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Where traditional learning and assessment approaches have previously been found to negatively impact on student well-being, the COVID-19 pandemic provided a novel opportunity to explore alternative online learning and assessment conditions conducive to student well-being and academic performance as part of a whole university strategy. To this end, the present study employed a mixed-methodological approach using a quantitative survey and 10 focus groups to examine the impact of online learning and assessment on the undergraduate students' well-being. The findings indicate that whilst some students report online learning and assessment to require more effort in comparison to traditional methods, other students value the increased flexibility afforded by online learning and assessment. It is recommended that academic staff scaffold online learning and assessment methods in the curriculum.

In recent years, the wellbeing of students and staff in Higher Education has received increased attention in pedagogical research. However, the experiences of Graduate Teaching Assistants (GTAs), or PhD researchers who teach alongside their doctoral studies, are notably absent from this literature. In this mixed-methods study, we examined predictors of GTA's wellbeing in UK institutions. This demonstrated that greater perceived agency and lower levels of over-commitment predicted higher wellbeing. Other variables, including social identity, role pride, work/life balance, effort-reward imbalance, and perceived effectiveness of teaching, did not predict wellbeing. We also qualitatively examined the identity management practices of GTAs, using a brief story completion task. A reflexive thematic analysis generated two dominant themes (1), the 'paradox of credibility', whereby GTAs reported grappling with a concern to be perceived as credible and worthy of teaching whilst also managing student expectations about their own knowledge, and (2) GTAs' desire to use their staff-student role to engage in 'approachability and advocacy' with and for students. We end with a set of recommendations for Higher Education Institutions that employ GTAs, informed by first-hand accounts of lived experiences.

Over the last two decades the use of E-learning technology increased to such an extent that the role of the traditional academic has been forced to change. Focusing on academics' views, this study examines their interactions in the E-learning environment and whether online learning applications have increased academic workload (Eynon, 2005; Olaniran, 2006). This study also identifies how their role has changed and the underlying factors which may cause negativity in their working environment. Based on a literature review and twelve interviews with academics the work suggests that online learning applications have increased workload. For some academics the use of E-learning technology in UK higher education can be a full time occupation. It is evident from the data that the drawbacks to current E-learning technology outweigh the number of benefits. A key concern is the high number of working hours spent on E-learning systems by academics. This research states unequivocally that the level of complexity for some academics is daunting as well as frustrating. A key finding from this research is a wish list made by academics that can help in their role as teachers in utilising E-learning technology. Managing expectations of academics is vital to the success of E-learning technology in higher education institutions.

Higher education institutions (HEIs) in the UK are increasingly engaging in work-based learning. The tripartite relationship between the HEI, the employer and the employee is viewed to be of great significance in work-based learning, not only in the initial stages of procurement of a contract, but also in designing and delivering the programme to meet the employer and employee needs, and those of the HEI, to make the programmes successful. This paper is based on one theme related to a larger EU-funded project on work-based learning leading to qualifications. Based on in-depth interviews at a post-1992 university in the UK with a range of staff including executive, senior management, managerial, teaching and administrative staff, we focus on this theme, to analyse employer engagement from the perspective of the HEI. We recommend strategies to enhance the tripartite relationship for the benefit of those involved and to improve policy and practice in the field. These include a strategic approach to work-based learning and regarding it as an integral part of higher education activity rather than a supplementary pursuit.

Purpose: Hearing loss is most prevalent among older adults, yet underestimated by patients, clinicians, and research communities. This study aimed to assess the accuracy of self-reported hearing difficulties among a group of adults aged 61--63 years, against audiometric measures. Method: The analysis used a sample (N = 346) of the Newcastle Thousand Families Study birth cohort. Data from audiological examinations and selfreported hearing difficulties were used to compare subjective and objective hearing. Hearing aid use was also assessed. Results: Over 40% of the participants had some level of hearing loss (n = 155, 44.8%), and 31% (n = 133) of these reported having hearing problems during subjective assessment. Only 18 (10%) of those with objectively measured hearing loss reported using hearing aids. Conclusions: There was an inconsistency between measured and selfperceived hearing loss among adults aged 61--63 years in this cohort. The small number of hearing aid users in the cohort is a concern, in that people in this age group appear not to be getting the help they need. The data also add to the research evidence that people at this age underestimate their hearing loss. [ABSTRACT FROM AUTHOR]

This Teaching Resource outlines and reflects upon the use of an innovative corporate associate partnership scheme as part of the delivery of an Auditing course to final year undergraduate Accounting students at a university in the UK. It outlines the motivations behind a practitioner's involvement in teaching delivery, along with the formulation, design, and implementation of the scheme. The authors provide insights from their experiences so that others, at different institutions, may replicate or adapt such a scheme. This could be extended into subject areas other than Auditing, with the delivery pattern being altered as appropriate to suit the needs of other institutions and associated practitioners. The Teaching Resource provides reflections on the partnership from the students, the module tutor, and the associate involved in its delivery.

This quantitative study is concerned with what determines prospective university students' first choice between universities of different status. The results suggest that examination performance, going to an independent school and fear of debt independently affect students' decisions. Social factors and students' perceived level of information on universities had no independent effect "at this stage" of decision-making. There were considerable differences between two geographic areas considered in the study, with a large decrease in the probability of attending a high-status institution in the locality with no such local institution. This particularly affects high-achieving students, with an estimate suggesting an increased probability of 18% of going to a high-ranking institution where such an institution is local for such students. If these findings apply similarly to other areas, the results suggest a "postcode lottery" in higher education. (Contains 4 tables and 1 figure.)

The expansion of higher education (HE) in the UK has disproportionately benefited young people from relatively rich families: the gap between rich and poor in terms of participation in HE having widened since the 1970s. We explore a neglected possible cause of this class difference: that the labour market fails to provide sufficient incentives for potential entrants from less advantaged backgrounds to enter HE. Most studies of the rewards from participating in HE in the UK suggest that the rates of returns are sufficiently high to provide clear economic incentives to participate. However, until recently, most studies generated estimates of the average rate of return to graduation, which could overestimate returns to marginal entrants, particularly those from disadvantaged backgrounds. In this review we examine the methodological problems faced by more targeted studies of the rates of return to graduation and review their key findings concerning the economic returns to non-traditional entrants.

Young, white, provincial working-class men are portrayed as a threat to lifelong learning goals. They are least likely to enter university and most likely to drop out. However, white provincial masculinities are neglected in debates on gender and lifelong learning. This article uses a UK-wide study of working-class "drop-out" to explore the situated nature of such masculinities, how they are performed by students and consumed by others and reproduced by university cultures and pedagogies. It concludes that such students struggle to fit the fluid paradigm of the new lifelong learner and are constantly being fixed in place by structural inequality, discursive frames and institutional practices. Their "drop-out" is shaped by masculinity, but need not be viewed pejoratively. It can be a frustrated search for lifelong learning, often inspired by a love of informal learning. This should be respected, not ignored.

This article reports on a series of interviews held with individuals in the middle of a Foundation Degree, during which they were asked for their views of studying for this qualification. It draws on a research project conducted with part-time students involved in work-based learning. The research into their "learning journeys" aimed to explore the process of becoming and being a student. Findings suggested that individuals had embarked on a Foundation Degree for career-related reasons, although they also noted that their course returned secondary benefits, such as an increase in self-confidence and additional life skills. Interviewees found it difficult to juggle competing demands on their time, and needed emotional and practical support from those around them to do so. Other areas of concern were the lack of adequate assistance from tutors that some students felt when it came to writing assignments and the financial hardship that undertaking such a vocational qualification could bring. Results from this study highlight facets of Foundation Degrees that need to be considered by those delivering such courses. (Contains 1 table.)

Community-based and work-based learning projects to promote lifelong learning for marginalized British adults were compared on the following criteria: target audience, outreach, meeting new learners' needs, student development, sustainability, and generalizability. Systematic analysis showed the projects were more complex than a stereotypical economic versus progressive dichotomy. The evaluation framework could help balance elements in project development. (Contains 48 references.) (SK)

Describes the development and use of online kiosks in contexts where users are away from fixed technologies. Uses a case study of a United Kingdom airport terminal to illustrate different types of kiosk applications; makes comparisons with mobile phone technologies; and considers their role in self-managed, self-service delivery of information and services. (Author/LRW)

Pneumococcal disease (PD) significantly contributes to morbidity and mortality, carrying substantial economic and public health burden. This article is a targeted review of evidence for pneumococcal vaccination in the UK, the definitions of groups at particular risk of PD and vaccine effectiveness. Relevant evidence focusing on UK data from surveillance systems, randomized controlled trials, observational studies and publicly available government documents is collated and reviewed. Selected global data are included where appropriate. National vaccination programs have reduced the incidence of vaccine-type PD, despite the rising prominence of non-vaccine serotypes in the UK. The introduction of higher-valency conjugate vaccines provides an opportunity to improve protection against PD for adults in risk groups. Several incentives are in place to encourage general practitioners to vaccinate risk groups, but uptake is low-suboptimal particularly among at-risk individuals. Wider awareness and understanding among the public and healthcare professionals may increase vaccination uptake and coverage. National strategies targeting organizational factors are urgently needed to achieve optimal access to vaccines. Finally, identifying new risk factors and approaches to risk assessment for PD are crucial to ensure those at risk of PD can benefit from pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

Objectives To investigate which five activity interference categories out of pain, fatigue, mood, dryness and brain fog/mental fatigue scored highest in patients with primary Sjögren's syndrome (pSS) and to investigate the association between activity interference and mood and physical functioning in these patients. Methods The Comprehensive Pain Evaluation Questionnaire (CPEQ) assessed activity interference (actions performed in daily life that are hindered) in 149 UK pSS patients. This was modified to include four additional symptoms (fatigue, mood, dryness and brainfog/mental fatigue). Functional impairment was measured using the Hospital Anxiety and Depression Scale (HADS) and the Improved Health Assessment Questionnaire (Improved HAQ). Univariable linear regression models were estimated to investigate the association between CPEQ results and the outcome scores obtained from the HADS and Improved HAQ. Multivariable linear regression models were estimated adjusting for patient age and length of disease. Results Fatigue had the biggest impact on seven activity domains: physical exercise (mean score of 3.49 out of 5 [ s. d. 1.26]), performing household chores (mean 3.14 [ s. d. 1.18]), gardening or shopping (mean 3.18 [ s. d. 1.20]), socializing with others (mean 2.62 [ s. d. 1.24]), recreation/hobbies (mean 2.88 [ s. d. 1.20]), sexual relations (mean 3.00 [ s. d. 1.52]), and mental efficacy (mean 2.69 [ s. d. 1.17]). Regression analysis showed a positive correlation in which every point increase in an activity interference category saw the overall mood and physical functioning scores increase. Conclusion Fatigue has the largest impact on pSS patients' daily activities in this cohort. Length of disease reduced the impact of activity interference on patients' overall health score. [ABSTRACT FROM AUTHOR]

The burden of pneumococcal disease in older UK adults remains substantial. Higher valency pneumococcal conjugate vaccines (PCVs) are currently in development with adult formulations for two of these anticipated to become available in 2022. This article collates and reviews relevant candidate data now available that may be used to support cost effectiveness assessments of vaccinating immunocompetent UK adults aged ≥65-years with PCVs. This article uses published data from surveillance systems, randomized controlled trials and observational studies. It focuses on local data from the UK but where these are either limited or not available relevant global data are considered. The body of relevant data now available suggests the UK is well placed to assess the cost effectiveness of vaccinating immunocompetent ≥65-year olds with new generation higher valency PCVs. Recent contemporary data provide important new and robust insights into the epidemiology of pneumococcal disease in older UK adults and help to address much of the uncertainty and data gaps associated with previous analyses. Using these data to make informed decisions about use of new higher valency PCVs for routine use in older adults will be important for public health in the UK. [ABSTRACT FROM AUTHOR]

The present study evaluated the effectiveness of a Mental Toughness Education and Training Program (MTETP) in elite football officiating. The MTETP consisted of four individual and two group-based workshops designed to develop mental toughness (MT) and enhance performance in three English Football League (EFL) referees. Adopting a single-subject, multiple-baseline-across-participants design, MT and referee-assessor reports were evaluated. Self and coach-ratings of MT highlighted an instant and continued improvement in all three referees during the intervention phases. Performance reports of all referees improved throughout the intervention phases compared with the baseline phase. Social validation data indicated that an array of strategies within the MTETP facilitated MT development. Discussions acknowledge theoretical and practical implications relating to the continued progression of MT interventions in elite sport. [ABSTRACT FROM AUTHOR]

Background: Convalescent plasma containing neutralising antibody to SARS-CoV-2 is under investigation for COVID-19 treatment. We report diverse virological characteristics of UK intensive care patients enrolled in the Immunoglobulin Domain of the REMAP-CAP randomised controlled trial that potentially influence treatment outcomes.Methods: SARS-CoV-2 RNA in nasopharyngeal swabs collected pre-treatment was quantified by PCR. Antibody status was determined by spike-protein ELISA. B.1.1.7 was differentiated from other SARS-CoV-2 strains using allele-specific probes or restriction site polymorphism (SfcI) targeting D1118H.Results: Of 1274 subjects, 90% were PCR-positive with viral loads 118-1.7x10 11 IU/ml. Median viral loads were 40-fold higher in those seronegative for IgG antibodies (n=354; 28%) compared to seropositives (n=939; 72%). Frequencies of B.1.1.7 increased from <1% in early November, 2020 to 82% of subjects in January 2021. Seronegative individuals with wild-type SARS-CoV-2 had significantly higher viral loads than seropositives (medians 5.8x10 6 and 2.0 x10 5 IU/ml respectively; p=2x10 -15). However, viral load distributions were elevated in both seronegative and seropositive subjects infected with B.1.1.7 (4.0x10 6 and 1.6x10 6 IU/ml respectively).Conclusions: High viral loads in seropositive B.1.1.7-infected subjects and resistance to seroconversion indicate less effective clearance by innate and adaptive immune responses. SARS-CoV-2 strain, viral loads and antibody status define subgroups for analysis of treatment efficacy. [ABSTRACT FROM AUTHOR]

Background: After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues. Objective: To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery. Methods: In a secondary analysis of an international qualitative data set, 66 telephone interviews with patients were undertaken across 14 sites in Australia, the United Kingdom, and the United States to understand the effect of peer support during recovery from critical illness. Prevalent themes were documented with framework analysis. Results: Most patients who had been involved in peer support programs reported benefit. Patients described 3 primary mechanisms: (1) sharing experiences, (2) care debriefing, and (3) altruism. Conclusion: Peer support is a relatively simple intervention that could be implemented to support patients during recovery from critical illness. However, more research is required into how these programs can be implemented in a safe and sustainable way in clinical practice. [ABSTRACT FROM AUTHOR]

Getting on Board 2017 suggests that the recruitment of trustees to the Board of Trustees (henceforth volunteer trustees) by charities in the United Kingdom is in a state of crisis. This report and a range of other stakeholders offer advice and guidance about recruitment, but attention to what motivates individuals to become trustees is lacking. Drawing upon the Pathways Through Participation framework , we argue that an important part of addressing the crisis in trustee recruitment is to consider the motivations of volunteer trustees in tandem with their resources and triggers for volunteering. We draw upon a study of 14 volunteer trustees of learning disability charities to explore how a critical understanding of volunteer trusteeship as a pathway through participation provides a full and rounded picture of trustee recruitment. Building on other research on volunteer recruitment and markets, we argue that recruitment can be improved when charities better understand what motivates their volunteer trustees. We recommend that charities consider trusteeship as a pathway through participation as part of their recruitment practices. [ABSTRACT FROM AUTHOR]

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease with poor prognosis and a significant unmet medical need. This study evaluated the safety, pharmacokinetics (PK) and target engagement in the lungs, of GSK3008348, a novel inhaled alpha-v beta-6 (αvβ6) integrin inhibitor, in participants with IPF.Methods: This was a phase 1b, randomised, double-blind (sponsor unblind) study, conducted in the UK (two clinical sites, one imaging unit) between June 2017 and July 2018 (NCT03069989). Participants with a definite or probable diagnosis of IPF received a single nebulised dose of 1000 mcg GSK3008348 or placebo (ratio 5:2) in two dosing periods. In period 1, safety and PK assessments were performed up to 24 h post-dose; in period 2, after a 7-day to 28-day washout, participants underwent a total of three positron emission tomography (PET) scans: baseline, Day 1 (~ 30 min post-dosing) and Day 2 (~ 24 h post-dosing), using a radiolabelled αvβ6-specific ligand, [18F]FB-A20FMDV2. The primary endpoint was whole lung volume of distribution (VT), not corrected for air volume, at ~ 30 min post-dose compared with pre-dose. The study success criterion, determined using Bayesian analysis, was a posterior probability (true % reduction in VT > 0%) of ≥80%.Results: Eight participants with IPF were enrolled and seven completed the study. Adjusted posterior median reduction in uncorrected VT at ~ 30 min after GSK3008348 inhalation was 20% (95% CrI: - 9 to 42%). The posterior probability that the true % reduction in VT > 0% was 93%. GSK3008348 was well tolerated with no reports of serious adverse events or clinically significant abnormalities that were attributable to study treatment. PK was successfully characterised showing rapid absorption followed by a multiphasic elimination.Conclusions: This study demonstrated engagement of the αvβ6 integrin target in the lung following nebulised dosing with GSK3008348 to participants with IPF. To the best of our knowledge this is the first time a target-specific PET radioligand has been used to assess target engagement in the lung, not least for an inhaled drug.Trial Registration: clinicaltrials.gov: NCT03069989; date of registration: 3 March 2017. [ABSTRACT FROM AUTHOR]

Background. Nontypeable Haemophilus influenzae (NTHi) frequently causes noninvasive upper respiratory tract infections in children but can cause invasive disease, mainly in older adults. An increased burden of invasive NTHi disease in the perinatal period has been reported by a number of studies. Here we describe the epidemiology, clinical characteristics, and outcome of neonatal invasive H. influenzae disease in England and Wales over a 5-year period. Methods. Public Health England conducts enhanced national surveillance of invasive H. influenzae disease in England and Wales. Detailed clinical information was obtained for all laboratory-confirmed cases in infants aged ≤31 days during 2009-2013. Results. Overall, 118 live-born neonates had laboratory-confirmed invasive H. influenzae disease: 115 (97%) were NTHi, 2 were serotype f, and 1 was serotype b. NTHi was isolated within 48 hours of birth (early-onset) in 110 of 115 (96%) cases, and 70 of 110 (64%) presented with septicemia. Only 17 mothers (15%) had suspected bacterial infection requiring antibiotics during labor. Few (8/110 [7%]) neonates had comorbidities. The incidence of early-onset NTHi increased exponentially with prematurity, from 0.9 per 100 000 (95% confidence interval [CI], .6-1.4) in term neonates to 342 per 100 000 (95% CI, 233.9-482.7) in neonates born at <28 weeks' gestation (incidence rate ratio, 365 [95% CI, 205-659]; P < .001). Case fatality for early-onset NTHi was 19% (21/110); each additional gestational week reduced the odds of dying by 21% (odds ratio, 0.79 [95% CI, .69-.90]; P < .01). A quarter of neonates who survived experienced long-term complications. Conclusions. Early-onset neonatal NTHi disease is strongly associated with premature birth and causes significant morbidity and mortality. [ABSTRACT FROM AUTHOR]

This article discusses the previous literature on student retention in the post-compulsory education sector and the ‘24+Advanced Learning Loan’. Adult students participating in an Access to Higher Education course are at particularly high risk of non-completion. Literature indicates that whilst stakeholders may require factual statistics regarding education, the reasons for student withdrawal are often multiple and complex, hence this research was conducted via a mixed-methods approach. This study took place at a large inner-city college of further education in Staffordshire, England. A full population sample of the college’s existing data was analysed, tutors participated in short, informal, unstructured one-to-one interviews, the author produced fieldnotes relating to retention and 12 adult students from the Access to Higher Education Diploma in Health self-selected to participate in short semi-structured interviews about student retention. Data showed that students aged 24 years and over were already less likely to withdraw from their course prior to the introduction of the 24+Advanced Learning Loan, and that the introduction of the loan had little impact on this data. Interview transcripts and fieldnotes indicated mixed opinions amongst students regarding the 24+Loan, that the application process had been overly complex and that the introduction of loans had produced an increased divide between older and younger students. Recommendations for students, college staff, managers and policy writers are discussed in light of the findings of this study. [ABSTRACT FROM AUTHOR]

Background: This study aimed to estimate, following invasive pneumococcal disease (IPD), the proportion of children with protective immunoglobulin G (IgG) concentrations against the infecting serotype compared with other vaccine serotypes, and to assess risk of recurrent IPD. Methods: Pneumococcal antibody concentrations were available for 413 children with vaccine-type IPD diagnosed during 2006-2013. We compared serotype-specific IgG concentrations against the infecting vs other vaccine serotypes, after adjusting for confounders such as age using multilevel analyses. Results: After IPD, a higher proportion of vaccine-naive children had IgG concentrations ≥0.35 μg/mL against their infecting serotype than other vaccine serotypes (51% vs 36%; P < .001). In contrast, among children immunized with pneumococcal conjugate vaccine (PCV) both before and after IPD, the proportion with IgG concentrations ≥0.35 μg/mL against the infecting serotype was lower compared with other vaccine serotypes (71% vs 98%; P < .001). These children also had lower IgG geometric mean concentrations (GMCs) against the infecting serotype (2.22 μg/mL) vs other vaccine serotypes (15.64 μg/mL) in multilevel models (IgG GMC ratio, 0.24; 95% confidence interval, .18-.32), although their IgG GMC was higher compared with vaccine-naive children. Vaccinated children with IgG concentrations <0.35 μg/mL against their infecting serotype generally remained unresponsive despite further vaccine doses. However, recurrent IPD with the same infecting serotype was rare (7/3030 children [0.2%]) and not associated with unresponsiveness. Conclusions: Vaccination with PCV before and/or after IPD was associated with lower IgG concentrations against the infecting serotype compared with other vaccine serotypes, but recurrent IPD was rare. Further studies are needed to understand this phenomenon in immunized children. [ABSTRACT FROM AUTHOR]

This paper draws on research with young people from similar working-class backgrounds in a deprived urban area in England. Although all the participants achieved a high enough attainment level to remain in full-time education beyond compulsory schooling, they each elected to follow different post-16 pathways. Drawing on in-depth interviews with nine young people, the paper focuses on the social and educational lives of these young adults as they reflect on their schooling and the decisions they made regarding their post-16 pathway. The analysis and discussion draws on the concepts of approaches to learning and self-efficacy to support a more nuanced understanding of intra-class differences in the educational experiences of these young people that may have influenced the pathway they followed when they left compulsory schooling. The findings of this research suggest a potential relationship between these concepts, the nature of which may influence educational outcomes and notions around possible post-16 futures. [ABSTRACT FROM PUBLISHER]

Objective: The main aim of the survey was to explore current practices with regards to cervical cerclage procedures amongst UK consultants with particular emphasis on the type of suture material used. Methods: An electronic survey of UK consultant members and fellows of the Royal College of Obstetricians and Gynaecologists and who previously agreed to be contacted for survey purposes. Results: There were 261 respondents to the survey and 88% routinely performed cerclage. The majority performed the procedure between 12 and 16 weeks' gestation (88.7%; n = 180/203), following the McDonald technique (83.4%; n = 166/199) and using a braided suture material (86.6%; n = 175/202). Although only 27 of the 202 responders (13.4%) used a monofilament suture for cerclage (75%; n = 149/201) of clinicians stated that they were not sure what is the best suture material to be used. Conclusion: There is considerable variation in practice amongst Consultant obstetricians with regards to cervical cerclage. Although most respondents use the traditional braided suture material, a significant proportion of them were not sure what is the best suture material to use. The 'gestation at delivery' rate was judged to be the most important outcome for a future study. [ABSTRACT FROM AUTHOR]

Background Pre-school children in families of recently settled refugees often have very high rates of early childhood caries (ECC). ECC is associated with a high level of morbidity and is largely preventable, however effective culturally appropriate models of care are lacking. This study aimed to provide a deeper understanding of the refugee experience related to early oral health by exploring pre-school refugee families (i) understanding of ECC and child oral health, (ii) experiences of accessing dental services and (iii) barriers and enablers for achieving improved oral health. The knowledge gained will be critical to the development of effective early oral health programs in refugee children. Methods Community based participatory qualitative methodology using focus groups of resettled refugee families and community refugee nurse interviews. A community reference group was established and a bi-lingual community research associate was employed. Transcripts were analysed for thematic content using NVivo software. Results There were 44 participants: eight focus groups (nine countries of origin) and five interviews. Emergent themes were (i) the major influence of parents' previous experience, including their beliefs about deciduous (baby) teeth, traditional feeding practices and poverty; and a consequent lack of understanding of the importance of early oral health and early dental caries, (ii) the burden of resettlement including prioritising, parenting, learning about new foods and how to assimilate into the community, and (iii) refugees' difficulties in accessing both information and dental services, and the role of schools in addressing these issues. An Opportunities for Change Model was proposed. Conclusions The main implication of the study is the demonstration of how enhanced understanding of the refugee experience can inform improvement in early oral prevention and treatment. The community participatory methodology of the study provided a basis for cross-cultural understanding and has already assisted in translating the findings and raising awareness in the provision of targeted refugee oral health services. [ABSTRACT FROM AUTHOR]

Highlights: [•] We test a process for identifying research questions with practitioners. [•] We identify 51 priority research questions relating to energy in UK cities. [•] Academic research priorities are largely congruent with practitioner priorities. [•] Academic research emphasizes links between energy systems and other urban systems. [ABSTRACT FROM AUTHOR]

Labour market outcomes of undergraduates' choice of subject are important for public policy and for students. Policy interest is indicated by the prominence of 'employability' in public discourse and in proposals to concentrate government funding in England in supporting STEM subjects (science, technology, engineering and mathematics). As students in England face the prospect of bearing the full financial burden of undergraduate tuition, the large differences between wage premia for different subjects may become of increasing interest. We find that, even after taking account of differences in motivation towards the choice of undergraduate subject, males and members of certain non-White ethnic groups are more likely to choose 'high wage-premium' subjects. We also find some significant differences between the motivations of different minority ethnic groups. However, students from lower income households are less likely to choose high wage premium subjects, which is a concern for this aspect of policy towards participation in higher education and social mobility. [ABSTRACT FROM AUTHOR]

Different ethical frameworks have been proposed as appropriate for integrating into crisis management strategies. This study examines an ethic of care approach to crisis management analysing the case of Northern Rock bank which was at the centre of the recent financial crisis in the UK. The development and maintenance of relationships is fundamental to an ethic of care approach and the research recognises this by examining the bank-stakeholder relationship both before and after the crisis. Considerable anger was directed at the bank post-crisis and, subsequently, the management team resigned. An important contention is that because an ethic of care approach had not been followed external parties judged that management should have foreseen the crisis and the harm caused was deemed intentional, even though predicting the crisis would have been difficult and it is improbable any harm was intended. Additionally, this negative reaction was heightened due to three facets of Northern Rock's history: (i) its previous existence as a building society, (ii) the 'local' nature of the bank and (iii) the creation of The Northern Rock Foundation. These historical factors caused local stakeholders to presume a 'caring' relationship between themselves, and the bank had continued to exist post-demutualisation. The events of the crisis compelled stakeholders to re-appraise this presumption, amplifying the post-crisis anger. [ABSTRACT FROM AUTHOR]

The article reports on the occupational cancer in Great Britain that affects the respiratory cancer sites including larynx, lung and mesothelioma. It states that laryngeal cancers are squamous in origin and it originates in the glottis. Lung cancer is a common malignant neoplasm which is prevalent in men as compared to the female population. Mesothelioma is described as a form of cancer that develops from the mesothelium. A table containing information on carcinogenic agents is presented.

The article discusses occupational nasopharengeal and sinonasal cancers in Great Britain. Causal factors for these cancers include Epstein-Barr virus infection, consumption of preserved food and respiratory tract infections. Formaldehyde, wood dusts, leather dust and nickel are considered as carcinogens.

The article discusses the occupational cancers in Great Britain which includes liver, esophagus and stomach. It states that these cancers arise due to exposure to carcinogenic agents including asbestos, mineral oils, solar radiation and silica. It is estimated that mortality due to occupational disease in Great Britain accounts to four percents.

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of alitretinoin (Basilea Pharmaceuticals Ltd, Basel, Switzerland) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of patients with severe chronic hand eczema (CHE), as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and NICE's subsequent decisions. The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the manufacturer's submission to NICE. The ERG also independently searched for relevant evidence and modified the manufacturer's decision analytic model to examine the impact of altering some of the key assumptions. The main clinical effectiveness data were derived from a single-placebo randomized controlled trial (RCT) of daily treatment with alitretinoin for 12-24 weeks, with follow-up for a further 24 weeks, in patients with severe CHE unresponsive to topical corticosteroids. A significantly greater proportion of patients achieved 'clear' or 'almost clear' hands by week 24 with alitretinoin than those using placebo: 48% with alitretinoin 30mg (p < 0.001); 28% with alitretinoin 10 mg (p < 0.005); 17% with placebo. Most patients who responded remained in remission during the 24-week follow-up period. The most commonly reported adverse event was dose-dependent headache, with rates of 20% in the alitretinoin 30 mg group and 11% in the alitretinoin 10mg group, respectively. Serious adverse events were rare, although alitretinoin was associated with increases in both total cholesterol and triglycerides. No direct or indirect comparisons of alitretinoin with any of the relevant treatment comparators (psoralen +UVA [PUVA], ciclosporin or azathioprine) were available. In the manufacturer's original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were £8614 per QALY versus ciclosporin, -£469 per QALY versus PUVA (with alitretinoin dominant) and £10 612 per QALY versus azathioprine (year 2007-8 values). In response to a request from the ERG, the manufacturers provided a revised model that compared alitretinoin only with placebo, for which the ICER was reported to be £12 931. However, the omission of adverse events entirely from this revised model, in combination with a number of other factors, led the ERG to conclude that the model underestimated the costs of treatment associated with alitretinoin. Estimates of health-related quality of life (HR-QOL) were the primary source of uncertainty, with the use of values from an alternative source producing ICERs of around £30 000 per QALY gained. The ERG concluded that, although the evidence presented indicates that alitretinoin is efficacious in the treatment of severe CHE, it gives little indication of alitretinoin's efficacy relative to likely alternative treatment options or its efficacy and safety in the longer term. Although the ICERs estimated by the manufacturer suggested that alitretinoin may be cost effective for use in the UK NHS, utilizing the alternative HR-QOL estimates resulted in a 2-fold increase in the ICER. Thus, there was considerable uncertainty as to the true ICER of alitretinoin versus the relevant treatment comparators. TheAppraisal Committee recommended that alitretinoin be provided to those patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. They recommended that treatment be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks. [ABSTRACT FROM AUTHOR]

Background: Prioritising control measures for occupationally related cancers should be evidence based. We estimated the current burden of cancer in Britain attributable to past occupational exposures for International Agency for Research on Cancer (IARC) group 1 (established) and 2A (probable) carcinogens.Methods: We calculated attributable fractions and numbers for cancer mortality and incidence using risk estimates from the literature and national data sources to estimate proportions exposed.Results: 5.3% (8019) cancer deaths were attributable to occupation in 2005 (men, 8.2% (6362); women, 2.3% (1657)). Attributable incidence estimates are 13 679 (4.0%) cancer registrations (men, 10 063 (5.7%); women, 3616 (2.2%)). Occupational attributable fractions are over 2% for mesothelioma, sinonasal, lung, nasopharynx, breast, non-melanoma skin cancer, bladder, oesophagus, soft tissue sarcoma, larynx and stomach cancers. Asbestos, shift work, mineral oils, solar radiation, silica, diesel engine exhaust, coal tars and pitches, occupation as a painter or welder, dioxins, environmental tobacco smoke, radon, tetrachloroethylene, arsenic and strong inorganic mists each contribute 100 or more registrations. Industries and occupations with high cancer registrations include construction, metal working, personal and household services, mining, land transport, printing/publishing, retail/hotels/restaurants, public administration/defence, farming and several manufacturing sectors. 56% of cancer registrations in men are attributable to work in the construction industry (mainly mesotheliomas, lung, stomach, bladder and non-melanoma skin cancers) and 54% of cancer registrations in women are attributable to shift work (breast cancer).Conclusion: This project is the first to quantify in detail the burden of cancer and mortality due to occupation specifically for Britain. It highlights the impact of occupational exposures, together with the occupational circumstances and industrial areas where exposures to carcinogenic agents occurred in the past, on population cancer morbidity and mortality; this can be compared with the impact of other causes of cancer. Risk reduction strategies should focus on those workplaces where such exposures are still occurring. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh. Design The investigation was designed as a prospective observational study (clinical audit). Setting The study was undertaken at a tertiary referral urogynaecology unit in the UK. Population The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options. Methods The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus. Main outcome measures Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden–Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed. Results The mean age of the 51 women was 52.5 years (range 19–71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores. Conclusions Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome. [ABSTRACT FROM AUTHOR]

This paper develops a set of 16 criteria, divided into four groupings, for responsible business practice (RBP) in Small and Medium-Sized Enterprises (SMEs) drawn from the existing SME/RBP literature. The current lack of a general set of criteria against which such activity can be judged is noted and this deficit is redressed. In order to make an initial assessment in support of the criteria so derived, an exploratory feasibility study of RBP in U.K. Fair Trade organisations was conducted. The findings from this study show that most but not all of the RBP criteria seem to be applicable to U.K. Fair Trade organisations but it is recommended that the complete set of criteria continues to be used in further research until such time as there is a general consensus as to which criteria are appropriate. Implications for RBP in small businesses in general, and for Fair Trade organisations in particular, are drawn out and suggestions for further research are identified. [ABSTRACT FROM AUTHOR]

In the later seventeenth century, material progress was first identified in England as a recent achievement with boundless future promise, and it was welcomed despite fears about the threats that it was perceived to present to national and personal well-being. The article investigates the roots of that confidence, and finds them in political economy and other intellectual developments that shaped interpretations of changing standards of living. The civic and moral ‘challenge of affluence’ was fully recognized but never resolved. Progress was accepted, and had to be defended in war-time, as the route to general happiness, ‘ease’, and plenty. [ABSTRACT FROM AUTHOR]

Background. It is not known how long children with Haemophilus influenzae serotype b (Hib) vaccine failure retain protective Hib antibody concentrations after infection. The objective of this study was to determine Hib antibody concentrations in children several years after infection and to identify risk factors for low antibody concentrations. Methods. The families of children from the United Kingdom who developed invasive Hib disease after prior immunization with Hib conjugate vaccine (i.e., Hib vaccine failure) from October 1992 through December 2005 were asked to complete a questionnaire. A blood sample was also obtained from each child. Results. Of 323 families approached, 260 (80.5%) returned a completed questionnaire, and 175 (54.2%) children provided a blood sample. The median age at follow-up was 8.4 years (interquartile range [IQR], 6.2-15.4 years), and the median duration of follow-up was 4.1 years (IQR, 3.5-9.7 years). Twenty-seven children (16.1%) had been born prematurely and/or had an underlying medical condition, and 18 (10.8%) had immunoglobulin deficiency. The median Hib antibody concentration was 0.70 μg/mL (IQR, 0.22-5.8 μg/mL). Overall, 95 children (56.9%) had antibody concentrations <1.0 μg/mL, and 27 (16.2%) had antibody concentrations <0.15 μg/mL. All 3 children with Down syndrome and 10 (42%) of 24 children aged <5 years at follow-up had Hib antibody concentrations <0.15 μg/mL. An antibody concentration <0.15 μg/mL was independently associated with underlying conditions, young age at onset of Hib disease, and shorter time from Hib disease to follow-up. Conclusions. More than one-half of the children with Hib vaccine failure had antibody concentrations below those considered to confer long-term protection, which suggests that these children might be at further risk of invasive Hib disease and would benefit from another dose of Hib vaccine. [ABSTRACT FROM AUTHOR]

Abstract: Waste legislation in the United Kingdom (UK) implements European Union (EU) Directives and Regulations. However, the term used to refer to hazardous waste generated in household or municipal situations, household hazardous waste (HHW), does not occur in UK, or EU, legislation. The EU''s Hazardous Waste Directive and European Waste Catalogue are the principal legislation influencing HHW, although the waste categories described are difficult to interpret. Other legislation also have impacts on HHW definition and disposal, some of which will alter current HHW disposal practices, leading to a variety of potential consequences. This paper discusses the issues affecting the management of HHW in the UK, including the apparent absence of a HHW-specific regulatory structure. Policy and regulatory measures that influence HHW management before disposal and after disposal are considered, with particular emphasis placed on disposal to landfill. [Copyright &y& Elsevier]

To develop this study of strategic philanthropy in the United Kingdom, voluntary charitable donations policy disclosures were captured from the annual reports of two samples of U.K. companies: one of the entire Financial Times Stock Exchange 100 at year-end 2002 and another of 14 selected companies over a 15-year period. Post and Waddock's descriptions of "philanthropy strategy" and "strategic philanthropy" were employed to establish the extent to which these concepts were conveyed to readers of annual reports based on the belief that high disclosure serves both agency accountability to shareholders and the information needs of soliciting charities. Conclusions drawn include that although there is a relatively high level of policy disclosure, the detail of narrative in, and consistency (over time) of, these disclosures is very patchy, and only a minority of companies show evidence of adopting a fully strategic approach to philanthropy. [ABSTRACT FROM AUTHOR]

Background. Despite the excellent immunogenicity of Haemophilus influenzae type b (Hib) conjugate vaccines, breakthrough cases of Hib disease still affect a small proportion of vaccinated children in the United Kingdom. We performed a retrospective study to compare the avidity of antibody directed against the Hib polysaccharide capsule (PRP) in children who experienced Hib vaccine failure in the United Kingdom among 3 historical cohorts and with age-matched healthy control subjects. Methods. Serum samples from vaccinated children with invasive Hib disease were collected beginning in 1992 as part of enhanced surveillance for Hib disease following vaccine introduction. A total of 251 children who experienced Hib vaccine failure were identified from 3 historical cohorts (1992-1995, 1996-1999, and 2000-2003). The anti-PRP antibody concentration and avidity from healthy age-matched control subjects was obtained for the 3 contemporary time points (1995, 1999, and 2002). Serum anti-PRP antibody concentration was measured in each of the samples using a standard Hib ELISA, and antibody avidity was determined using thiocyanate elution. Results. Within the first 60 days after disease onset, there was no change in the anti-PRP antibody avidity, and there was no statistically significant difference in the geometric mean Hib antibody avidity over the 3 study periods. However, the children who experienced Hib vaccine failure had significantly lower Hib antibody avidity than did healthy control subjects, despite a marked antibody response following infection. Conclusions. Children who experience Hib disease despite vaccination appear to have a defect in immunological priming, leading to a qualitative difference in Hib-specific memory B cells. Low anti-PRP antibody avidity decreases the functional activity of anti-PRP antibody in the sera of these children experiencing vaccine failure, leading to disease susceptibility. [ABSTRACT FROM AUTHOR]

Objectives To report the short- and medium-term complications of laparoscopic laser excisional surgery for rectovaginal endometriosis. Design Retrospective cohort study. Setting University teaching hospital, UK. Population A total of 128 women with histologically confirmed rectovaginal endometriosis who underwent laparoscopic laser surgery between May 1999 and September 2006. Methods Women were identified from operative database, and a case note review was performed. Data for surgical outcome and surgical complications were collected. Main outcome measures Rates of urinary tract and colorectal complications. Results A total of 128 women underwent surgery. Of these, 32 required intraoperative closure of a rectal wall defect, including 3 segmental rectosigmoid resections. There were three rectovaginal fistulae and one ureterovaginal fistula. Ureteric damage occurred in two women, and five women suffered postoperative urinary retention. The risk of intraoperative bowel intervention was increased in women who complained of cyclical rectal bleeding. Conclusion Laparoscopic laser excision of rectovaginal endometriosis is a safe procedure with similar, if not lower, complication rates to other published surgical series. [ABSTRACT FROM AUTHOR]

This paper examines the strategic use of corporate philanthropy in the 1990s by UK building societies faced with an intensification of societal pressure to change legal form from mutual to corporate status. While the economic case for mutuality has been made elsewhere, this paper examines the observation that community relationships were thought by management to be capable of assisting in the strategic positioning of mutual societies with regard to their legal form. By increasing charitable giving to respond to the level of societal scrutiny and discussion on the issue of mutuality, this paper argues that charitable giving, as one proxy for community involvement, was used as a strategic tool to deflect calls for demutualisation, thereby preserving the existing mutual status of building societies. [ABSTRACT FROM AUTHOR]

Background Psychology and educational theory has a long tradition of research into learning styles. However, the current educational policy and practice interest in learning styles in the UK has resulted in concepts and practices being adopted with little rigorous empirical evaluation. Purpose This small-scale, experimental study aimed to test the reliability and validity of an available inventory designed to identify learning styles (visual, auditory and kinaesthetic). Sample, design and methods Nineteen children, aged 7–10 years, with different styles as identified by the inventory, participated in a class experimental evaluation of their differential response to the teaching of word spelling using different teaching methods. Results The study found that the visual and auditory scales, but not the kinaesthetic scale, were reliable (internally and re-test). The three groups of pupils with different learning styles—visual only, auditory only and mixed visual and auditory—showed different gains to teaching that matched these styles (visual and auditory teaching approaches). Retention of word spelling was higher one week after the teaching when the teaching matched the learning style. Conclusions The findings in this exploratory study suggest the significance of learning style for classroom-based teaching. [ABSTRACT FROM AUTHOR]

The article focuses on the undergraduate training being given by Pre-Registration House Officers (PRHO) in Great Britain. The idea of PRHO teaching is controversial as they have limited knowledge. According to the General Medical Council, people involved in educating medical students should have the necessary skills, knowledge and attitudes to do so.

Current discourse around widening participation emphasises the importance of partnership and collaboration. For example, the Learning Skills Council and government policy all cite the need to adopt collaborative approaches to assist with widening participation and student progression. In 1998 the Higher Education Funding Council for England (HEFCE) called for proposals for higher education institutions to build partnerships to widen participation. Successful partnership bids were subsequently funded for a period of one year initially and extended up to three years in total. One of the aims of the partnerships as outlined by the HEFCE was to address uneven rates of demand for higher education amongst certain socio-economic groups by working in collaboration with other organisations. This article focuses on one aspect of an evaluative research project examining collaboration resulting from the HEFCE initiative: the involvement of communities in developing partnerships. It examines their initial involvement and the extent to which they were then incorporated into ongoing partnerships and decision-making. Factors that mitigate against community involvement are discussed. It is concluded that although organizational and institutional links can be highly beneficial to realizing the objective of a widened base of involvement in HE there may be a sense in which the role of communities is either neglected, or worse, omitted. [ABSTRACT FROM AUTHOR]

To determine the immune response of premature infants to meningococcal serogroup C capsular polysaccharide (MCC) and combined diphtheria-tetanus toxoids-acellular pertussis- Haemophilus influenzae type b (DTaP-Hib) conjugate vaccines, 105 infants born at <32 weeks' gestation had Hib IgG geometric mean concentrations (GMCs) and MCC serum bactericidal anti-body (SBA) geometric mean titers (GMTs) measured 1 month after the third immunization. Term infants served as control subjects. Premature infants had Hib GMCs of 0.27 mg/mL, with 21% achieving GMCs >1.0 mg/mL, compared with 0.81 mg/mL and 46% in term infants (P <.001 and P = .003, respectively). The MCC SBA GMT was 398, with 99% achieving an SBA >8, com-pared with 380 and 98% in term infants (P = .84 and P = 1.0, respectively). Hib IgG was associ-ated with age at third immunization (P < .001). When combined with the DTaP vaccine used in this study, the Hib GMC of premature infants was extremely low. The SBA GMT to MCC was similar to that of term infants. [ABSTRACT FROM AUTHOR]

Background Superficial basal cell carcinomas of the skin (sBCC) often respond poorly to single-treatment aminolaevulinic acid-based photodynamic therapy (ALA–PDT), with a number of reports indicating a relapse rate of 50% or more. Objectives To determine whether a second treatment at seven days can improve the response. Methods Twenty-six lesions were treated twice with ALA–PDT, with an interval of 7 days between the two treatment sessions. Results We observed a complete response rate of 100% 1 month after treatment. Only one lesion relapsed (16 months post-PDT), a relapse rate of 4% (median follow up 27 months; range 15–45 months). Cosmetic results were excellent. Conclusions We consider routine double treatments with ALA–PDT to be an effective approach to the management of sBCC, particularly those located in anatomically difficult, or cosmetically sensitive, sites. [ABSTRACT FROM AUTHOR]