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Live animal shows, which combine animal facts with trained behaviours, are commonly used to engage zoo visitors globally. However, such shows have been criticised for portraying a potentially unhelpful image of 'performing animals' and have raised issues of animal welfare ethics. Little is known about the educational effectiveness of these shows. Furthermore, the impact of 'tricks', used as attention-grabbing hooks, has received limited research attention. We evaluated the impact of a sea lion and a mixed species bird show on audience knowledge of animal facts. Over a quarter of zoo visitors attended some form of live animal show, demonstrating quantitatively that they are a major potential source of knowledge transfer. Show audiences were questioned immediately before (n = 299) or after (n = 265) each performance about relevant show content knowledge. Additionally, a general zoo visitor survey (n = 160) investigated post-visit knowledge recall. Audiences demonstrated significantly higher animal knowledge post-show compared to pre-show. Conservation action awareness showed weak positive change post-show. Audience education levels and weather conditions also had a weak positive effect on correct responses. However, animals performing trick-type behaviours were found to cause confusion regarding natural adaptations. We conclude that live animal shows should prioritise natural behaviours with a focus on conservation action.

The experience of visiting a zoo as a child can be remembered decades later and potentially influences future environmental attitudes. In light of steadily growing criticism of the ethics and value of live animal shows, some zoos are seeking alternative means of delivering 'edutainment' to a broad audience. One such alternative is through theatre. We examine whether a family-orientated zoo theatre performance achieved animal knowledge and conservation awareness impacts. Impact was demonstrated if individuals correctly stated more animal and conservation facts post-performance compared to pre-performance. The theatre production was seen to have a very strong positive effect on both children's (pre-performance s.d.=1.69, post-performance s.d.=1.79 effect size (d)=0.70, w = 4403.5, p = 0.001) and adults' (pre-performance s.d.=1.88, post-performance s.d.=2.14, effect size (d)=0.71, w = 1931.5, p = 0.001) learning. Significantly more correct answers were given post-performance compared to pre-performance. We conclude that educational, family theatre can effectively deliver animal information and raise awareness of conservation efforts within a leisure setting. Further studies are needed to investigate the impact of theatre on conservation actions. Comparative studies between live animal shows and theatre could establish the best methods for conveying conservation information to zoo visitors.

Oestrogen receptor (ER)-positive breast cancer (BC) is generally well responsive to endocrine therapy. Neoadjuvant endocrine therapy (NAET) is increasingly being used for downstaging ER-positive tumours. This study aims to analyse the effect of NAET on a well-characterised cohort of ER-positive BC with particular emphasis on receptor expression. This is a retrospective United Kingdom (UK) multicentre study of 391 patients who received NAET between October 2012 and October 2020. Detailed analyses of the paired pre- and post-NAET morphological changes and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) expression were performed. The median duration of NAET was 86 days, with median survival and overall survival rates of 380 days and 93.4%, respectively. A total of 90.3% of cases achieved a pathological partial response, with a significantly higher rate of response in the HER2-low cancers. Following NAET, BC displayed some pathological changes involving the tumour stroma including central scarring and an increase in tumour infiltrating lymphocytes (TILs) and tumour cell morphology. Significant changes associated with the duration of NAET were observed in tumour grade (30.6% of cases), with downgrading identified in 19.3% of tumours (p < 0.001). The conversion of ER status from positive to low or negative was insignificant. The conversion of progesterone receptor (PR) and HER2 status to negative status was observed in 31.3% and 38.1% of cases, respectively (p < 0.001). HER2-low breast cancer decreased from 63% to 37% following NAET in the paired samples. Significant morphological and biomarker changes involving PR and HER2 expression occurred following NAET. The findings support biomarker testing on pre-treatment core biopsies and post-treatment residual carcinoma. [ABSTRACT FROM AUTHOR]

Background This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. Methods We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. Results Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. Conclusions While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners. [ABSTRACT FROM AUTHOR]

The National Health Service (NHS) Diabetes Prevention Program (DPP) is a comprehensive initiative in the United Kingdom aimed at preventing type 2 diabetes (T2DM) among individuals with prediabetes. The NHS DPP emphasizes early intervention and underscores the potential for preventing or delaying T2DM. Currently, it operates since 2015 at 44 geographically defined sites, serving an estimated annual volume of 200,000 patients. This narrative review evaluates the NHS DPP. A literature search, adhering to the Participants, Concept, and Context review framework, was conducted in various databases and sources, limited to the period from 2015 to 2023. Data were categorized based on publication date, study type, program indicators, and focus areas, forming the framework for the review discussion. The review search yielded a total of 18,357 articles, of which 45 were included, with a predominant focus on program effectiveness. The NHS DPP demonstrates strengths in risk reduction and cost-effectiveness but faces challenges related to fidelity and the needs of diverse populations. The review highlights the importance of evidence-based service delivery, stakeholder engagement, and digital innovation in future DPP programs. While a centralized approach provides structure, local flexibility is essential to cater to population-specific needs. This review underscores the importance of strategic planning, political support, partnerships, and robust data collection in DPP implementation. It recommends targeting high-risk individuals, intensive lifestyle interventions, and embracing digital solutions for program delivery. Ongoing research, including analysis of long-term data and user perspectives, will further enhance the evidence base for DPP programs worldwide. [ABSTRACT FROM AUTHOR]

In this piece, the Association of Nephrology Nurses (ANN) UK provides details on the STOP programme, which denote safety principles to reduce the risk of needle or catheter dislodgment during haemodialysis [ABSTRACT FROM AUTHOR]

Objective English primary care faces significant challenges, including 'persistent high turnover' of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and whether it is associated with poorer population health outcomes. Design A retrospective observational study. Methods We linked workforce data on individual GPs to practice- level data from Hospital Episode Statistics and the GP Patient Survey (2007--2019). We classified practices as experiencing persistent high turnover if more than 10% of GPs changed in at least 3 consecutive years. We used multivariable logistic or linear regression models for panel data with random effects to identify practice characteristics that predicted persistent high turnover and associations of practice outcomes (higher emergency hospital use and patient experience of continuity of care, access to care and overall patient satisfaction) with persistent high turnover. Results Each year, 6% of English practices experienced persistent high turnover, with a maximum of 9% (688/7619) in 2014. Larger practices, in more deprived areas and with a higher morbidity burden were more likely to experience persistent high turnover. Persistent high turnover was associated with 1.8 (95% CI 1.5 to 2.1) more emergency hospital attendances per 100 patients, 0.1 (95% CI 0.1 to 0.2) more admissions per 100 patients, 5.2% (95% CI -5.6% to -4.9%) fewer people seeing their preferred doctor, 10.6% (95% CI-11.4% to -9.8%) fewer people reporting obtaining an appointment on the same day and 1.3% (95% CI -1.6% to -1.1%) lower overall satisfaction with the practice. Conclusions Persistent high turnover is independently linked to indicators of poorer service and health outcomes. Although causality needs to be further investigated, strategies and policies may be needed to both reduce high turnover and support practices facing challenges with high GP turnover when it occurs. [ABSTRACT FROM AUTHOR]

Background: General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined. Objectives: To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs. Methods: Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest. Results: Almost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)]. Conclusion: Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care. [ABSTRACT FROM AUTHOR]

The article presents the discussion on distribution and increasing frequency of the aphid Patchiella reaumuri in Britain, particularly highlighting recent records from southern England and beyond, suggesting that the species is more common than previously thought. Topics include the identification of distinctive galls on lime trees, updated distribution records; and historical documentation of the species.

Aims: Neoadjuvant endocrine therapy (NAET) is used in the management of oestrogen receptor (ER)‐positive breast cancer. The optimal method for histological assessment of response and the effect of NAET on the tumour morphology, grade and molecular profile remain unclear. The aim of this study is to investigate the NAET effect on tumour type, grade and molecular profile by analysing a well‐characterised cohort of breast cancer samples in a single large UK tertiary referral centre, and to provide guidance on the pathological assessment of those lesions to inform adjuvant management and prognosis. Methods and results: A single large‐institution cohort of 132 patients who received NAET over a 13‐year period was identified. Comprehensive clinical, histopathological and follow‐up data were collected. A detailed histological review of a subset with residual post‐treatment carcinoma was undertaken. Two carcinomas (both of the lobular type) achieved complete pathological response. Central scarring was seen in 49.3% of tumours post‐treatment. Significant changes in tumour type (41.6%), tumour grade (downgrading in one‐third of tumours), and progesterone receptor (PR) expression (22.3%), with a switch to PR‐negative status in 17.6% of cases, were observed. The last of these was associated with an absence of tumour‐infiltrating lymphocytes (P = 0.005). Ten per cent of cases showed a change in HER2 expression (P = 0.002). The median patient survival was 60 months, and downgrading of tumours was associated with better overall survival (P = 0.05). Conclusions: We propose a histological method for assessment of residual carcinoma following NAET, and recommend repeat ER/PR/HER2 testing to inform management and prognosis. [ABSTRACT FROM AUTHOR]

To move away from the 'take-make-dispose' economy there is a drive to reuse and recycle materials. For the steel industry this means using more steel scrap. This has a consequence on the quality of the steel produced due to the presence of undesirable residuals from steel scrap. In this work, the effect of the UK steel industry utilising national scrap stocks to meet the UK demand for steel is explored through an iterative production model. Scrap qualities and volumes were obtained from compiled literature data to generate a reliable feed stock of material. The scrap feed is considered in the BF-BOF and EAF production routes to model the enrichment of residuals through cycles of the materials use. It was found that with current process and product specification the UK could sustainably migrate towards a 50/50 production split between BF-BOF/EAF. This shift would reduce the UK's steel industry emissions by ~20%. [ABSTRACT FROM AUTHOR]

Background: The standard first- and second- line chemotherapy backbone regimens for metastatic colorectal cancer (mCRC) are 5-fluorouracil (5-FU)/capecitabine-based with addition of irinotecan or oxaliplatin. Until recently, evidence for optimal sequencing post second-line was sparse. Trifluridine/tipiracil (indicated for mCRC and gastric cancer after standard chemotherapies) was made available to UK patients via a named patient programme (NPP) before receiving marketing authorisation in Europe in 2016, allowing characterisation of UK treatment pathways, and evaluation of trifluridine/tipiracil in a UK non-trial population.Methods: Data collected routinely for the NPP were analysed to describe the patient demographics, clinical characteristics and treatment pathways. Patients eligible for the programme were adults (≥18 years) with histologically or cytologically confirmed mCRC who had previously received chemotherapy treatment(s).Results: Of the 250 eligible patients enrolled in the NPP, 194 patients received ≥1 dose of trifluridine/tipiracil and 56 patients did not receive trifluridine/tipiracil. The following results are reported first for patients who received trifluridine/tipiracil and second for those who did not receive trifluridine/tipiracil: median (IQR) age was 63.0 (54.0-69.0) and 62.0 (54.8-69.0) years; Eastern Cooperative Oncology Group performance status score was 0 for 28 and 14%, 1 for 65 and 70%, 2 for 7 and 16%. In terms of previous systemic treatments 47 and 43% had 2 prior lines of therapy. FOLFOX-, FOLFIRI- and CAPOX-based therapies were the most common first-line regimens in patients receiving trifluridine/tipiracil (37, 35 and 21%, respectively), and in patients not receiving trifluridine/tipiracil (41, 30 and 20%, respectively). Second-line treatment regimens in patients receiving and not receiving trifluridine/tipiracil were most commonly FOLFIRI-based (48 and 41%, respectively) and FOLFOX-based (19 and 21%, respectively). Patients received a median of 2 cycles of trifluridine/tipiracil with a median treatment duration of 1.8 (95% CI: 1.8-2.4) months. In patients who discontinued treatment due to disease progression, the median progression-free duration was 2.8 (95% CI: 2.4-2.9) months.Conclusions: The results highlight the number of treatment pathways used to treat mCRC in routine UK clinical practice prior to the marketing authorisation and National Institute for Health and Care Excellence approval of trifluridine/tipiracil and highlight the lack of clinical guidelines for mCRC. [ABSTRACT FROM AUTHOR]

Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n = 49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and costeffectiveness in Australia. [ABSTRACT FROM AUTHOR]

The article reports on the introduction of peer assisted learning activities (PAL) to encourage students to develop their skills in teaching, learning, and assessing and to engage in co-operative learning in Great Britain. PAL is common to pre-school, primary, secondary, tertiary and work-based education. The medical school introduced the first PAL initiative in the year 2000 and, with the support of teaching staff and students.

The host range and distribution of species of Epichloë in Britain are investigated based on herbarium material held at Kew and an assessment of the literature and other available records. Six species of the genus can now be recognised in Britain, three of which are reported for the first time, and Holcus mollis is confirmed as a host for E. clarkii. A potential seventh species, E. elymi, requires confirmation as British. Brief descriptions, with host range, and a key for the identification of these species are presented. [Copyright &y& Elsevier]

Editorial. Focuses on the drug prevention program for young people in Great Britain. Aetiology of drug abuse; Factors influencing the choice of peers; Characterization of social environments.

Although place-marketing and image-enhancement are increasingly common elements of Western urban policy, when applied to specific locales, these abstract theories have to negotiate local conditions and contexts. This paper discusses the ways attempts to place-market the city of Hull, England, prompted debates surrounding questions of place, memory and heritage. Despite being Britain's leading fishing port in the 20th century, Hull's place-marketing strategy elided this past in favour of a sanitised vision of a modern, post-industrial city. These debates crystallised around a 1999 planning inquiry over the proposed redevelopment of the erstwhile fishing dock. While the proposals contained some reference to the dock's role as a site of place-memory, this was deemed insufficient by local protest groups and politicians who argued for a more appropriate memorial to Hull's fishing community. Eventually, the redevelopment proposals were accepted, but not before attendant debates exposed both the depth of local sentiments over place-memories and fishing heritage, and also the difficulties of negotiating inclusive and plural heritage landscapes. [ABSTRACT FROM AUTHOR]

Discusses the treatment of hemophilia in Great Britain from 1981 to 1996. Organization of hemophilia care in the country; Data on hemophiliacs; Data on patients with von Willebrand disease; Acquired hemophilia cases; Rare congenital disorders of coagulation; Treatment of hemophilia; Treatment of patients with inhibitors; Deaths of patients with hemophilia A, hemophilia B and von Willebrand disease.

Recent research on local and regional economic development has focused upon transformations in local governance and institutional capacity. It has been argued that local authorities have ceded power to other actors and institutions involved in economic development and regeneration, and that the success of local and regional economic development is closely related to the strength of ‘institutional capacity’ within an area. In this paper, we examine these claims with reference to the operation of EU Structural Funds in the Humber Sub-region of the UK. Previous research on local governance and institutional capacity has had a limited empirical focus, drawing conclusions from studies of either economically ‘successful’ regions or regions undergoing regulatory and institutional transformation and precluding analysis of the nature and conditions of local governance and institutional capacity in less developed regions. Our case study evidence not only suggests that arguments about the declining influence of the local state are overdrawn, but also indicates a need for more nuanced accounts of the role of institutional capacity in regional development. [ABSTRACT FROM AUTHOR]

A large evidence base demonstrates that the outcomes of COVID-19 and national and local interventions are not distributed equally across different communities. The need to inform policies and mitigation measures aimed at reducing the spread of COVID-19 highlights the need to understand the complex links between our daily activities and COVID-19 transmission that reflect the characteristics of British society. As a result of a partnership between academic and private sector researchers, we introduce a novel data driven modelling framework together with a computationally efficient approach to running complex simulation models of this type. We demonstrate the power and spatial flexibility of the framework to assess the effects of different interventions in a case study where the effects of the first UK national lockdown are estimated for the county of Devon. Here we find that an earlier lockdown is estimated to result in a lower peak in COVID-19 cases and 47% fewer infections overall during the initial COVID-19 outbreak. The framework we outline here will be crucial in gaining a greater understanding of the effects of policy interventions in different areas and within different populations. • A microsimulation framework for modelling disease transmission within communities. • Integration of data from multiple, diverse sources to estimate exposure and risk. • Computationally efficient implementation allows rapid assessment of scenarios. • Allows the effects of different non-pharmaceutical interventions to be assessed. • Results show substantial reduction in infections associated with earlier UK lockdown. [ABSTRACT FROM AUTHOR]

Focuses on the treatment of hemophilia during 1976-80 in Great Britain. Increase in the amount of factor VIII antibodies used for patients as therapeutic materials; Occurrence of acute hepatitis in treated patients; Impact of the use of factor VIII on the number of hemophiliacs treated at hemophilia centers.

Unguiculella tityrii (Velen.) Huhtinen & Spooner, a tiny discomycete with whitish apothecia associated with pyrenomycete fruitbodies mainly in rabbit dung has been found in several localities in Scotland and one in England. It was previously unknown in Britain. A description and brief account of this species is provided. [Copyright &y& Elsevier]

Effective and safe practices during extracorporeal membrane oxygenation (ECMO) including infection precautions and securement of lines (cannulas and circuits) are critical to prevent life-threatening patient complications, yet little is known about the practices of bedside clinicians and data to support best practice is lacking. Therefore, the aim of this study was to identify and describe common line-related practices for patients supported by peripheral ECMO worldwide and to highlight any gaps for further investigation. An electronic survey was conducted to examine common line practices for patients managed on peripheral ECMO. Responses were obtained from 45 countries with the majority from the United States (n = 181) and United Kingdom (n = 32). Standardised infection precautions including hand hygiene, maximal barrier precautions and skin antisepsis were commonplace for cannulation. The most common antisepsis strategies included alcohol-based chlorhexidine gluconate (CHG) for cannula insertion (53%) and maintenance (54%), isopropyl alcohol on circuit access ports (39%), and CHG-impregnated dressings to cover insertion sites (36%). Adverse patient events due to line malposition or dislodgement were reported by 34% of respondents with most attributable to ineffective securement. Centres 'always' suturing peripheral cannula sites were more likely to experience a cannula adverse event than centres that 'never' sutured (35% [95% CI 30, 41] vs 0% [95% CI 0, 28]; Chi-square 4.40; p = 0.04) but this did not meet the a priori significance level of <0.01. An evidence-based guideline would be beneficial to improve ECMO line management according to 78% of respondents. Evidence gaps were identified for antiseptic agents, dressing products and regimens, securement methods, and needleless valves. Future research addressing these areas may provide opportunities for consensus guideline development and practice improvement. [ABSTRACT FROM AUTHOR]

The author reflects on how strict adherence to rules lessens doctors' and patients' autonomy. Topics discussed include the pros and cons of delegation in dealing with unsustainable workload, how to restore the balance in one's work, and the actions that need to be taken when choosing a career in practice. He also differentiates compliance versus responsiveness.

The article reports that the new minimum entry requirement for nurses in England will be elevated to four years degree to conform the standards set by the Nursing and Midwifery Council. It states that a review by the council standards had concluded that a higher standards for education allows newly qualified nurses to be more responsible and more assertive. According to Dr. Peter Carter, chief executive officer at the Royal College of Nursing, the move will make the nurses to be more prepared.

The article reports on the recommendation made by the British Medical Association for the National Health Service (NHS) in Great Britain to ditch its management-speak and start using a plain language. According to doctor Peter Bamber, there has been an inexorable move toward management-speak at the NHS. He further speculates that to refer patients as service users means an attempt to destigmatize illness.

Purpose Paget's osteosarcoma has a fearful reputation with a quoted survival of at best 5% at 5 years. We therefore reviewed our experience of 26 patients treated over the last 25 years using modern staging and limb salvage techniques to see if there had been any improvement in survival. Subjects: We identified 26 patients on the Royal Orthopaedic Hospital Oncological database with a diagnosis of sarcoma secondary to Paget's disease. Results: The survival rate was 53% at 1 year, 25% at 2 years and no patient survived for 5 years. The median survival was 21 months for those treated with curative intent and 7 months for those treated palliatively. Four of the five patients treated with limb-sparing surgery developed local recurrence between 5 and 12 months, the fifth died at 14 months. There was no difference in survival between amputation and limb salvage. Discussion: The development of sarcomatous change in Paget's disease is well recognised. It represents an important segment of primary bone tumours in patients over 40 years of age. The prognosis is appalling. Indeed only 15 of 368 cases (4%) from a number of historical series have survived more than 5 years. Our results are similarly disappointing with no survivors at 5 years despite modern methods of management of bone tumours. While there is no difference in local recurrence rates or survival between limb reconstruction and limb ablation the poor prognosis for both means that neither can be recommended at present. Sarcomatous change in Pagetoid bone should therefore be regarded as a different disease to primary osteosarcoma. It remains an incurable disease with a poor prognosis. [ABSTRACT FROM AUTHOR]

The article reports that the British government is launching a strategy to deal with the prevalence of dementia in the country. The strategy includes measures such as training physicians to diagnose early symptoms of dementia in patients and hiring more dementia specialists. Skeptics are reportedly not confident of the result of such a strategy due to factors such as discrepancies in drug accessibility. Diagnosing dementia and the cost of medical care for dementia patients is also discussed.

The article reports that Caroline Petrie, a British nurse who was suspended after offering to pray for a patient has been reinstated following an investigation by the National Health Service (NHS) in 2009. Andrew Fergusson of the Christian Medical Fellowship said some staff may have overinterpreted the NHS guidelines on religion and diversity. Moreover, Fergusson referred the new set of NHS guidelines which does not ban prayer, but warns that religious beliefs should not affect patient care.

Discusses the findings of a report on the impact of alcoholics on the health care costs and economic losses in Great Britain. Comparison between the rate of alcohol consumption in average and binge drinkers; Gender difference in alcohol consumption; Mortality rate associated with alcoholism.

Focuses on a training program offered by Bond Solon, a company in London, England that trains expert witnesses, for doctors and nurses to take better notes in order to improve patient care and help reduce medical negligence claims. Reason for the eagerness of British hospitals to improve staffers' record-keeping skills; Total amount of bill reached by the National Health Service for such claims in 2002; Problem posed by a lack of consistency in the use of medical acronyms, according to Mark Solon, a solicitor and creative director at Bond Solon.

Highlights the number of murders committed by British general practitioner Harold Shipman. Implication of Shipman's case for coroners' service in Great Britain; Requirements for death certificates.

Reveals that racism within the British National Health Service is affecting the careers of some physicians according to the British Medical Association. Number of hospital-based doctors in Great Britain which are comprised by ethnic minorities; Percentage of minority doctors who believe that ethnicity plays a significant role in early career opportunities.

Reports that a study by the British National Kidney Research Fund indicates that an acute shortage of dialysis machines is causing numerous premature deaths in England. Number of people who have kidney disease; Number of kidney treatment units that have been forced to turn away patients; Emergency measures that units have taken to accommodate increasing numbers of patients; Number of Britons receiving dialysis.

Reports that physicians in Great Britain may be asked to share all referral letters and consultation results with patients, regardless of the information they contain. Perception that referral letters and consultants' responses are symbols of physicians' power, and that the relationship between physicians and patients requires openness and joint decision-making; Advice of the General Medical Council that improved communication must come with care to ensure that the information letters contain does not cause unnecessary worry or distress for patients; Criticism of the plan by the Royal College of General Practitioners.

Reports that new employees of Britain's National Health Service (NHS) will undergo compulsory HIV testing if their jobs involve close contact with patients. Recommendation for the testing by a government medical panel studying the potential risk to patients from workers infected with serious communicable diseases; Screening of NHS recruits for tuberculosis and hepatitis.

Reports on an agreement under which patients in the European Union (EU) will have the right to seek free medical care in any of the member countries. Problem of long waiting periods for care in some countries; Ruling of the European Court of Justice that patients in the EU could go abroad for treatment if their own country is unable to provide care within a medically justifiable time limit; Payment of medical treatment abroad by the National Health Service of Great Britain.

Reports that the Department of Health of Great Britain has paid for the U.S. blood plasma company Life Resources Inc. to supply a percentage of blood plasma required by the National Health Service (NHS). Efforts of Britain to obtain blood plasma which is free of variant Creutzfeldt-Jakob disease (vCJD); Deaths from vCJD in Britain, where patients may have been exposed to the disease during surgery at the Middlesbrough General Hospital; Guidelines which call for surgical instruments used on patients suspected of having vCJD to be quarantined and subjected to strict decontamination procedures.

Cites the death of a Scottish naturalist, Donald McRae, who contracted rabies within Great Britain. Infected with European bat lyssavirus; Scottish Natural Heritage revoking most of the bat-handling licenses it had issued; Canada's last case of mortality involving rabies.

Reports that physicians returning to general practice work in Great Britain's National Health Service will be receiving bonuses. Factors which contribute to a decline in popularity of general practice; Description of salaries and bonuses of general practitioners in Great Britain.

Reports on under age drinking in the United Kingdom. Discussion about reasons for the increase in under age drinking; Statistics on under age drinking; Types of drinks being consumed by under age drinkers.

Reports that the Great Britain Department of Health will recruit more physicians from abroad and will send more patients out of the country for treatment. Trusts of the National Health Service which are setting up recruiting booths in Germany; Claims of some German doctors that they have encountered hostility from British colleagues.

Reports on attempts by the British Medical Association (BMA) International Committee in Great Britain to help refugee physicians practice in the country. Shortage of doctors in National Health Service (NHS); Publication of a guide for refugee doctors; Difficulty in funding the requalification of doctors.

Focuses on the number of female medical students in Great Britain. Efforts of the country to encourage more men to enter the profession; Idea that it would be sexist to encourage more males to consider careers in medicine; Plans of the government to hire more specialists and general practitioners.

Reports on long waits in casualty departments in Great Britain's National Health Service hospitals. Report from the Association of Community Health Councils (ACHC) of waiting times in accident and emergency departments; Extended waiting times from 20 to 47 hours; Shortage of beds in the hospitals.

Reports that physicians in Great Britain have resisted providing medical care for asylum seekers. Statement of the barnet, Enfield and Haringey Mental Health Trust that it would not longer accept referrals for patients of undetermined status; Complex health problems of a number of asylum-seekers; Outlook for problems such as the misuse of emergency services.

Addresses the decision to use private hospitals to reduce waiting times and how it may undermine needed reforms within the National Health Service of Great Britain. Details of the agreement between the British government and private hospitals throughout the country to rent spare operating rooms and share information on clinical mistakes, workforce supplies, and patient demand; Criticism of why the NHS could not provide timely treatment for its own employees.