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Universities are facing growing internal and external pressures to generate income, educate a widening continuum of learners, and make effective use of digital technologies. One response has been growth of online education, catalysed by Massive Open Online Courses, availability of digital devices and technologies, and notions of borderless global education. In growing online education, learning and teaching provision has become increasingly disaggregated, and universities are partnering with a range of private companies to reach new learners, and commercialise educational provision. In this paper, we explore the competing drivers which impact decision making within English universities and their strategies to grow online education provision, through interviews with senior managers, and interrogation of their views through the lens of a range of internal, external and organisational drivers. We show that pressures facing universities may be alleviated by growth of online education provision, but that negotiating an appropriate route to realise this ambition involves attempts to resolve these underlying tensions deriving from competing drivers. We use a modified form of the PEST model to demonstrate the complexities, inter-dependencies and processes associated with these drivers when negotiating delivery of unbundled online education through use of private company services, or in partnership with private companies.

Purpose: COVID-19 pandemic has had long-standing consequences for all aspects of life. Although young people appear less susceptible to severe forms of physical illness due to the coronavirus, they have not escaped unscathed from its' psychological impacts. The present study measured the content of worries in young people residing in the UK during the pandemic and how it varied with sociodemographic factors. Methods: Between May and December 2020, UK-residing participants aged 12–25 years completed an online survey that presented participants with free-text fields to describe their top three worries over the last two weeks, in addition to demographic and other information. Cross-sectional data from 2560 participants (Males = 767; Female = 1793) was analyzed. Results: Irrespective of sociodemographic, a majority of the participants reported worries related to academics, followed by social relationships, own physical health, social and work routines, and physical health of others. Significantly more females reported concerns about academics, finances, physical health, social and work routines, social relationships, mental health and emotions, and physical health of others. Expectedly, more older (18–25 years) than younger (12–17 years) participants reported concerns about career-prospects and finances, while more younger than older ones were worried about academics (98.41% vs. 80.90%). With respect to financial worries, a higher percentage of BAME (Black, Asian and Minority Ethnic) communities in the UK reported such worries. Ethnicity significantly predicted more worries about social relationships among White than BAME participants. Significant differences also existed across different SES groups regarding endorsement of a particular category of worry. Conclusion: These findings highlight the need for tailored interventions depending on the major concerns for young people of different ages, sexes, ethnicities, and SES. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the contexts in which action learning has been used and provide implications for the design of action learning programmes. We performed a content analysis of 127 articles (case studies and case reports included) published in "Action Learning: Research and Practice" between 2004 and 2012. In this study, we address the following research questions: (a) In what contexts has action learning been used? (b) What are the distinctive features of cases identified? (c) What are the implications for the design of action learning programmes? The results showed that the UK and European countries have most frequently used action learning, and the most dominant purposes for action learning were leadership development, organization development, and professional development. We also elaborated on design considerations and implications for action learning research and practice. (Contains 3 figures, 1 table, and 1 note.)

Dog ownership is believed to benefit owner wellbeing but, contrary to popular belief, there is limited evidence to suggest that simply owning a dog is associated with improved mental health. This mixed-methods study investigates whether dog owners with stronger relationships with their dogs experience better mental health. Participants (n = 1,693, adult United Kingdom dog owners) completed an online survey. Owners' health was measured using the validated PROMIS questions regarding depression, anxiety, emotional support, and companionship. The dog-owner relationship was measured using the validated MDORS scale, which has three subscales: interaction, emotional closeness, and perceived costs. Univariable and multivariable linear regression analyses were conducted, adjusting for confounding factors. Additionally, positive and negative impacts of dog ownership on mental wellbeing were coded from open questions using thematic analysis. A stronger dog-owner relationship was associated with greater feelings of emotional support and companionship but poorer mental health in terms of anxiety or depression. However, the perceived costs (burden) subscale was consistently associated with better mental health outcomes. Direction of causality cannot be inferred as people with poor mental health may acquire dogs to help relieve symptoms, which qualitative analysis supported. Key themes included positive impacts on owner wellbeing and happiness through providing purpose, companionship and self-acceptance, pleasure and distraction, as well as lessening emotional pain and suffering and reducing risk behaviors. However, negative impacts of a strong relationship include anticipatory grief over loss of the dog, and concerns regarding the burden of responsibility and ability to meet dog's needs. Perceived ability to adequately meet dog's needs promoted personal growth and positive relationships with others, whereas perceived inability led to feelings of guilt, or anger/frustration, and reduced autonomy and sense of environmental mastery. Dog ownership contributes to both hedonic and eudaimonic wellbeing in multiple ways, including supporting owners through periods of poor mental health and providing purpose. However, the burden of responsibility and owner and dog characteristics can create challenges, and owners may benefit from support in caring for their dogs and reducing problematic behaviors. [ABSTRACT FROM AUTHOR]

Haemophagocytic lymphohistiocytosis is a life-threatening systemic inflammatory syndrome defined by persistent fever, cytopenia and multi-organ dysfunction. Primary haemophagocytic lymphohistiocytosis classically presents in childhood as a result of genetically abnormal perforin or inflammasome function, leading to the aberrant release of pro-inflammatory cytokines causing a hyperinflammatory state. Secondary haemophagocytic lymphohistiocytosis is an acquired phenomenon occurring at any age as a result of immune dysregulation to a specific trigger such as infection, haematological malignancy or autoimmune disease. Secondary haemophagocytic lymphohistiocytosis occurring in the pregnant woman represents a diagnostic challenge and carries a significant mortality. This has led to its first inclusion in the fourth Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the United Kingdom annual maternal report in 2017. This article presents an overview of haemophagocytic lymphohistiocytosis, reviews the literature on haemophagocytic lymphohistiocytosis in pregnancy, suggests diagnostic pathways and explores the safety and efficacy of existing and potential treatment strategies for haemophagocytic lymphohistiocytosis occurring during pregnancy. [ABSTRACT FROM AUTHOR]

Approximately 50% of UK dramatherapists deliver their work in schools. Despite this, little is currently known about the way in which school settings affect the dramatherapy that is delivered within them. This qualitative investigation utilised semi-structured interviews (N = 12) and reflexive thematic analysis to identify the facilitators and barriers of providing dramatherapy in school settings. In addition, the unique experiences of working as a dramatherapist in a school setting were also investigated. Amongst others, the facilitators identified included school as an accessible and safe place for therapy to occur. In addition, the structure provided by the school's daily and annual timetable, and the support of other school-based professionals and organisations were also identified. The barriers identified related to funding challenges, inappropriate referrals, schools seeking quick results and a lack of access to suitable spaces for therapy to occur. Regarding their experiences of employment, many dramatherapists spoke of working in multiple schools and, whilst some enjoyed the flexibility this offered, many found it challenging to become part of the school community and experienced a sense of isolation whilst working. Feeling like they are lower paid than clinical counterparts, such as colleagues in Child and Adolescent Mental Health Services (CAMHS), was also raised by those interviewed. These findings suggest that resource investment and investment into teachers' and other school-based professionals' knowledge of dramatherapy is warranted. In addition, dramatherapists who work in schools may benefit from community building. Future research, which explores the experience of dramatherapists in other settings is also encouraged. • The facilitators and barriers of UK school-based dramatherapy are, largely, unknown. • School is typically an accessible and safe place for dramatherapy to occur. • Challenges in relation to space, funding, referrals and employment are noted. • Some school-based dramatherapists feel isolated and under-paid. • Investment into school-based dramatherapy is recommended. [ABSTRACT FROM AUTHOR]

This paper examines the nature of the relationship between right-wing populism and radicalisation to Islamic extremism in the UK. Through the critical analysis of themes and commonalities within existing literature on both individual fields, it is shown that there exists a relationship between the two phenomena, though this relationship has many intricacies. This paper argues that right-wing populism, along with counter-terrorism policy and the media, construct an anti-Muslim narrative, which fosters discrimination and, ultimately, leads to the social exclusion of Muslim suspect communities, a known cause of radicalisation. This research further reveals that this relationship, while significant, is not causal, using cumulative extremism to explain its multidirectional nature. Drawing attention to the relationship between right-wing populism and radicalisation opens up a new approach to understanding the impact current UK politics and the media have on the issue of "homegrown" terrorism. This paper aims to promote engagement with the question of how, as a society, we can implement more effective and less discriminative counter-terrorism policy, as well as become more aware of the impact of the media. [ABSTRACT FROM AUTHOR]

Objectives Hereditary systemic autoinflammatory diseases are rare genetic disorders, which if untreated, can be complicated by AA amyloidosis leading to renal failure and premature death. Our objective was to find a genetic cause in a British family with a dominantly inherited autoinflammatory disease complicated by AA amyloidosis. Methods The index patient and his sister underwent comprehensive clinical and laboratory assessment including the next-generation sequencing panel targeting autoinflammatory genes. Subsequently, other relatives underwent clinical evaluation and genetic testing. Screening of the SAA1 gene was performed in all symptomatic cases. Results The index case and his sister presented with proteinuria due to AA amyloidosis. They have been suffering from episodes of fever accompanied by severe abdominal and chest pain, arthritis and erythema since childhood. Their father died aged 52 years from complications following a cadaveric renal transplantation. The post-mortem examination demonstrated AA amyloidosis. The index case's grandmother, two paternal cousins and two of their children described similar symptoms. All symptomatic individuals had excellent responses to colchicine. Next-generation sequencing analysis identified a single MEFV p.P373L variant in the index case, his sister and subsequently, in symptomatic family members. Sequencing of the SAA1 gene revealed all cases were heterozygous for the SAA1.1 allele. Conclusion Typically FMF is an autosomal recessive disorder; nonetheless rare cases of dominantly inherited disease have previously been described. Here we report a novel MEFV variant p.P373L, causing dominant FMF complicated by AA amyloidosis in four generations of a British family. [ABSTRACT FROM AUTHOR]

Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11–19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke. [ABSTRACT FROM AUTHOR]

Vitamin D is a unique nutrient. First, it acts as a pro-hormone and secondly, the requirement for vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This complicates the determination of dietary requirements for vitamin D, which along with the definition of optimal vitamin D status, have been highly controversial and much debated over recent years. Adolescents are a population group at high risk of low vitamin D status, which is concerning given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations are important from a public health perspective in helping to avoid deficiency and optimise vitamin D status for health. However limited experimental data from winter-based dose-response randomised trials in adolescents has hindered the development of evidence-based dietary requirements for vitamin D in this population group. This review will highlight how specifically designed randomised trials and the approach adopted for estimating such requirements can lead to improved recommendations. Such data indicate that vitamin D intakes of between 10 and about 30 µg/d may be required to avoid deficiency and ensure adequacy in adolescents, considerably greater than the current recommendations of 10-15 µg/d. Finally this review will consider the implications of this on public health policy, in terms of future refinements of vitamin D requirement recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Background: The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS).Objectives: To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features.Methods: A questionnaire was developed using nominal group technique and transmitted via email links through professional networks. The questionnaire collected demographic data, information on priority areas and anticipated impact of EPMA. Responses from different respondent groups were compared using the Mann-Whitney U -test.Results: Responses were received from 164 individuals (142 analysable). Respondents were predominantly specialist infection pharmacists (48%) or medical microbiologists (37%). Of the pharmacists, 59% had experience of EPMA in their hospitals compared with 35% of microbiologists. Pharmacists assigned higher priority to indication prompt ( P  <   0.001), allergy checker ( P  =   0.003), treatment protocols ( P  =   0.003), drug-indication mismatch alerts ( P  =   0.031) and prolonged course alerts ( P  =   0.041) and lower priority to a dose checker for adults ( P  =   0.02) and an interaction checker ( P  <   0.05) than microbiologists. A 'soft stop' functionality was rated essential or high priority by 89% of respondents. Potential EPMA software features were expected to have the greatest impact on stewardship, treatment efficacy and patient safety outcomes with lowest impact on Clostridium difficile infection, antimicrobial resistance and drug expenditure.Conclusions: The survey demonstrates key differences in health professionals' opinions of potential healthcare benefits of EPMA, but a consensus of anticipated positive impact on patient safety and AMS. [ABSTRACT FROM AUTHOR]

Background: Adolescents are a population group at high risk of low vitamin D status, yet the evidence base for establishing dietary vitamin D requirements remains weak. Objective: The aim was to establish the distribution of vitamin D intakes required to maintain serum 25-hydroxyvitamin D [25(OH)D] concentrations above proposed cutoffs (25, 30, 40, and 50 nmol/L) during winter in white males and females (14-18 y of age) in the United Kingdom (51°N). Design: In a dose-response trial, 110 adolescents (aged 15.9 ± 1.4 y; 43% males) were randomly assigned to receive 0, 10, or 20 mg vitamin D3 supplements/d for 20 wk during winter. A nonlinear regression model was fit to total vitamin D intake and postintervention serum 25(OH)D concentrations, and regression-predicted values estimated the vitamin D intakes required to maintain serum 25(OH)D concentrations above specific cutoffs. Results: Mean ± SD serum 25(OH)D concentrations increased from 49.2 ± 12.0 to 56.6 ± 12.4 nmol/L and from 51.7 ± 13.4 to 63.9 ± 10.6 nmol/L in the 10- and 20-μg/d groups, respectively, and decreased in the placebo group from 46.8 ± 11.4 to 30.7 ± 8.6 nmol/L (all P # 0.001). Vitamin D intakes required to maintain 25(OH)D concentrations >25 and >30 nmol/L in 97.5% of adolescents were estimated to be 10.1 and 13.1 μg/d, respectively, and 6.6 μg/d to maintain 50% of adolescents at concentrations >40 nmol/L. Because the response of 25(OH)D reached a plateau at 46 nmol/L, there is uncertainty in estimating the vitamin D intake required to maintain 25(OH)D concentrations >50 nmol/L in 97.5% of adolescents, but it exceeded 30 μg/d. Conclusion: Vitamin D intakes between 10 and ~30 μg/d are required by white adolescents during winter to maintain serum 25(OH)D concentrations >25-50 nmol/L, depending on the serum 25(OH)D threshold chosen. This trial was registered at clinicaltrials. gov as NCT02150122 and as International Standard Randomized Controlled Trial Number ISRCTN40736890. [ABSTRACT FROM AUTHOR]

Taryn Storey believes that a series of letters recently discovered in the archive of the Arts Council of Great Britain (ACGB) makes it important that we reassess the genesis of the English Stage Company at the Royal Court. Dating from November 1952, the correspondence between George Devine and William Emrys Williams, the Secretary General of the ACGB, offers an insight into a professional and personal relationship that was to have a profound influence on the emerging Arts Council policy for drama. Storey makes the case that in 1953 Devine not only shaped his Royal Court proposal to fit the priorities of the ACGB Drama Panel, but that Devine and senior members of the ACGB then collaborated to ensure that the proposal became a key part of Arts Council strategic planning. Furthermore, she puts forward the argument that the relationship between Devine and Williams was instrumental to new writing and innovation becoming central to the future rationale for state subsidy to the theatre. Taryn Storey is a doctoral student at the University of Reading. Her PhD thesis examines the relationship between practice and policy in the development of new writing in post-war British theatre, and forms part of the AHRC-funded project ‘Giving Voice to the Nation: The Arts Council of Great Britain and the Development of Theatre and Performance in Britain 1945–1995’, a collaboration between the University of Reading and the Victoria and Albert Museum. [ABSTRACT FROM PUBLISHER]

The article presents a summary of updates in the 2011 National Institute for Health and Clinical Excellence (NICE) hypertension guideline. The areas where updates were made include the use of ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) in diagnosis, new thresholds and targets for treatment, and a re-examination of angiotensin-converting inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCBs), and diuretics position.

Several letters to the editor are presented in response to the article related to National Institute for Health and Clinical Evidence (NICE) guideline on the management of hypertension which was published in the previous issue of the journal.

The article presents a summary of the recommendations made in the recent guidance from the Great Britain National Institute for Health and Clinical Excellence (NICE) for the diagnosis and clinical management of alcohol related physical complications in adults and children. The recommendations are said to be based on systemic reviews of best available evidence and explicit considerations of cost effectiveness. It also notes the importance of additional training and staff time for the implementation of symptom triggered dosing regimens for acute alcohol withdrawal.

The COVID-19 pandemic continues to pose unprecedented threat globally. Adolescents and youth may be especially susceptible to the long-term impact of these stressors, thus intervening early is an important priority. However, it is also crucial to understand how young people maintain psychological well-being in the face of adversity, particularly given that many nations are experiencing further waves of the pandemic. The understanding of such resilient outcomes could inform the development of programs to encourage positive mental health.We explored adolescents' resilience to the COVID-19 pandemic stress by examining core aspects of well-being across countries using network analysis. Using the short Warwick–Edinburgh Mental Wellbeing Scale, cross-sectional data was collected online from adolescents from India (N = 310; Males = 159, Females = 151, aged 12–18 years), Israel (N = 306; Males = 154, Females = 152, aged 12–18 years) and the United Kingdom (UK; N = 1666; Males = 598, Females = 1068, aged 12–25 years). Two highly similar network clusters were identified for UK and Israel, with three clusters emerging for India. UK and Israeli networks centred on "dealing with problems well" while the Indian network centred on "feeling useful". As central items highlight aspects of well-being that influence or are influenced by other aspects, these findings may inform interventions to safeguard adolescent mental health during future phases of the pandemic. [ABSTRACT FROM AUTHOR]