 (1.3%; 0.7-2.4) in the intervention group. There was a 75% reduction in AKP risk in the intervention group (unadjusted hazard ratio = 0.25; 95% CI, 0.13-0.52; P < .001). Three participants (0.4%) from the intervention group were discharged from the military for medical reasons compared to 25 (3.4%) in the control group.Conclusion: A simple set of lower limb stretching and strengthening exercises resulted in a substantial and safe reduction in the incidence of AKP in a young military population undertaking a physical conditioning program. Such exercises could also be beneficial for preventing this common injury among nonmilitary participants in recreational physical activity. [ABSTRACT FROM AUTHOR]

Background. To help prevent drug errors, it is recommended that drugs should be confirmed/checked with a second person before administration. We aimed to assess the feasibility of introducing second-person or electronic bar-code confirmation of drugs, administered during anaesthesia, in the National Health Service (NHS) settings in the UK. Methods. Seven NHS sites took part in a pilot study over a 3 month period. Five used a second-person and two used bar-code electronic confirmation of drugs given during anaesthesia. A total of 36 consultant anaesthetists and three trainees, 15 operating department practitioners (ODPs), and seven anaesthetic nurses participated. A group of anaesthetists, ODPs, and nurse practitioners (n = 11) from different NHS sites independently observed both methodologies. In addition, each site was visited and observed by one of the study investigators. At the end of the study period, four focus groups (two with participants from pilot sites and two with observers) were held. The discussions were taped, transcribed, and qualitatively analysed. Data were triangulated using observer's notes and investigator's reflective diaries, and processed using line-byline coding. The codes were then synthesized into themes. Results. Both methods were perceived to contribute to the prevention of drug errors. For the two-person confirmation to be carried out correctly, there should be no distraction or time pressure. The main limitation to the feasibility was that the continuous presence of the second person was not always possible. The process also met with resistance from the staff at some pilot sites. Electronic confirmation was always feasible, as it did not require the presence of a second person. It was found to be intuitive to the anaesthetist's current working practice. However, there were some practical issues related to introduction of new technology and an initial learning curve. Conclusions. The introduction of two-person confirmation to the NHS would have a significant impact on the existing working practices. Issues related to resources and a cultural change will need to be addressed. Electronic confirmation was more feasible, but the technological aspects of its integration into the operating theatre environment, and learning, will require further attention. [ABSTRACT FROM AUTHOR]

The pro rata addition of 0-20 wt% Fe2O3 to a UK high level waste (HLW) borosilicate glass containing 25 wt% model UK HLW has been studied in terms of the effects of Fe2O3 addition on glass chemical durability, thermal properties, density and redox. Mixtures have been successfully melted in Pt crucibles at 1050 and 1150°C, and resulting glasses are x-ray amorphous. Addition of Fe2O3 increases glass density and HLW loading per unit volume increases by 3·5% for 10 wt% Fe Fe2O3 addition. Chemical durability has been measured using the methodology of product consistency test B (ASTM C1285)for 7, 14 and 28 days. Leach rate and solution pH is reduced by the addition of Fe2O3. Overall test results suggest that 5-10% Fe2O3 addition provides optimum improvement in chemical durability. Thermal stability and Tg are unaffected by 0-15 wt% Fe2O3 addition. Fe Mössbauer spectroscopy reveals that Fe is present in these glasses as Fe3+ ions in tetrahedral coordination, strengthening the glass network through increased network polymerisation. The results also suggest that increasing the Fe2O3 content of the glass changes the character and makeup of the interracial layers formed during corrosion. [ABSTRACT FROM AUTHOR]

The extent of functional trait diversity is quantified for 157 different Capsella bursa-pastoris (L.) medic (shepherd’s purse) accessions. These individuals encompass replicate progeny generated from seed of 53 different Capsella‘maternal lines’ that were isolated at random as they emerged from soil cores (used to estimate baseline seed bank numbers and weed diversity) at 34 different arable sites across the United Kingdom. The replicate progeny were subject to ex situ characterisation for traits determining life history and architecture. Seven leaf-type classes were identified and representative parents of each leaf type were distinguishable using four different simple sequence repeat markers. Life-history traits were only loosely associated with leaf shape, and cluster analysis grouped the accessions into three broad types: small plants that flowered early with intermediate reproductive output; large plants, with intermediate time to flowering and a high reproductive output; late-flowering plants, of intermediate size and low reproductive output. The most common leaf-type variants (83% of accessions) demonstrated a short time to flowering (ca. 70 days), while rarer variants included those that flowered after 140 days, accumulated more nitrogen and produced less seed: possibly representing advantageous and disadvantageous traits (respectively), in modern arable rotations. A wide trait variation was therefore found in Capsella bursa-pastoris despite decades of agricultural intensification, the range of time-to-flowering for C. bursa-pastoris being as broad the mean flowering times of the commoner annual and winter annual arable species. We propose the use of traits, rather than species, as the accounting unit to quantify functional biodiversity in arable systems. [ABSTRACT FROM AUTHOR]

Amidst the winds of change that are blowing across the UK public health (PH) landscape in relation to the essential abilities and national standards that are required for the 'art and science' of PH, the preparation for a new cadre of 'PH professionals' is already underway. Several postgraduate masters programmes in public health (MPH) have taken on board the challenge of addressing the requisite sets of skirts and expertise as a guide to their content and delivery. Although there are recommendations regarding teaching PH to undergraduate medical students, little consensus seems to exist on teaching postgraduate PH to non-medically qualified professionals, health managers and administrators. Employing a case study approach, this article analyses the methods used, philosophies and processes, structure and organization, outcomes to date, and lessons learnt from MPH programmes implemented at two institutions in the UK. The programmes have been initiated recently, and have had the opportunity to take on board the recent national guidelines about training standards. The findings indicate that preparatory work of the programmes, and the challenges and strengths in meeting the recent policy developments in PH training are pertinent points. The MPH programmes highlight key issues in interprofessional education and its purpose, its process and its outcomes in relation to multidisciplinary specialist practice. These programmes provide a variety of models for others wishing to develop or restructure their postgraduate PH teaching programmes. The finalization of the national standards for specialist practice in PH in the UK is encouraged, along with clearer working definitions of the domains of expertise required. Collectively, attention to these measures can ensure that the processes which teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with PH knowledge and skills. [ABSTRACT FROM AUTHOR]

Focuses on the introduction of public health concepts in health care curricula in Great Britain. Primary care-based health system; Population-based health principles; Public health-oriented educational strategy.

A set of biographical data was collected for a sample of 420 Royal Naval officers in training. Different scoring keys were developed for four training criteria, using England's (1971) Weighted Application Blank technique, and cross-validated on a further sample of 282 officers. Appropriately weighted biodata predicted one of the training performance criteria almost as well as the composite score of four psychometric tests of aptitude, and as the overall assessment rating of a lengthy assessment centre procedure. Of the two training wastage criteria, biodata succeeded in predicting voluntary withdrawal from training at a low level while neither of the other two predictors did so. Different biographical items predicted voluntary withdrawal and success in professional training. There was no evidence of differential validity for subsamples from different socio-economic or educational backgrounds. [ABSTRACT FROM AUTHOR]

The article discusses the study which is aimed to determine the psychological aspects of the stereotactic treatment of Parkinsonism in Great Britain. The beneficial clinical effects of stereotactic lesions in the venterolateral nucleus of the thalamus in the treatment of Parkinsonism are well established. Personality changes were considered at three weeks and nine months after operation. The psychological tests have given no evidence of any permanent change resulting from stereotactic lesions of the venterolateral nucleus of the thalamus.

Background: On 1 June 2005, amendments to the Coroners Rules 1984 were introduced in England and Wales. These principally cover the retention of tissues from autopsies and their subsequent disposal. This study assesses regional variations in the interpretations of the amendments, and their impact on local autopsy practice in Oxford. Methods: A questionnaire was circulated to pathologists in 120 coronial jurisdictions, addressing conditions under which histological material could be retained. A local review of autopsy practice was conducted before and after the introduction of the amendments. Results: Questionnaires were returned from 71 coronial jurisdictions. 35 (49%) coroners provided written guidelines on their interpretation of the amendments. In 52 (73%) jurisdictions, pathologists are authorised to retain material to confirm/refine causes of death from natural causes. In 77% of jurisdictions, coroner's officers are responsible for obtaining instructions from the next of kin on subsequent retention, use or disposal of retained tissues. In Oxford, there has been a reduction in the proportion of cases in which histology is taken, but an increase in the proportion of cases in which a histology report is issued. Conclusions: There is considerable regional variation in the interpretation of the 2005 Coroners Rules Amendments. These variations have potentially important implications for clinical practice. [ABSTRACT FROM AUTHOR]

Abiraterone acetate plus prednisolone (herein referred to as abiraterone) or enzalutamide added at the start of androgen deprivation therapy improves outcomes for patients with metastatic prostate cancer. Here, we aimed to evaluate long-term outcomes and test whether combining enzalutamide with abiraterone and androgen deprivation therapy improves survival. We analysed two open-label, randomised, controlled, phase 3 trials of the STAMPEDE platform protocol, with no overlapping controls, conducted at 117 sites in the UK and Switzerland. Eligible patients (no age restriction) had metastatic, histologically-confirmed prostate adenocarcinoma; a WHO performance status of 0–2; and adequate haematological, renal, and liver function. Patients were randomly assigned (1:1) using a computerised algorithm and a minimisation technique to either standard of care (androgen deprivation therapy; docetaxel 75 mg/m2 intravenously for six cycles with prednisolone 10 mg orally once per day allowed from Dec 17, 2015) or standard of care plus abiraterone acetate 1000 mg and prednisolone 5 mg (in the abiraterone trial) orally or abiraterone acetate and prednisolone plus enzalutamide 160 mg orally once a day (in the abiraterone and enzalutamide trial). Patients were stratified by centre, age, WHO performance status, type of androgen deprivation therapy, use of aspirin or non-steroidal anti-inflammatory drugs, pelvic nodal status, planned radiotherapy, and planned docetaxel use. The primary outcome was overall survival assessed in the intention-to-treat population. Safety was assessed in all patients who started treatment. A fixed-effects meta-analysis of individual patient data was used to compare differences in survival between the two trials. STAMPEDE is registered with ClinicalTrials.gov (NCT00268476) and ISRCTN (ISRCTN78818544). Between Nov 15, 2011, and Jan 17, 2014, 1003 patients were randomly assigned to standard of care (n=502) or standard of care plus abiraterone (n=501) in the abiraterone trial. Between July 29, 2014, and March 31, 2016, 916 patients were randomly assigned to standard of care (n=454) or standard of care plus abiraterone and enzalutamide (n=462) in the abiraterone and enzalutamide trial. Median follow-up was 96 months (IQR 86–107) in the abiraterone trial and 72 months (61–74) in the abiraterone and enzalutamide trial. In the abiraterone trial, median overall survival was 76·6 months (95% CI 67·8–86·9) in the abiraterone group versus 45·7 months (41·6–52·0) in the standard of care group (hazard ratio [HR] 0·62 [95% CI 0·53–0·73]; p<0·0001). In the abiraterone and enzalutamide trial, median overall survival was 73·1 months (61·9–81·3) in the abiraterone and enzalutamide group versus 51·8 months (45·3–59·0) in the standard of care group (HR 0·65 [0·55–0·77]; p<0·0001). We found no difference in the treatment effect between these two trials (interaction HR 1·05 [0·83–1·32]; p interaction =0·71) or between-trial heterogeneity (I 2 p=0·70). In the first 5 years of treatment, grade 3–5 toxic effects were higher when abiraterone was added to standard of care (271 [54%] of 498 vs 192 [38%] of 502 with standard of care) and the highest toxic effects were seen when abiraterone and enzalutamide were added to standard of care (302 [68%] of 445 vs 204 [45%] of 454 with standard of care). Cardiac causes were the most common cause of death due to adverse events (five [1%] with standard of care plus abiraterone and enzalutamide [two attributed to treatment] and one (<1%) with standard of care in the abiraterone trial). Enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas. [ABSTRACT FROM AUTHOR]

Studies on glass durability are important to our understanding of the likely long term behaviour of vitrified nuclear wastes, natural and archaeological glasses; there has, however, been little in the way of systematic reporting of features associated with localised chemical attack on such glasses. Durability experiments performed in water at 90 °C from 28 d to 672 d on glass monoliths of 5 different compositions: 3 basaltic compositions; an inactive version of the 25 wt% loaded UK mixture Windscale (MW25) glass and the International Simple Glass (ISG) all yielded locally extended or vermiform alteration features. Similar features are seen on all glasses at all dissolution times studied. The number of features and whether they were filled by alteration products or not was dependant on glass composition. The majority of features have quite simple geometries but lesser numbers of more complex morphologies are seen. The location of these features is thought to be most probably linked to residual damage arising from the monolith production providing sites for locally accelerated dissolution. Despite being sites of localised accelerated dissolution the impact of these features on the total surface area is calculated to be limited. Hence the surface area term used to calculate normalised mass losses and normalised loss rates will not be greatly in error as a result of these features. [ABSTRACT FROM AUTHOR]

Compositional modification of United Kingdom high level nuclear waste (HLW) glasses was investigated with the aim of understanding the impact of adopting a ZnO/CaO modified base glass on the vitrified product phase assemblage, glass structure, processing characteristics and dissolution kinetics. Crystalline spinel phases were identified in the vitrified products derived from the Na 2 O/Li 2 O and the ZnO/CaO modified base glass compositions; the volume fraction of the spinel crystallites increased with increasing waste loading from 15 to 20 wt%. The spinel composition was influenced by the base glass components; in the vitrified product obtained with the ZnO/CaO modified base glass, the spinel phase contained a greater proportion of Zn, with a nominal composition of (Zn 0.60 Ni 0.20 Mg 0.20 )(Cr 1.37 Fe 0.63 )O 4 . The addition of ZnO and CaO to the base glass was also found to significantly alter the glass structure, with changes identified in both borate and silicate glass networks using Raman spectroscopy. In particular, these glasses were characterised by a significantly higher Q 3 species, which we attribute to Si–O–Zn linkages; addition of ZnO and CaO to the glass composition therefore enhanced glass network polymerisation. The increase in network polymerisation, and the presence of spinel crystallites, were found to increase the glass viscosity of the ZnO/CaO modified base glass; however, the viscosities were within the accepted range for nuclear waste glass processing. The ZnO/CaO modified glass compositions were observed to be significantly more durable than the Na 2 O/Li 2 O base glass up to 28 days, due to a combination of the enhanced network polymerisation and the formation of Ca/Si containing alteration layers. [ABSTRACT FROM AUTHOR]

Magnesium aluminosilicate and magnesium borosilicate glass formulations were developed and evaluated for the immobilisation of the radioactive waste known as Magnox sludge. Glass compositions were synthesised using two simplified bounding waste simulants, including corroded and metallic uranium and magnesium at waste loadings of up to 50 wt.%. The glasses immobilising corroded simulant waste formed generally homogenous and fully amorphous glasses, while those immobilising metallic wastes contained crystallites of UO 2 and U 3 O 8. Uranium speciation within the glass was investigated by micro-focus X-ray absorption near edge spectroscopy and it was shown that the borosilicate glass compositions were characterised by a slightly lower mean uranium oxidation state than the aluminosilicate counterparts. This had an impact upon the durability, and uranium within glasses of higher mean oxidation states was dissolved more readily. All material showed dissolution rates that were comparable with simulant high level radioactive waste glasses, while the borosilicate-based formulations melted at a temperature suitable for modern vitrification technologies used in radioactive waste applications. These data highlight the potential for vitrification of hazardous radioactive Magnox sludge waste in borosilicate or aluminosilicate glass formulations, with the potential to achieve >95 % reduction in conditioned waste volume over the current baseline plan. • Magnesium aluminosilicate and magnesium borosilicate glass systems were synthesised to incorporate metallic uranium and magnesium, U 3 O 8 and Mg(OH) 2 • Uranium speciation within the glass was investigated by micro-focus X-ray absorption near edge spectroscopy • Borosilicate glasses possessed greater chemically durable than their aluminosilicate counterparts • All glass compositions demonstrated durability that is comparable to UK and French high level waste glass [ABSTRACT FROM AUTHOR]

Dissolution of a simulant UK nuclear waste glass containing Mg, Ca and Zn was investigated over 35 d at 50 °C in ultra-high quality (UHQ) water and simulant groundwater solutions. The dissolution rates were influenced subtly by the groundwater composition, following the trend, from least to most durable: clay > UHQ water > granite ≈ saline. Solutions were rapidly silica saturated but boron dissolution rates continued to increase. This is hypothesised to be due to the formation of secondary Mg-silicate precipitates, preventing the formation of a passivating silica gel layer and allowing glass dissolution to proceed at close to the maximum rate. [ABSTRACT FROM AUTHOR]

Background: Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes., Objective: Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice., Design: This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan., Participants: All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed., Approach: Data collection occurred in GP-patient consultations during 2017-2018 across 7 practices in UK during 2017-2018., Key Results: GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion., Conclusions: We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty., (© 2024. The Author(s).)

Background: The UK's National Institute for Health and Care Excellence (NICE) advises GPs to inform patients referred to the Urgent Suspected Cancer (USC) pathway about their impending service and expectations. However, little is known about patient experiences and information needs post-referral. GPs often grapple with conveying the urgency of referrals while offering reassurance., Aim: This study explores GP communication regarding cancer and USC referrals., Method: A secondary analysis of 23 audio-recorded GP-patient consultations, selected from a larger dataset of 200 consultations in Surrey and London (2017-2018), was conducted, focusing on discussions related to cancer., Results: We found that most GPs informed patients that they might have cancer and engaged in reassurance about the patient's low risk of cancer using personalised risk statements. Some GPs, however, avoided all mention of cancer, using symptom-led language instead. GPs tended to focus on communicating practical rather than support-based information when discussing the referral. While most GPs informed patients that they would be seen by a specialist within two weeks, few discussed patients' support needs during the referral or specialist appointment., Conclusion: This presentation will offer language recommendations for clear communication about cancer referrals. This plays an important role in promoting shared decision-making and driving patient attendance for investigations. The study highlights the need for further research on communication practices around cancer referral to improve patient understanding and experience. Our recommendations for enhanced communication may improve patient outcomes by optimising routes to diagnosis via primary care., (© British Journal of General Practice 2024.)

Background: Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual's one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to 'conventional' heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain., Methods: This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18-55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study., Discussion: LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI., Trial Registration: ClinicalTrials.org reference number, NCT05719922., (© 2023. Crown.)

Background: Low levels of cancer awareness may contribute to delays in seeking medical help and subsequent delays in diagnosis. For blood cancer this may be a particularly prominent problem due to the high prevalence of undifferentiated symptoms such as bodily pain, weakness, nausea and weight loss, resulting in low symptom awareness. The delay is exacerbated by the dismissal of similar symptoms which are often interpreted as mild disease, resulting in multiple consultations prior to diagnosis. This study describes the development of a Cancer Awareness Measure for Blood Cancer (Blood CAM) and presents results from a population-representative survey using the measure., Methods: A rapid systematic review identified constructs relevant to blood cancer. Items were taken from previous awareness measures and other literature and reviewed by expert groups including health care professionals and patients. Cognitive interviews were conducted with ten members of the public to check comprehension and clarity. A total sample of 434 participants completed the survey at Time 1 and n = 302 at Time 2 (two weeks later)., Results: Internal reliability was high across the different constructs included in the questionnaire (> 0.70) and test-retest reliability was moderate to good (0.49-0.79). The most commonly recognised blood cancer symptoms were unexplained weight loss (68.9%) and unexplained bleeding (64.9%) and the least commonly recognised symptoms were night sweats (31.3%) breathlessness and rash/itchy skin (both 44%). In terms of symptom experience, fatigue was the most commonly reported symptom (26.7%) followed by night sweats (25.4%). Exploratory factor analysis of barriers to presenting at primary care revealed three distinct categories of barriers; emotional, external/practical and service/healthcare professional related. Service and emotional barriers were most common., Conclusions: We developed a valid and reliable tool to assess blood cancer awareness and showed variable awareness of blood cancer symptoms which can help target public health campaigns. We also incorporated additional measures (e.g. confidence to re-consult, ability to understand symptoms) that could be used to tailor public messaging for blood cancer and for other harder to suspect and diagnose cancers., (© 2023. The Author(s).)

Introduction: Establishing research priorities help to address knowledge gaps and exploit emerging opportunities to develop a clinical evidence base. The previous clinical engagement exercise to determine UK Defence Rehabilitation practitioner-based research priorities was conducted in 2014. The aim of this article is to (1) describe how research priorities are established for UK Defence Rehabilitation; (2) review, reassess and rate the priorities highlighted and set by rehabilitation practitioners following the 2014 survey and (3) identify new rehabilitation research themes and topics reflecting 2020 priorities., Methods: Stage 1: delegates (n=72) at the October 2019 Defence Medical Services Rehabilitation Conference participated in a series of focus group workshops. Stage 2: an online survey circulated through the military chain of command to all Defence Primary Health Care clinical rehabilitation staff. Stage 3: a thematic analysis of all survey submissions yielding a ranked order of priority by topic., Results: 165 clinical rehabilitation staff completed an online survey. 'Rehabilitation outcomes', 'Psychological factors in rehabilitation' and 'Residential/Inpatient treatment paradigm' emerged as three clear research priorities across all three tiers of UK Defence Rehabilitation. New research priorities emerging from the 2020 survey were 'lifestyle factors during rehabilitation', 'management of pain during rehabilitation' and 'anterior knee pain'., Conclusion: It is essential that funding directed to musculoskeletal rehabilitation focuses on the highest research priorities in the field to ensure optimum health return on investment. The results of this survey will assist in guiding the clinical research being conducted within UK Defence Rehabilitation over the next five years., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sickle cell disease (SCD) is characterized by frequent, unpredictable pain episodes and other vaso-occlusive crises (VOCs) leading to significant healthcare utilization. VOC frequency is often an endpoint in clinical trials investigating novel therapies for this devastating disease., Procedure: The Consortium for the Advancement of Sickle Cell Research (CASiRe) is an international collaboration investigating clinical severity in SCD using a validated questionnaire and medical chart review standardized across four countries (United States, United Kingdom, Italy and Ghana)., Results: This study, focused on pain crisis incidence and healthcare utilization, included 868 patients, equally represented according to age and gender. HgbSS was the most common genotype. Patients from Ghana used the Emergency Room/Day Hospital for pain more frequently (annualized mean 2.01) than patients from other regions (annualized mean 1.56 U.S.; 1.09 U.K.; 0.02 Italy), while U.K. patients were hospitalized for pain more often (annualized mean: U.K. 2.98) than patients in other regions (annualized mean 1.98 U.S.; 1.18 Ghana; Italy 0.54). Italy's hospitalization rate for pain (annualized mean: 0.57) was nearly 20 times greater than its emergency room/day hospital only visits for pain (annualized mean: 0.03). When categorized by genotype and age, similar results were seen., Conclusions: Geographic differences in pain crisis frequency and healthcare utilization may correlate with variable organization of healthcare systems among countries and should be considered regarding trial design, endpoints, and analysis of results when investigating novel agents for clinical benefit., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Pain is a hallmark of Sickle Cell Disease (SCD) affecting patients throughout their life; the first pain crisis may occur at any age and is often the first presentation of the disease. Universal newborn screening identifies children with SCD at birth, significantly improving morbidity and mortality. Without early screening, diagnosis is generally made after disease manifestations appear. The Consortium for the Advancement of Sickle Cell Research (CASiRe) is an international collaborative group evaluating the clinical severity of subjects with SCD using a validated questionnaire and medical chart review, standardized across 4 countries (United States, United Kingdom, Italy and Ghana). We investigated the age of first pain crisis in 555 sickle cell subjects, 344 adults and 211 children. Median age of the first crisis in the whole group was 4 years old, 5 years old among adults and 2 years old among children. Patients from the United States generally reported the first crisis earlier than Ghanaians. Experiencing the first pain crisis early in life correlated with the genotype and disease severity. Early recognition of the first pain crisis could be useful to guide counseling and management of the disease., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Millions are affected by sickle cell disease (SCD) worldwide with the greatest burden in sub-Saharan Africa. While its origin lies historically within the malaria belt, ongoing changes in migration patterns have shifted the burden of disease resulting in a global public health concern. We created the Consortium for the Advancement of Sickle Cell Research (CASiRe) to understand the different phenotypes of SCD across 4 countries (USA, UK, Italy, and Ghana). Here, we report the multi-generational ethnic and racial background of 877 SCD patients recruited in Ghana (n = 365, 41.6%), the USA (n = 254, 29%), Italy (n = 81, 9.2%), and the UK (n = 177, 20.2%). West Africa (including Benin Gulf) (N = 556, 63.4%) was the most common geographic region of origin, followed by North America (N = 184, 21%), Caribbean (N = 51, 5.8%), Europe (N = 27, 3.1%), Central Africa (N = 24, 2.7%), and West Africa (excluding Benin Gulf) (N = 21, 2.4%). SCD patients in Europe were primarily West African (73%), European (10%), Caribbean (8%), and Central African (8%). In the USA, patients were largely African American (71%), Caribbean (13%), or West African (10%). Most subjects identified themselves as Black or African American; the European cohort had the largest group of Caucasian SCD patients (8%), including 21% of the Italian patients. This is the first report of a comprehensive analysis of ethnicity within an international, transcontinental group of SCD patients. The diverse ethnic backgrounds observed in our cohort raises the possibility that genetic and environmental heterogeneity within each SCD population subgroup can affect the clinical phenotype and research outcomes.

Background and Aims: A proportion of chronic heart failure (CHF) patients will experience regurgitation secondary to ventricular remodeling in CHF, known as functional mitral (MR) or tricuspid (TR) regurgitation. Its presence adversely impacts the prognosis and healthcare utilization in CHF patients. The advent of interventional devices for both atrioventricular valves modifies both aspects. We present an economic model structure suitable for comparing interventions used in MR and TR, and assess the cost-effectiveness of transcatheter mitral valve repair (TMVr) plus guideline directed medical therapy (GDMT) compared with GDMT alone in people with MR., Methods: An economic model with a lifetime time horizon was developed based on extrapolated survival data and using New York Heart Association classifications to describe disease severity in people with functional MR at high risk of surgical mortality or deemed inoperable. Cost and utility values (describing health-related quality-of-life) were assigned to patients dependent on their disease severity. The analysis was conducted from a UK National Health Service perspective. An incremental cost per additional quality-adjusted life year (QALY) was estimated, and sensitivity (one-way and probabilistic) and scenario analyses conducted., Results and Conclusions: Compared with GDMT, the use of TMVr results in an additional 1.07 QALYs and an increase in costs of £32,267 per patient over a lifetime time horizon. The estimated incremental cost per QALY gained is £30,057 and would therefore be on the threshold of cost-effectiveness at £30,000 per quality adjusted life year. Thus, from a UK reimbursement perspective, in patients with severe functional MR who are at high risk of surgical mortality or deemed inoperable with conventional surgery, TMVr plus medical therapy is likely to represent a cost-effective treatment option compared with GDMT alone. The choice of device (MitraClip or PASCAL) will need to be confirmed once further clinical data are reported.

Background: The 2017 European Society of Cardiology guidelines for valvular heart disease included changes in the definition of severe aortic stenosis (AS). We wanted to evaluate its influence on management decisions in asymptomatic patients with moderate-severe AS., Methods: We reclassified the AS severity of the participants of the PRIMID-AS study (Prognostic Importance of Microvascular Dysfunction in Asymptomatic Patients With AS), using the 2017 guidelines, determined their risk of reaching a clinical end point (valve replacement for symptoms, hospitalization, or cardiovascular death) and evaluated the prognostic value of aortic valve calcium score and biomarkers. Patients underwent echocardiography, cardiac magnetic resonance imaging, exercise tolerance testing, and biomarker assessment., Results: Of the 174 participants, 45% (56/124) classified as severe AS were reclassified as moderate AS. This reclassified group was similar to the original moderate group in clinical characteristics, gradients, calcium scores, and remodeling parameters. There were 47 primary end points (41 valve replacement, 1 death, and 5 hospitalizations-1 chest pain, 2 dyspnea, 1 heart failure, and 1 syncope) over 368±156 days follow-up. The severe and reclassified groups had a higher risk compared with moderate group (adjusted hazard ratio 4.95 [2.02-12.13] and 2.78 [1.07-7.22], respectively), with the reclassified group demonstrating an intermediate risk. A mean pressure gradient ≥31 mm Hg had a 7× higher risk of the primary end point in the reclassified group. Aortic valve calcium score was more prognostic in females and low valve area but not after adjusting for gradients. NT-proBNP (N-terminal pro-brain-type natriuretic peptide) and myocardial perfusion reserve were associated with the primary end point but not after adjusting for positive exercise tolerance testing. Troponin was associated with cardiovascular death or unplanned hospitalizations., Conclusions: Reclassification of asymptomatic severe AS into moderate AS was common using the European Society of Cardiology 2017 guidelines. This group had an intermediate risk of reaching the primary end point. Exercise testing, multimodality imaging, and lower mean pressure gradient threshold of 31 mm Hg may improve risk stratification. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01658345.

Vasculopathy is a hallmark of sickle cell disease ultimately resulting in chronic end organ damage. Leg ulcer is one of its sequelae, occurring in ~ 5-10% of adult sickle cell patients. The majority of leg ulcer publications to date have emanated from single center cohort studies. As such, there are limited studies on the geographic distribution of leg ulcers and associated risk factors worldwide. The Consortium for the Advancement of Sickle Cell Research (CASiRe) was formed to improve the understanding of the different phenotypes of sickle cell disease patients living in different geographic locations around the world (USA, UK, Italy, Ghana). This cross-sectional cohort sub-study of 659 sickle cell patients aimed to determine the geographic distribution and risk factors associated with leg ulcers. The prevalence of leg ulcers was 10.3% and was associated with older age, SS genotype, male gender, and Ghanaian origin. In fact, the highest prevalence (18.6%) was observed in Ghana. Albuminuria, proteinuria, increased markers of hemolysis (lower hemoglobin, higher total bilirubin), lower oxygen saturation, and lower body mass index were also associated with leg ulceration. Overall, our study identified a predominance of leg ulcers within male hemoglobin SS patients living in sub-Saharan Africa with renal dysfunction and increased hemolysis.

Recovery Colleges aim to assist people with mental health difficulties in the journey to recovery through education. They bring together professional and lived experience of mental health challenges in a non-stigmatising college environment and operate on college principles. All courses are designed to contribute towards well-being and recovery. Despite the ever-growing number of Recovery Colleges (both in the UK and internationally), the evaluative evidence is limited; comprising mostly non-peer-reviewed evaluations, audits and case studies. The present article comprises a mixed-methods evaluation of a newly established Recovery College in South East Essex, UK. The evaluation comprised questionnaires of mental well-being and social inclusion at baseline and 3 and 6 month follow-up, in addition to three focus groups. There were significant improvements in both mental well-being and social inclusion from baseline to 6 month follow-up (25 participants completed the measure of well-being at both time points and 19 completed the measure of social inclusion). This was supported by additional free-text questionnaire comments and focus group findings (17 participants participated across the focus groups), with reports of increased confidence, reduced anxiety and increased social inclusion/reduced social isolation. Additionally, at 6 month follow-up a majority of respondents were planning on attending courses external to the Recovery College, volunteering and/or gaining paid employment. Challenges and recommendations identified through the focus groups indicate the importance for standardisation of processes (which is particularly important when multiple organisations are involved in the running of a Recovery College), as well as consideration of longer-running courses. Funders should continue to invest in the Recovery College movement as the growing evidence-base is demonstrating how these colleges can help address the high prevalence of mental health difficulties, by promoting mental well-being and social inclusion., (© 2019 John Wiley & Sons Ltd.)

AimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. BACKGROUND: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are 'chronic migraine' and 'medication overuse headache'. They are either no better or worse than when their headaches first started despite their efforts. METHOD: We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients' headache characteristics, the 'burden' of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.

Background: Results from large randomised controlled trials have shown that adding docetaxel to the standard of care (SOC) for men initiating hormone therapy for prostate cancer (PC) prolongs survival for those with metastatic disease and prolongs failure-free survival for those without. To date there has been no formal assessment of whether funding docetaxel in this setting represents an appropriate use of UK National Health Service (NHS) resources., Objective: To assess whether administering docetaxel to men with PC starting long-term hormone therapy is cost-effective in a UK setting., Design, Setting, and Participants: We modelled health outcomes and costs in the UK NHS using data collected within the STAMPEDE trial, which enrolled men with high-risk, locally advanced metastatic or recurrent PC starting first-line hormone therapy., Intervention: SOC was hormone therapy for ≥2 yr and radiotherapy in some patients. Docetaxel (75mg/m 2 ) was administered alongside SOC for six three-weekly cycles., Outcome Measurements and Statistical Analysis: The model generated lifetime predictions of costs, changes in survival duration, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs)., Results and Limitations: The model predicted that docetaxel would extend survival (discounted quality-adjusted survival) by 0.89 yr (0.51) for metastatic PC and 0.78 yr (0.39) for nonmetastatic PC, and would be cost-effective in metastatic PC (ICER £5514/QALY vs SOC) and nonmetastatic PC (higher QALYs, lower costs vs SOC). Docetaxel remained cost-effective in nonmetastatic PC when the assumption of no survival advantage was modelled., Conclusions: Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available., Patient Summary: Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: University represents a key transition into adulthood for many adolescents but there are associated concerns about health and behaviours. One important aspect relates to diet and there is emerging evidence that university students may consume poor quality diets, with potential implications for body weight and long-term health. This research aimed to characterise dietary patterns of university students in the UK and their sociodemographic and lifestyle antecedents., Methods: An online, cross-sectional survey was undertaken with a convenience sample of 1448 university students from five UK universities (King's College London, Universities of St Andrews, Southampton and Sheffield, and Ulster University). The survey comprised a validated food frequency questionnaire alongside lifestyle and sociodemographic questions. Dietary patterns were generated from food frequency intake data using principal components analysis. Nutrient intakes were estimated to characterise the nutrient profile of each dietary pattern. Associations with sociodemographic variables were assessed through general linear modelling., Results: Dietary analyses revealed four major dietary patterns: 'vegetarian'; 'snacking'; 'health-conscious'; and 'convenience, red meat & alcohol'. The 'health-conscious' pattern had the most favourable micronutrient profile. Students' gender, age, year of study, geographical location and cooking ability were associated with differences in pattern behaviour. Female students favoured the 'vegetarian' pattern, whilst male students preferred the 'convenience, red meat & alcohol' pattern. Less healthful dietary patterns were positively associated with lifestyle risk factors such as smoking, low physical activity and take-away consumption. The health-conscious pattern had greatest nutrient density. The 'convenience, red meat & alcohol' pattern was associated with higher weekly food spending; this pattern was also identified most consistently across universities. Students reporting greater cooking ability tended towards the 'vegetarian' and 'health-conscious' patterns., Conclusions: Food intake varied amongst university students. A substantial proportion of students followed health-promoting diets, which had good nutrient profiles obviating a need for dietary intervention. However, some students consumed poor diets, incurred greater food costs and practised unfavourable lifestyle behaviours, which may have long-term health effects. University policy to improve students' diets should incorporate efforts to promote student engagement in cooking and food preparation, and increased availability of low cost healthier food items.