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Despite the breadth and depth of educational neuroscience research and teachers' interest in neuroscience, teachers often have limited access to reputable sources. As a result, neuromyths--misapplied or over-simplified claims related to brain science--have proliferated. School Psychologists have training in education, applied neuroscience, and evidence-based practices. As such, school psychologists are poised to mitigate the negative impact of teacher neuromyth endorsement. This study examined the endorsement rate of neuromyths by teachers to identify knowledge gaps to inform future training in this area. In-service and preservice teachers from grades K-12 completed an online survey of common neuromyths. Many neuromyths are pernicious and continue to be endorsed by teachers, most commonly related to learning styles and multiple intelligences. These results support the need for increased training in neuroscience for teachers and suggest a desire for factual and useful information about educational neuroscience, which school psychologists can provide in educational contexts.

Despite their emerging use, the in vivo behaviour of dual-mobility (DM) total hip replacements (THRs) is not well understood. Therefore, the purpose of this study was to assess the articulating surfaces of 20 early-retrieved DM polyethylene liners (mean length of implantation 20.0 ± 18.8 months) for damage to improve the current understanding of their in vivo functional mechanisms. The internal and external surfaces of each liner were visually and geometrically assessed, and the material composition of embedded debris particles were further characterized. Scratching and pitting were the most common modes of damage identified on either surface, and a high incidence of burnishing (50%) and embedded debris (65%) were observed on the internal and external surfaces, respectively. Embedded debris particles were commonly titanium- or iron-based, although other materials such as cobalt-chrome and tantalum were also identified. The geometric assessment demonstrated highly variable damage patterns across the liners, with the internal surfaces commonly presenting with crescent-shaped, circumferential, or circular regions of penetration whilst the external surfaces commonly presented with regions of deep pitting or gouging. This study demonstrates that DM-THRs primarily articulate at the head/liner junction, and that polyethylene liners are capable of rotating about the femoral neck axis, although the extent of this may be limited in some cases. Additionally, this study suggests that intra-prosthetic dislocation and edge loading may remain pertinent failure mechanisms of DM implants despite the advent of highly crosslinked polyethylene and design features, thus highlighting the need for enhanced monitoring of these devices. [ABSTRACT FROM AUTHOR]

Background: Intravenous immunoglobulin (IVIg) for Clostridioides difficile infection (CDI) no longer features in treatment guidelines. However, IVIg is still used by some clinicians for severe or recurrent CDI (rCDI) cases. The main objective of this study was to investigate the efficacy of IVIg and to identify possible predictors of disease resolution post IVIg administration for patients with CDI. Methods: This retrospective observational cohort study of patients ≥2 years old hospitalised with severe, relapsing, or rCDI treated with IVIg therapy was performed in a large UK tertiary hospital between April 2018 and March 2023. Scanned electronic notes from patient admissions and clinical reporting systems were used to collect relevant data. Results: In total, 20/978 patients diagnosed with CDI over the 5-year study were treated with IVIg. Twelve (60%) had hospital-onset CDI. Eleven of the twenty patients (55%) responded to treatment, with a mean of 8.6 (SD 10.7) days to disease resolution. Sixteen (80%) patients were treated for severe CDI and four (20%) for rCDI (n = 3) and relapsing CDI (n = 1). There were no statistically significant differences in possible independent predictors of disease resolution post IVIg administration between groups. There was an average of 6.2 (4.9) days to IVIg administration after diagnosis with no difference between responders and non-responders (p = 0.88) and no further significant difference in additional indicators. Four (36%) of the responders were immunosuppressed compared to just one (11%) of the non-responders (p = 0.15). Six of the responders (two with recurrent and four with severe CDI) improved rapidly within 2 days, and three of these were immunosuppressed. Conclusion: We observed disease resolution post IVIg therapy in over 50% of patients with refractory CDI. Our data also support a potential enhanced effect of IVIg in immunosuppressed individuals. Thus, the role of IVIg for CDI treatment, particularly in the immunosuppressed, warrants future case–control studies coupled to mechanistic investigations to improve care for this ongoing significant healthcare-associated infection. [ABSTRACT FROM AUTHOR]

UK water resources face a number of challenges when planning for an uncertain future. Climate change impacts and what future droughts might look like can be a significant contributor to this uncertainty. Recent and potential future developments (e.g. ever‐finer resolutions) in climate modelling offer the potential for running bias‐corrected transient future scenarios through hydrological, hydrogeological and water supply models, providing users with droughts of differing severity, frequency, spatial extent and duration to those experienced historically, incorporating changes over time and an understanding of climate model uncertainty. The recent enhanced Future Flows and Groundwater (eFLaG) project sought to demonstrate a climate service using these transient scenarios, with the aim of enhancing the resilience of the water industry to drought events and complementing existing approaches. The project demonstrated the use of this transient climate change information within a water resource setting, using a variety of hydrological and water resource models to help illuminate potential gaps and issues with such an approach. If we are to realise the potential of transient scenarios, a number of barriers – both scientific and organisational – need to be overcome. We present a road map for the future based on outcomes from the eFLaG project, as well as ways the eFLaG projections could be used to improve system resilience in the present. [ABSTRACT FROM AUTHOR]

Objective: Polycystic ovary syndrome (PCOS) is a chronic lifelong condition affecting up to 20% of women worldwide. There is limited input from affected women to guide the provision of healthcare services and future research needs. Our objective was to scope the healthcare and research priorities of women with PCOS in the United Kingdom. Design: A three‐staged modified Delphi method, consisting of two questionnaires and a consensus meeting involving lay representatives and healthcare professionals. Patients and Measurements: Lay patient representatives of women with PCOS. Participants were asked to identify and rank healthcare and research priorities for their importance. Results: Six hundred and twenty‐four lay participants took part in our Delphi method. Over 98% were diagnosed with PCOS (614/624, 98.4%). More than half experienced difficulties to receive a PCOS diagnosis (375/624, 60%), and the majority found it difficult to access specialised PCOS health services in the NHS (594/624, 95%). The top two healthcare priorities included better education for health professionals on the diagnosis and management of PCOS (238/273, 87.1%) and the need to set up specialist PCOS services (234/273, 85.7%). The top two research priorities focused on identifying better treatments for irregular periods (233/273, 85.3%) followed by better tests for early PCOS diagnosis (230/273, 84.2%). Conclusions: We identified 13 healthcare and 14 research priorities that reflect the current health needs of women with PCOS in the United Kingdom. Adopting these priorities in future healthcare and research planning will help to optimise the health of women with PCOS and increase patient satisfaction. [ABSTRACT FROM AUTHOR]

This project explored how iPads were being used in a range of K-12 schools to support the learning of students with a range of learning support needs. Groups of teachers (and other professionals) from the USA, Canada, Australia and the UK were invited to complete an online survey focused on the use of iPads in their classrooms, perspectives of their skill level, and how their school and school districts support the use of iPads. The survey focused on iPad use in classrooms (curriculum and skills); teachers' skill levels; whether iPads are addressed in the Individualised Education Program (IEP); the systemic support for the iPads; and the perceived benefits and barriers. The results reveal that respondents are using iPads across many areas of the curriculum, which affirms the research in the emerging literature base. However, there are teacher-reported differences in the manner and scope of iPad use in the classrooms and also the integration of the iPad in the IEP. The research also highlights variability in reported skill level for the iPad and an increased need for enhanced systemic support, such as training, funding, technical support and administrative support for the use of the iPad as a pedagogical tool.

Purpose: To evaluate the new Clinical Practice Research Datalink (CPRD) Aurum database, we estimated 'correctness' (ie accuracy, validity) and 'completeness' (ie presence, missingness) of malignant breast cancer diagnoses recorded in CPRD Aurum compared to external linked data sources: Hospital Episode Statistics (HES) Admitted Patient Care (APC), HES Outpatient (OP), and Cancer Registry (CR), and to the previously validated CPRD GOLD.Methods: Linkage-eligible, female patients with incident malignant breast cancer diagnosis recorded in at least one study data source were selected. Correctness was the proportion of malignant breast cancer cases recorded in CPRD Aurum or GOLD who also had a diagnosis recorded in HES APC/OP (2004– 2019) or CR (2004– 2016). Completeness was estimated by identifying all malignant breast cancer diagnoses in HES APC/OP or CR and calculating the proportion with a concordant diagnosis in CPRD Aurum or GOLD.Results: Compared to HES APC/OP, there were 85,659 and 31,452 eligible patients in CPRD Aurum and GOLD, respectively. Correctness estimates were high (CPRD Aurum 83.5%, GOLD 81.7%). Compared to CR, there were 70,190 and 29,597 eligible patients in CPRD Aurum and GOLD, respectively: correctness was 89.1% for CPRD Aurum and 88.2% for GOLD. Completeness estimates for CPRD Aurum and GOLD were high (> 90%). Diagnoses were recorded in CPRD Aurum within − 7 to 74 days of those in the linked sources. Reasons for discordant diagnostic coding included presence of treatment or other clinical codes only, diagnosis coded after end of follow-up, non-malignant breast cancer in linked data, and administrative codes in lieu of diagnostic codes.Conclusion: These results indicate that correctness and completeness of malignant breast cancer diagnoses in CPRD Aurum were high and similar to CPRD GOLD. This provides confidence in use of CPRD Aurum for research purposes. Where complete case capture is important, researchers should consider linkage to HES APC or CR. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the presence of data elements related to diagnosis and treatment of malignant breast cancer in CPRD Aurum compared to those in the previously validated CPRD GOLD.Methods: Females in CPRD Aurum or GOLD with a first-time code for malignant breast cancer, mastectomy, or ≥ 1 prescription for tamoxifen or aromatase inhibitors (2004– 2019) were selected. We compared the presence of the codes for breast cancer diagnosis, surgeries (mastectomy, lumpectomy), tamoxifen and aromatase inhibitor prescriptions, radiation, chemotherapy, and supporting clinical codes (suspected breast cancer, lump symptoms, biopsy, lumpectomy, cancer care, referral/visit to specialist, palliative care). Age standardized incidence rates of breast cancer diagnosis in CPRD Aurum and GOLD were calculated.Results: There were 131,936 eligible patients in CPRD Aurum and 69,102 patients in GOLD. A similar proportion of patients in CPRD Aurum and GOLD had codes for breast cancer diagnosis, mastectomy, drug prescriptions, lump, biopsy, lumpectomy, chemotherapy, and cancer and palliative care coded in their electronic record during follow-up. However, suspected breast cancer, radiation, and referral/visits to specialists were coded more frequently in patients in CPRD Aurum compared to GOLD. Age-standardized incidence rates were similar for CPRD Aurum and GOLD.Conclusion: Overall, there was consistency between data elements related to malignant breast cancer recorded in CPRD Aurum and GOLD, particularly for the most informative clinical details. These findings provide reassurance that breast cancer information recorded in CPRD Aurum is generally comparable to that recorded in the previously validated CPRD GOLD and support the use of CPRD Aurum for breast cancer research. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is there an association between sedentary behavior and risk of all-cause dementia in older adults? Findings: In this retrospective study of prospectively collected data of 49 841 adults participating in the UK Biobank, more time spent in sedentary behaviors (determined through a machine learning–based analysis of wrist-worn accelerometer data) was significantly associated with higher risk of incident dementia. Meaning: Among older adults, more time spent in sedentary behaviors was associated with higher risk of incident all-cause dementia. Importance: Sedentary behavior is associated with cardiometabolic disease and mortality, but its association with dementia is unclear. Objective: To investigate whether accelerometer-assessed sedentary behavior is associated with incident dementia. Design, Setting, and Participants: A retrospective study of prospectively collected data from the UK Biobank including 49 841 adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer and living in England, Scotland, or Wales. Follow-up began at the time of wearing the accelerometer (February 2013 to December 2015) and continued until September 2021 in England, July 2021 in Scotland, and February 2018 in Wales. Exposures: Mean daily sedentary behavior time (included in the primary analysis) and mean daily sedentary bout length, maximum daily sedentary bout length, and mean number of daily sedentary bouts (included in the secondary analyses) were derived from a machine learning–based analysis of 1 week of wrist-worn accelerometer data. Main Outcome and Measures: Incident all-cause dementia diagnosis from inpatient hospital records and death registry data. Cox proportional hazard models with linear and cubic spline terms were used to assess associations. Results: A total of 49 841 older adults (mean age, 67.19 [SD, 4.29] years; 54.7% were female) were followed up for a mean of 6.72 years (SD, 0.95 years). During this time, 414 individuals were diagnosed with incident all-cause dementia. In the fully adjusted models, there was a significant nonlinear association between time spent in sedentary behavior and incident dementia. Relative to a median of 9.27 hours/d for sedentary behavior, the hazard ratios (HRs) for dementia were 1.08 (95% CI, 1.04-1.12, P <.001) for 10 hours/d, 1.63 (95% CI, 1.35-1.97, P <.001) for 12 hours/d, and 3.21 (95% CI, 2.05-5.04, P <.001) for 15 hours/d. The adjusted incidence rate of dementia per 1000 person-years was 7.49 (95% CI, 7.48-7.49) for 9.27 hours/d of sedentary behavior, 8.06 (95% CI, 7.76-8.36) for 10 hours/d, 12.00 (95% CI, 10.00-14.36) for 12 hours/d, and 22.74 (95% CI, 14.92-34.11) for 15 hours/d. Mean daily sedentary bout length (HR, 1.53 [95% CI, 1.03-2.27], P =.04 and 0.65 [95% CI, 0.04-1.57] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 0.48 hours) and maximum daily sedentary bout length (HR, 1.15 [95% CI, 1.02-1.31], P =.02 and 0.19 [95% CI, 0.02-0.38] more dementia cases per 1000 person-years for a 1-hour increase from the mean of 1.95 hours) were significantly associated with higher risk of incident dementia. The number of sedentary bouts per day was not associated with higher risk of incident dementia (HR, 1.00 [95% CI, 0.99-1.01], P =.89). In the sensitivity analyses, after adjustment for time spent in sedentary behavior, the mean daily sedentary bout length and the maximum daily sedentary bout length were no longer significantly associated with incident dementia. Conclusions and Relevance: Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia. Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal. This study of prospectively collected data from the UK Biobank investigates whether accelerometer-assessed sedentary behavior is associated with incident dementia in adults aged 60 years or older without a diagnosis of dementia at the time of wearing the wrist accelerometer. [ABSTRACT FROM AUTHOR]

Background: Gyrate atrophy of the choroid and retina is a rare autosomal recessive metabolic disorder caused by biallelic variants in the OAT gene, encoding the enzyme ornithine δ-aminotransferase. Impaired enzymatic activity leads to systemic hyperornithinaemia, which in turn underlies progressive chorioretinal degeneration. In this study, we describe the clinical and molecular findings in a cohort of individuals with gyrate atrophy. Methods: Study participants were recruited through a tertiary UK clinical ophthalmic genetic service. All cases had a biochemical and molecular diagnosis of gyrate atrophy. Retrospective phenotypic and biochemical data were collected using electronic healthcare records. Results: 18 affected individuals from 12 families (8 male, 10 female) met the study inclusion criteria. The median age at diagnosis was 8 years (range 10 months – 33 years) and all cases had hyperornithinaemia (median: 800 micromoles/L; range: 458–1244 micromoles/L). Common features at presentation included high myopia (10/18) and nyctalopia (5/18). Ophthalmic findings were present in all study participants who were above the age of 6 years. One third of patients had co-existing macular oedema and two thirds developed pre-senile cataracts. Compliance with dietary modifications was suboptimal in most cases. A subset of participants had extraocular features including a trend towards reduced fat-free mass and developmental delay. Conclusions: Our findings highlight the importance of multidisciplinary care in families with gyrate atrophy. Secondary ophthalmic complications such as macular oedema and cataract formation are common. Management of affected individuals remains challenging due to the highly restrictive nature of the recommended diet and the limited evidence-base for current strategies. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of suspected urinary tract infection (UTI) in care and nursing home residents is commonly based on vague non-localising symptoms (for example, confusion), potentially leading to inappropriate antibiotic prescription. The safety of withholding antibiotics in such cases could be addressed by a randomised controlled trial (RCT); however, this would require close monitoring of residents, and support from care home staff, clinicians, residents, and families. Aim: To explore the views of residential care and nursing home staff (herein referred to as care home staff) and primary care clinicians on the feasibility and design of a potential RCT of antibiotics for suspected UTI in care home residents, with no localising urinary symptoms. Design & setting: A qualitative interview study with primary care clinicians and care home staff in the UK. Method: Semi-structured interviews with 16 care home staff and 11 primary care clinicians were thematically analysed. Results: Participants were broadly supportive of the proposed RCT. The safety of residents was a priority and there was strong support for using the RESTORE2 (Recognise Early Soft Signs, Take Observations, Respond, Escalate) assessment tool to monitor residents; however, there were concerns about associated training requirements, especially for night and temporary staff. Effective communication (with residents, families, and staff) was deemed essential, and carers were confident that residents and families would be supportive of the RCT if the rationale was clearly explained and safety systems were robust. There were mixed views on a placebo-controlled design. The perceived additional burden was seen as a potential barrier, and the use of temporary staff and the out-of-hours period were highlighted as potential risk areas. Conclusion: The support for this potential trial was encouraging. Future development will need to prioritise resident safety (especially in the out-of-hours period), effective communication, and minimising additional burden on staff to optimise recruitment. [ABSTRACT FROM AUTHOR]

Background: People diagnosed with von Willebrand disease (VWD) have reduced quality of life versus the general population, and there is limited evidence of increased rates of anxiety and/or depression among people diagnosed with VWD.Aim: To understand the association between VWD and mental health outcomes.Design and Setting: A retrospective cohort study was conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD database (1988– 2016).Methods: People diagnosed with VWD were matched 1:10 to randomly selected people in the database without VWD based on sex, birth year ± 2 years, CPRD record start year ± 2 years, and general practice attended. Individuals were followed from VWD diagnosis or match date to censoring (first event date, CPRD end date, or death). Treated anxiety and treated depression were identified by a diagnostic Read Code and a prescription for anxiety/depression medication recorded within 90 days of each other, after VWD diagnosis/match date.Results: Treated anxiety was recorded in 89 of 1119 (8.0%) people diagnosed with VWD and 624 of 10,423 (6.0%) without VWD (age- and sex-adjusted incidence rate ratio [IRR], 1.37; 95% confidence interval [CI], 1.10– 1.71). Treated depression was recorded in 119 of 1083 (11.0%) people diagnosed with VWD and 846 of 9845 (8.6%) without VWD (adjusted IRR, 1.35; 95% CI, 1.11– 1.63). Females aged 20– 39 and 0– 19 years were at greatest risk for treated anxiety and treated depression, respectively.Conclusion: Higher rates of treated anxiety and depression were observed among people diagnosed with versus without VWD, predominantly in young females. [ABSTRACT FROM AUTHOR]

This study examines the effectiveness of three risk assessment instruments: Static-99, Risk Matrix 2000 (RM2000) and the Rapid Risk of Sex Offender Recidivism (RRASOR), in predicting sexual recidivism among 27 intellectually disabled sex offenders. The overall sexual offence reconviction rate was 30%, while non-recidivists remained offence-free over 76 months of follow-up. Static-99 presented as performing as well as guided clinical judgements in mainstream population studies [area under the curve (AUC)=0.64] exceeding the performance of RM2000 (AUC=0.58) in predicting sexual recidivism. However, the results were not statistically significant. In contrast to previous findings, the RRASOR presented the worst level of prediction (AUC=0.42). These results highlight the need to investigate further with larger sample sizes and in conjunction with more dynamic measures of risk. Proposed relevant factors are discussed in detail. (Contains 2 tables.)

This paper presents some of the initial findings of a series of studies documenting the UK eUniversity (UKeU) approach to and experience of e-learning. It will focus on the experiences and lessons learned of members of the learning technology team within the UKeU or people working closely with them. Our particular interest is to describe the various roles and approaches to e-learning. We will concentrate in this paper on the organizational cultures and processes. The paper will critique the relationships between the different stakeholders involved in the experience. In particular, we will explore the relationship between the documented UKeU vision and how this was instantiated and its impact on practice. The paper also explores the roles of the different stakeholders, their perceptions of the project and their interrelationships. One of the most important findings of the research is the mismatch between those with more of a business-orientated vision for UKeU and those more interested in the academic aspects and the potential educational innovation. We believe the paper is important in terms of helping practitioners to understand the complexity and challenges of large-scale e-learning developments. We believe it offers valuable insights for future national continuing education policy and practice, by considering the following issues: (1) How is e-learning policy conceptualized and implemented?; (2) How can e-learning be developed in different organizational cultures, which may involve cross-sector stakeholders?; (3) How can the potential damage of the tensions between business and educational stakeholders be minimized?; (4) What are the appropriate organizational structures and processes needed to support large-scale e-learning development?; and (5) What staff development mechanisms are needed to ensure success? (Contains 1 table.)

This article argues that to understand higher education student retention, equal emphasis needs to be placed on successful integration into the social world of the university as into the academic world. To date, sociological research reflecting first-year students' perceptions of the processes involved in developing social lives at university is scarce. Here the concept of "social support" is used to analyse interviews with 34 first-year students, investigating the processes through which social integration (or lack of it) influenced their decision as to whether or not to leave university. Our data support the claim that making compatible friends is essential to retention, and that students' living arrangements are central to this process. Such friends provide direct emotional support, equivalent to family relationships, as well as buffering support in stressful situations. Course friendships and relationships with personal tutors are important but less significant, providing primarily instrumental, informational and appraisive support.

Background Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic. Methods We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number. Results There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85–1.21 and OR 0.84, 95% CI 0.67–1.07, respectively). Conclusion Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the use of an innovative resilience-building training programme delivered to NHS Safeguarding Leads and other participating professionals over a five-month period concluding in March 2019. The developers used knowledge and expertise in both the fields of psychology and drama-based learning to promote comprehension, retention and a capacity for using and conveying these strategies to other health-care workers. Design/methodology/approach: Attendees were given pre- and post-questionnaires to examine the effectiveness of the training in terms of understanding the stages of burnout, developing an awareness of personal risk factors that may be associated with potential burnout and their perceptions of the confidence they have in both evaluating their personal resilience and using acquired skills and coping techniques that they may apply to their personal and professional lives. A Wilcoxon Signed Ranks test was administered, to assess the significance of the difference between pre- and post-training scores. Findings: Following the training, participants reported statistically significant improvements relating to their understanding of terms, including "burnout". They also reported an increased awareness of their personal risk factors associated with burnout and felt more resilient having completed the training. Statistically significant changes were reported in all of these areas, with the drama element of the training being commended on about one third of all feedback forms where, with the post-test results, a narrative (unscored) opportunity for feedback was sought. Research limitations/implications: The authors note that a long-term follow-up of retention and use of this training was not undertaken, though they consider that, post-pandemic, this necessary training can be reinitiated and that, as with other professional initiatives, video-engagement technology may be, through innovative efforts, merged with these effective training techniques as an option for future training applications. Practical implications: To the best of the authors' knowledge, this training programme was the first of its kind to use a psychologically underpinned drama-based didactic approach to build resilience and protect against burnout. The results of this paper show that this training used an effective and efficient medium for successfully meeting these primary objectives. Social implications: It is considered that using a similar training approach would be effective in building resilience and preventing burnout in health-care professionals. Originality/value: This paper evaluates the effectiveness of an innovative resilience-building training programme drawing upon the field of psychology and drama-based learning to support safeguarding professionals within the NHS. [ABSTRACT FROM AUTHOR]

The important part played in monitoring systems by site visits by inspectors is discussed and illustrated with a review of the role played by the national inspectorate for education in England (Her Majesty's Inspectorate). Inspection has the potential to generate performance indicators of educational quality. (SLD)

Sedentary behavior (SB) is associated with cardiometabolic disease and mortality, but its association with dementia is currently unclear. This study investigates whether SB is associated with incident dementia regardless of engagement in physical activity (PA). A total of 146,651 participants from the UK Biobank who were 60 years or older and did not have a diagnosis of dementia (mean [SD] age: 64.59 [2.84] years) were included. Selfreported leisure-time SBs were divided into two domains: time spent watching television (TV) or time spent using a computer. A total of 3,507 individuals were diagnosed with all-cause dementia over a mean follow-up of 11.87 (±1.17) years. In models adjusted for a wide range of covariates, including time spent in PA, time spent watching TV was associated with increased risk of incident dementia (HR [95% CI] = 1.24 [1.15 to 1.32]) and time spent using a computer was associated with decreased risk of incident dementia (HR [95% CI] = 0.85 [0.81 to 0.90]). In joint associations with PA, TV time and computer time remained significantly associated with dementia risk at all PA levels. Reducing time spent in cognitively passive SB (i.e., TV time) and increasing time spent in cognitively active SB (i.e., computer time) may be effective behavioral modification targets for reducing risk of dementia regardless of engagement in PA. [ABSTRACT FROM AUTHOR]

Background: Recently published European Society for Phenylketonuria (ESPKU) guidelines have recommended a lifelong diet with phenylalanine (Phe) control ≤ 600 μmol/L for phenylketonuria (PKU) patients. This study aimed to identify whether PKU adult patients are at a higher risk of mental health diagnoses if their 2-year average Phe level is higher than the ESPKU European guidelines. Published studies identified by a literature review showed that related studies have been published in American and European PKU study populations but not in the United Kingdom (UK) study populations. Previous studies also involved a smaller number of participants due to this being a rare disease.Results: We undertook a retrospective audit at a single large PKU centre in the UK. 244 adult PKU patients at the centre were included, 220 of which had a recorded Phe level. Approximately 75% of the patients in this study did not meet the ESPKU European guidelines for Phe control. A systematic search of the electronic patient record was undertaken looking for mental health diagnoses. Compared to two-year average Phe levels ≤ 600 μmol/L, PKU adult patients with two-year average Phe levels > 600 μmol/L were more likely to have diagnoses of low mood, depression, anxiety, or mood swings, but only low mood reached statistical significance (p < 0.05).Conclusions: PKU patients with two-year average Phenylalanine levels greater than ESPKU guidelines may be at greater risk of mental health diagnoses and symptoms. Many of these adult PKU patients will be lost to follow-up, and therefore may be receiving treatment for mental health conditions in the community. Multicentre UK studies and international collaborations are required to overcome low participant numbers in the study of this rare disease. [ABSTRACT FROM AUTHOR]

The study examined if maturity status bio-banding reduces within-group variance in anthropometric, physical fitness and functional movement characteristics of 319, under-14 and under-15 players from 19 UK professional soccer academies. Bio-banding reduced the within-bio-banded group variance for anthropometric values, when compared to an aggregated chronological banded group (chronological: 5.1–16.7%CV; bio-banded: 3.0–17.3%CV). Differences between these bio-banded groups ranged from moderate to very large (ES = 0.97 to 2.88). Physical performance variance (chronological: 4.8–24.9%CV; bio-banded: 3.8–26.5%CV) was also reduced with bio-banding compared to chronological aged grouping. However, not to the same extent as anthropometric values with only 68.3% of values reduced across banding methods compared to 92.6% for anthropometric data. Differences between the bio-banded groups physical qualities ranged from trivial to very large (ES = 0.00 to 3.00). The number of functional movement metrics and %CV reduced by bio-banding was lowest within the 'circa-PHV' groups (11.1–44.4%). The proportion of players achieving the threshold value score of ≥ 14 for the FMS™ was highest within the 'post-PHV' group (50.0–53.7%). The use of maturity status bio-banding can create more homogenous groups which may encourage greater competitive equity. However, findings here support a bio-banding maturity effect hypothesis, whereby maturity status bio-banding has a heightened effect on controlling for characteristics which have a stronger association to biological growth. [ABSTRACT FROM AUTHOR]

Background Urogenital testing misses extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Extragenital self-sampling is frequently undertaken despite no robust randomized, controlled trial evidence of efficacy. We compared clinician-taken rectal and pharyngeal samples with self-taken samples for diagnostic accuracy and cost in men who have sex with men (MSM) and in females. Methods This was a prospective convenience sample from a UK sexual health clinic. We randomized the order of clinician- and self-taken samples from the pharynx and rectum, plus first catch urine (MSM) and vulvovaginal swabs (females), for NG/CT detection. Results Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 9.4% infected females and 67.3% MSM were urogenital-negative. A total of 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx); 13.1% infected females and 71.8% MSM were urogenital-negative. Sexual history did not identify those with rectal infections. There was no difference in diagnostic accuracy between clinician- and self-taken samples from the rectum or pharynx. Clinicians took swabs more quickly than participants, so costs were lower. However, in asymptomatic people, nonqualified clinicians would oversee self-swabbing making these costs lower. Conclusions There was no difference in the diagnostic accuracy of clinician-taken compared with self-taken extragenital samples. Sexual history did not identify those with rectal infections, so individuals should have extragenital clinician- or self-taken samples. Clinician-taken swabs cost less than self-taken swabs; however, in asymptomatic people or those who perform home testing, the costs would be lower than for clinician-taken swabs. Clinical Trials Registration NCT02371109. [ABSTRACT FROM AUTHOR]

With the recent increase in research into ferroelectric, anti‐ferroelectric and piezoelectric materials, studying the solid‐state properties in situ under applied electric fields is vital in understanding the underlying processes. Where this behaviour is the result of atomic displacements, crystallographic insight has an important role. This work presents a sample environment designed to apply an electric field to single‐crystal samples in situ on the small‐molecule single‐crystal diffraction beamline I19, Diamond Light Source (UK). The configuration and operation of the cell is described as well as its application to studies of a proton‐transfer colour‐change material. [ABSTRACT FROM AUTHOR]

Background: Validation studies of the Clinical Practice Research Datalink (CPRD) Aurum database in the UK are critical for making decisions about its suitability and validity for research purposes. Objective: To examine data source agreement of myocardial infarction (MI) diagnoses recorded in CPRD Aurum compared with linked Hospital Episode Statistics (HES) data. This comparison provides information on CPRD Aurum data correctness (accuracy, validity) and completeness (presence, missingness). Methods: Patients with MI diagnoses recorded in either data source were selected from a random sample of 50,000 patients in CPRD Aurum with HES linkage (1997– 2017). Correctness was defined as the proportion of MI cases in CPRD Aurum with a concordant MI diagnosis recorded in HES or with strong supporting evidence in either data source. Completeness was defined as the proportion of patients with primary HES-coded MIs with strong supporting evidence that were also present in CPRD Aurum. Results: There were 1260 patients with MI recorded in the CPRD Aurum sample. The overall correctness of the recorded MI diagnoses was 94%: 986 patients (78%) had concordant diagnoses in HES within 90 days; 123 (10%) were concordant with HES, but with an inconclusive date and another 71 (6%) had strong supporting evidence for being a true MI case. There were 1125 patients with MI recorded in HES primary diagnosis fields with strong supporting evidence in either data source. Of these, 880 (78%) were present in CPRD Aurum, with completeness somewhat higher in more recent years. Conclusion: MI diagnoses recorded in CPRD Aurum were highly likely to be correct, supporting its use in clinical research studies. Completeness was lower, indicating the need for data linkage for some studies. [ABSTRACT FROM AUTHOR]

Background: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. Aim: To provide an evidence‐based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. Design: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. Methods: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non‐ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non‐ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. Results: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. Conclusion: Oral care is an important part of the care of critically ill patients, both ventilated and non‐ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. Relevance to Clinical practice: Effective oral care is integral to safe patient care in critical care. [ABSTRACT FROM AUTHOR]

Background: Primary hyperparathyroidism (PHPTH) is a common endocrine disorder and an estimated 10% of cases are hereditary, related to syndromes including; multiple endocrine neoplasia (MEN) type 1, MEN type 4, MEN2A and hereditary hyperparathyroidism‐jaw tumour syndrome. Establishing the underlying genetic cause for PHPTH allows for personalized and cost‐effective management. Familial hypocalicuric hypercalcaemia (FHH) is a benign disorder of hypercalcaemia associated with an inappropriately low urinary calcium excretion, which is quantified by the calcium creatinine clearance ratio (CCCR). Recent NHS England National Genomic Test Directory testing criteria for familial hyperparathyroidism state testing patients presenting with PHPTH and CCCR > 0.02 presenting (i) <35 years of age, or (ii) <45y with one of (a) multiglandular disease, or (b) hyperplasia on histology, or (c) ossifying fibroma(s) of the maxilla and/ or mandible, or (d) a family history of unexplained PHPTH. The testing criterion for FHH is a CCCR < 0.02. Aims and Methods: A retrospective review of patients referred for genetic testing over a 4 year period for suspected hereditary HPTH was performed. Genetic analysis was performed by next‐generation sequencing of the following genes; MEN1, CDC73, CASR, CDKN1A, CDKN1B, CDKN2B, CDKN2C, RET, GCM2, GNA11, and AP2S1 in NHS‐accredited Regional Genetic laboratories. Aims of this study were to better define testing criteria for suspected hereditary PHPTH in a UK cohort. Results: A total of 121 patients were included in this study (92 female) with a mean age of 41 years (SD 17). A pathogenic germline variant was identified in 16% (n = 19). A pathogenic variant was identified in the PHPTH genes CDC73 in a single patient and MEN1 in six patients (6% of total), in the FHH genes, CASR in 11 patients and AP2S1 in a single paediatric case (10% of total). A variant of uncertain significance (VUS) was identified in eight patients (6%) but over the course of this study familial segregation studies and computational analysis enabled re‐classification of four of the variants, with two VUS's in the CASR gene being upgraded to likely pathogenic variants. Age at diagnosis and multiglandular disease as sole risk factors were not predictive of a pathogenic germline variant in this cohort but a positive family history was strongly predictive (P =.0002). A significant difference in the mean calcium creatinine clearance ratio (CCCR) in those patients with an identified CASR pathogenic variant versus those without (P =.0001) was demonstrated in this study. Thirty‐three patients were aged over 50 years and the diagnostic rate of a pathogenic variant was 15.1% in those patients >50 years of age compared to 15.9% in those <50 years. Five patients >50 years and with a CCCR of <0.01, were diagnosed with a pathogenic variant in CASR. Conclusion: Family history was the strongest predictor of hereditary PHPTH in this cohort. This study has highlighted the importance of re‐evaluating VUS's in order to inform patient management and enable appropriate genetic counselling. Finally, this study has demonstrated the need to consider genetic testing for PHPTH in patients of any age, particularly those with additional risk factors. [ABSTRACT FROM AUTHOR]

In the UK, the NDE community is making a coordinated effort to underpin and enable the full benefits of the large-scale trend toward comprehensive digitalization and automation of industrial processes and assets, frequently referred to as "Industry 4.0". Certain facets of what is now considered to be NDE 4.0 have been the subject of research for some time and have already gained industrial traction, while others are quite new, with unexplored potential and pitfalls. However, in these areas there is scope for learning from progress in fields outside of, but related to, NDE such as dimensional metrology. This paper reviews progress to date based on UK activities, considers some planned and potential research tasks in this domain, and highlights the major challenges the NDE community must tackle. In particular, as interoperability and data reuse are key features of Industry 4.0 practices, international and cross-domain efforts on data format standardization are needed. It is clear that, without the NDE community stepping up to the challenge, much of Industry 4.0 cannot be realized; yet if the NDE 4.0 vision is implemented comprehensively, NDE has the potential to become more capable, more valuable, and therefore more highly valued. [ABSTRACT FROM AUTHOR]

Objectives: Antimicrobial resistance (AMR) represents a significant threat to patient and population health. The study aim was to develop and validate a model of AMR that defines and quantifies the value of new antibiotics. Methods: A dynamic disease transmission and cost-effectiveness model of AMR consisting of three components (disease transmission, treatment pathway and optimisation) was developed to evaluate the health economic value of new antibiotics. The model is based on the relationship between AMR, antimicrobial availability and consumption. Model analysis explored the impact of different antibiotic treatment strategies on the development of AMR, patient and population estimates of health benefit, across three common treatment indications and pathogens in the UK. Results: Population-level resistance to existing antimicrobials was estimated to increase from 10.3 to 16.1% over 10 years based on current antibiotic availability and consumption. In comparison, the diversified use of a new antibiotic was associated with significant reduction in AMR (12.8% vs. 16.1%) and quality-adjusted life year (QALY) gains at a patient (7.7–10.3, dependent on antimicrobial efficacy) and population level (3657–8197, dependent on antimicrobial efficacy and the prevalence of AMR). Validation across several real-world data sources showed that the model output does not tend to systematically under- or over-estimate observed data. Conclusions: The development of new antibiotics and the appropriate use of existing antibiotics are key to addressing the threat of AMR. This study presents a validated model that quantifies the value of new antibiotics through clinical and economic outcomes of relevance, and accounts for disease transmission of infection and development of AMR. In this context, the model may be a useful tool that could contribute to the decision-making process alongside other potential models and expert advice. [ABSTRACT FROM AUTHOR]

The White Fish Authority was the government development body for most of the British fishing industry from its establishment in 1951 until its merger with the Herring Industry Board thirty years later. Setting the WFA in the context of wider debates over the efficacy of development councils in general, this article surveys and critiques the record of the Authority. It argues that despite weaknesses in its conception, financing and management, the Authority was nevertheless a positive force overall. [ABSTRACT FROM AUTHOR]

Background: External validation of risk models is critical for risk-stratified breast cancer prevention. We used the Individualized Coherent Absolute Risk Estimation (iCARE) as a flexible tool for risk model development and comparative model validation and to make projections for population risk stratification.Methods: Performance of two recently developed models, one based on the Breast and Prostate Cancer Cohort Consortium analysis (iCARE-BPC3) and another based on a literature review (iCARE-Lit), were compared with two established models (Breast Cancer Risk Assessment Tool and International Breast Cancer Intervention Study Model) based on classical risk factors in a UK-based cohort of 64 874 white non-Hispanic women (863 patients) age 35-74 years. Risk projections in a target population of US white non-Hispanic women age 50-70 years assessed potential improvements in risk stratification by adding mammographic breast density (MD) and polygenic risk score (PRS).Results: The best calibrated models were iCARE-Lit (expected to observed number of cases [E/O] = 0.98, 95% confidence interval [CI] = 0.87 to 1.11) for women younger than 50 years, and iCARE-BPC3 (E/O = 1.00, 95% CI = 0.93 to 1.09) for women 50 years or older. Risk projections using iCARE-BPC3 indicated classical risk factors can identify approximately 500 000 women at moderate to high risk (>3% 5-year risk) in the target population. Addition of MD and a 313-variant PRS is expected to increase this number to approximately 3.5 million women, and among them, approximately 153 000 are expected to develop invasive breast cancer within 5 years.Conclusions: iCARE models based on classical risk factors perform similarly to or better than BCRAT or IBIS in white non-Hispanic women. Addition of MD and PRS can lead to substantial improvements in risk stratification. However, these integrated models require independent prospective validation before broad clinical applications. [ABSTRACT FROM AUTHOR]

A questionnaire and interview survey of health education carried out in the secondary schools of one local education authority is described. The survey revealed that health education was both widely dispersed throughout the curriculum in the context of other subject and across the pupil age range. (Author)

Farmland vegetative strips are a proven source of support for ecosystem services and are globally used to mitigate effects of agricultural intensification. However, increasing pressures on agricultural land require increases in their functionality, such as supporting multiple ecosystem services concurrently.The plant species sown in a vegetative strip seed mix determine the establishment, plant community, and ecosystem services that are supported. Currently, there is no clearly defined or structured method to select plant species for multifunctional vegetative strips.Plant traits determine how plants support ecosystem services. Also, the establishment and persistence of plant communities is influenced by key internal and external factors. We propose a novel, evidence‐informed method of multifunctional vegetative strip design based on these essential traits and factors.This study had three distinct stages. The first identified plant traits that support water quality protection, pollinators and/or crop pest natural enemies, using existing research evidence. We then identified key factors affecting plant community establishment and persistence. Finally, we applied these standardized methods to design a multifunctional vegetative strip for a specific case study (UK lowland farmland).Key plant traits identified, included floral display size, flower color, nectar content, leaf surface area, leaf trichome density, percentage fine roots, root length, rooting depth, and root density. Key internal and external establishment factors included life history, native status, distribution, established competitive strategy, associated floristic diversity, flowering time and duration, and preferred soil type and pH. In the United Kingdom case study, we used five different plant traits and all of the identified factors to design a seed mix for a multifunctional vegetative strip.We present a transferable method of vegetative strip design that can be adapted for other ecosystem services and climates. It provides landowners and advisors with an evidence‐informed approach to increase field margin functionality while supporting farmland biodiversity. OPEN RESEARCH BADGES: This article has earned an Open Data Badge for making publicly available the digitally‐shareable data necessary to reproduce the reported results. The data is available at https://doi.org/10.5061/dryad.8t52n38. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales.Design/methodology/approach The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance.Findings The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings.Research limitations/implications There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings.Practical implications The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently.Social implications For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings.Originality/value While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents. [ABSTRACT FROM AUTHOR]

Purpose This study aims to establish the complex nature of leadership in children’s centres in the UK and to demonstrate the value of system leadership as a vital concept for children’s centre leadership.Design/methodology/approach The study presents a case study of leadership development with 24 leaders of children’s centres across Hertfordshire.Findings The study considers the efficacy of system leadership, including distributed leadership, within this setting. Evaluation of the programme found that the concept of system leadership was appropriate, supportive and validating for leaders of children’s centres; however, the concept needed support with further practical tools and resources.Research limitations/implications The limitation of the study is its specificity to one local authority, and further research will be needed to see how generalisable the findings are.Practical implications The implication of the study is that leaders of children’s centres could be supported to work more effectively with system leadership.Social implications When leaders of children’s centres feel effective, they have enhanced well-being and achieve more outcomes, which in turn enhances the well-being of the children and families that they serve.Originality/value Leadership in children’s centres is an under-researched and under-supported area. This study makes a new contribution to this sector of leadership. [ABSTRACT FROM AUTHOR]

Objectives: Data quantifying outcomes of recurrent Clostridium difficile infection (rCDI) are lacking. We sought to determine the UK hospital resource use and health-related quality of life (HRQoL) associated with rCDI hospitalizations.Patients and methods: A non-interventional study in six UK acute hospitals collected retrospective clinical and resource use data from medical records of 64 adults hospitalized for rCDI and 64 matched inpatient controls with a first episode only (f)CDI. Patients were observed from the index event (date rCDI/fCDI confirmed) for 28 days (or death, if sooner); UK-specific reference costs were applied. HRQoL was assessed prospectively in a separate cohort of 30 patients hospitalized with CDI, who completed the EQ-5D-3L questionnaire during their illness.Results: The median total management cost (post-index) was £7539 and £6294 for rCDI and fCDI, respectively (cost difference, P = 0.075); median length of stay was 21 days and 15.5 days, respectively (P = 0.269). The median cost difference between matched rCDI and fCDI cases was £689 (IQR=£1873-£3954). Subgroup analysis demonstrated the highest median costs (£8542/patient) in severe rCDI cases. CDI management costs were driven primarily by hospital length of stay, which accounted for >85% of costs in both groups. Mean EQ-5D index values were 46% lower in CDI patients compared with UK population values (0.42 and 0.78, respectively); EQ visual analogue scale scores were 38% lower (47.82 and 77.3, respectively).Conclusions: CDI has considerable impact on patients and healthcare resources. This multicentre study provides a contemporaneous estimate of the real-world UK costs associated with rCDI management, which are substantial and comparable to fCDI costs. [ABSTRACT FROM AUTHOR]

The National Museums Scotland collections include clothes and textiles recovered from Scottish peat bogs, examples which are revealing of vernacular, non-elite dress in Scotland. One of these sets, the clothes recovered from peat moss at Quintfall Hill on the Barrock Estate, near Keiss, Caithness and dating from the late seventeenth century are the subject of this article. Although reported in some detail after their discovery in 1920, very little further consideration was given to these clothes. This article, the second of two, describes the finds in more detail and discusses them in the context of other Scottish and Irish finds of the period c. 1650-c. 1750, and draws on recent discoveries about the textiles. Pattern-cutting analyses of the garments are also presented as diagrams and discussed in relation to the cut and tailoring of surviving examples elsewhere. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the work of the new, free telephone helpline The Silver Line in empowering older people to overcome social isolation and loneliness, and where appropriate refer cases of abuse and neglect to specialist services. Design/methodology/approach -- Beginning with a family member's description of how the helpline made a difference to her relative this paper then outlines the rationale, methods and outcomes of The Silver Line, including a role it may play in reducing demand for NHS services. Findings -- The paper highlights that social isolation and loneliness can be tackled through a helpline which leaves control firmly in the hands of callers while offering them a gateway to activities and services. Practical implications -- It seems that telephone contact is a particularly helpful way for isolated people to begin to build social contact given that there is evidence of a stigma associated with admitting to loneliness. Social implications -- Given a straightforward way to connect to others, people are empowered to overcome their own loneliness, improve their well-being and sometimes to rejoin their community. The charity reports that callers to the helpline may themselves become volunteer befrienders ("Silver Line Friends") providing support to others and gaining evidence of their own value to society. In addition, a friendly chat over the phone can be an enabling link to gaining new skills, such as computer literacy, which may otherwise seem out of reach or irrelevant. Originality/value -- The paper emphasises the importance of this helpline specifically and the wider need for hard to reach, isolated older people to have an accessible stepping stone to greater social contact and a higher quality of life. [ABSTRACT FROM AUTHOR]

During the Napoleonic War, the Royal Navy grew to an unprecedented size, but with the return of peace it dispensed with the services of an also unprecedented 124,000 men. By 1818, around 90% of commissioned officers were unemployed and on half pay. Drawing on the papers of navy agent Robert Brine, as well as Admiralty and Parliamentary sources, this paper sets out the scale of the unemployment problem among commissioned officers and the effects it had upon them, and surveys the options available to erstwhile sea officers and the strategies the deployed to make a living amid the post-war slump. [ABSTRACT FROM PUBLISHER]

This paper describes the cut and construction of the doublet and hose worn as underdress to the robes and insignia of the Knights of the Most Noble Order of the Garter at the English Court under Charles II. This example belonged to Charles Stuart, sixth Duke of Lennox and third Duke of Richmond (1639-1672), who was created a knight of the Garter in 1661. It is interesting on several counts: the dominant textile is a very pure cloth of silver; the elaborate hose are constructed with reference to earlier seventeenth-century models; the garments exemplify Charles II's understanding of the importance of ceremony to successful kingship. The suit was conserved for an exhibition at the National Museum of Scotland in Edinburgh and the essay gives some account of discoveries made through this process. In addition, the garments are placed in the context of late seventeenth-century dress. [ABSTRACT FROM AUTHOR]

Background: Various factors, including treatment protocols, can influence the outcomes of frozen embryo transfers (FETs). The study objectives were to compare different endometrial preparation protocols of FET cycles and to evaluate the factors, including the endometrial thickness (ET), that affect outcomes. Methods: This observational cohort study involved 5037 women undergoing FETs at eight tertiary clinics in the UK between January 2016 and March 2019. The endometrial preparation protocols used were natural cycle (NC-FETs), artificial hormone support cycle with oestradiol valerate but without pituitary downregulation (AC-FETs) and artificial hormone support cycle with agonist downregulation (ACDR-FETs). Results: The mean (±SD) ages across NC-FET, AC-FET and ACDR-FET groups were 36.5 (±4.2), 35.9 (±5.0) and 36.4(±4.9) years, respectively. LBRs were comparable (40.7%, 175/430; 36.8%, 986/2658; and 36.7%, 716/1949, respectively) across the three groups. Clinical pregnancy, implantation, multiple pregnancies, miscarriage and ectopic pregnancy rates were also similar. In the regression analysis of variables including age, duration of infertility, number of embryos transferred, protocol type and endometrial thickness, age was the only significant predictor of LBRs, although its predictive ability was poor (AUC: 0.55). With the overall LBR of the study population being 37.1%, the post-test probability of a live birth at an ET of <5 mm was 0%, and at 5–5.9, 6–6.9, 7–7.9 and 8–8.9 mm, the probabilities were 16.7%, 33.8%, 36.7% and 37.7%, respectively. The LBR remained above 35% up to the 14–14.9 mm range and then declined gradually to 23% for the 17–25 mm range. Conclusions: The FET outcomes were similar for the three protocols used for endometrial preparation. The protocol type and endometrial thickness were not predictive of FET outcomes; age was the only predictive variable, despite its low predictive ability. [ABSTRACT FROM AUTHOR]

Purpose – There is little research addressing the delivery of training for health professionals who are interested in using cognitive-behaviour therapy (CBT) techniques as an adjunct to their current role. This paper describes the establishment and evaluation of a CBT training course to develop CBT skills in staff working with people with intellectual disabilities in Trust healthcare settings. The course would enable staff to learn how they could incorporate these skills into their daily practice to help them understand and work more effectively with people with intellectual disabilities. Design/methodology/approach – A CBT training course was designed to teach staff the use of a number of basic and specific CBT techniques and principles that staff could use within their current roles. Specific issues in relation to people with intellectual disabilities were included, e.g. understanding cognitive deficits as well as cognitive distortions. The course ran for six sessions on a fortnightly basis, followed by a two-month follow-up session. Participants completed a pre- and post-assessment questionnaire and kept a reflective diary. Findings – The training clearly focused on teaching skills that were feasible for staff to use in their own work settings. The evaluations, especially from the reflective diaries and the post-course questionnaires clearly demonstrated that this aim was achieved. Originality/value – This was a pilot study as there has been no previously published evidence of using this approach within intellectual disabilities services. A further training course has been planned to continue evaluating the effectiveness of this approach. [ABSTRACT FROM AUTHOR]

It is well known that the railways facilitated the development of the British fishing industry in the nineteenth century. Using sources only recently made available for research, this article explores the relationship between the fish trade and railways in the twentieth century. It concludes that the eventual withdrawal of British Railways from fish traffic was occasioned by the fact supply chains for many foodstuffs were revolutionised in the post-war period by the rise of large-scale processing industries and then multiple retailers, which mainly used road distribution. It was also, however, a product of the fish trades’ fragmentation and divisions, and of failures of negotiation on both sides. [ABSTRACT FROM PUBLISHER]

Many portable single-gas monitors are used for the detection of low concentrations of hydrogen sulfide (H2S) and sulfur dioxide (SO2) in the workplace. With the recent lowering of the H2S and SO2 ACGIH® threshold limit value (TLV®) the ability of these devices to selectively respond to these new lower levels is not well documented in petroleum industry environments, which often have potential interfering gases and vapors present as well as varying environmental conditions. Tests were carried out to measure the ability of various monitors with their respective sensors to correctly quantify and respond to H2S and SO2 in a simulated petroleum industry environment. This included the identification of selected interference effects and estimation of the reliable lower limit of detection for real workplace environments. None of the H2S monitors responded at 0.1 times the new TLV (0.1 ppm), only some of them responded at the new TLV concentration (1 ppm), and all the monitors exposed to five times the new TLV (5 ppm) responded with reasonable accuracy. There was generally little effect of interferent gases and vapors on the H2S monitors. None of the SO2 monitors responded at 0.1 and 1 times the new TLV (0.025 ppm and 0.25 ppm) concentrations, and all but one of them exposed to five times the new TLV (1.25 ppm) responded. There was much greater cross-sensitivity to interferents at the tested concentrations with the SO2 monitors, which responded to six out of eight of the interferents tested. Results demonstrate that these monitors cannot reliably alarm and measure H2S or SO2 concentrations at the new TLVs with an acceptable degree of accuracy. However, these monitors are designed to alarm as a safety device; these results do not change this important function. [ABSTRACT FROM AUTHOR]

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Study Objective. To compare the frequency of outpatient drug prescribing in the United States and United Kingdom according to individual drugs and therapeutic categories during 2004-2006. Design. Retrospective prescription record review. Data Sources. United Kingdom General Practice Research Database, and the MarketScan Commercial Claims and Encounters Database for U.S. data. Subjects. In the U.K. database, we identified 1.6 million people younger than 65 years who were prescribed at least one prescription drug in at least one of the calendar years during the study period (2004-2006). For comparison, for each U.K. person identified, we randomly identified one person of the same sex and year of birth in the U.S. database who was also prescribed at least one drug in the same calendar year. Measurements and Main Results. We compared the frequency of prescribing of individual drugs, as well as selected therapeutic categories. Substantially higher proportions of people in the United States were prescribed antibiotics, statins, and postmenopausal hormones, but asthma drugs were prescribed more frequently in the United Kingdom. In those younger than 20 years, antidepressants and antipsychotics were prescribed more than twice as frequently in the United States, and males in the United States were far more likely to be prescribed drugs for attention-deficit-hyperactivity disorder than were their counterparts in the United Kingdom. Conclusion. This study provides documented quantification of differing patterns of drug use in the United States and United Kingdom during 2004-2006. The higher proportionate prescribing for most indications in the United States and the greater use of drugs under patent suggest that monetary costs are likely to be considerably higher in the United States than in the United Kingdom. [ABSTRACT FROM AUTHOR]

As the prevalence of chronic conditions continues to rise in the United States, healthcare decision makers are evaluating strategies to provide quality, cost-effective care. Although relatively new in the United States, comparative effectiveness research (CER) has moved to the forefront of U.S. healthcare reform, with a $1.1 billion government investment in CER. Asthma is a challenging disease to manage because of its variable and recurring symptoms, including airflow obstruction, bronchial hyperresponsiveness, and inflammation. The National Asthma Education and Prevention Program (NAEPP) guide- i lines recommend a step-wise approach to treating asthma, including the important role of inhaled corticosteroid (ICS) therapy for all persistent asthma no matter how mild. This drug class is often overlooked and/or underused in favor of other monotherapies or combination therapies. Although the mechanisms of ICS therapies are similar, differences in formulation, particle size, and delivery system can affect the amount of drug deposited in the lungs. The National Institute for Health and Clinical Excellence (NICE), a well-known organization that embraces the principles of CER, found that among ICS therapies, beclomethasone dipropionate hydrofluoroalkane (BDP HFA) is a clinically effective and cost-efficient option among patients with persistent asthma. [ABSTRACT FROM AUTHOR]

Study Objective. To estimate the effectiveness of influenza vaccination in people in the United Kingdom at low risk for influenza during an 11-year period from July 1996-June 2007. Design. Case-control study. Data Source. United Kingdom General Practice Research Database. Subjects. A total of 4985 patients (aged < 80 yrs) who were considered to be at low risk for influenza, but were diagnosed with influenza or influenza-like illness from July 1996-June 2007, were identified as cases. A total of 19,940 controls who were also low-risk individuals, who had no diagnosis of influenza, were matched to the cases by year of birth, sex, specific general practice, and date on which case patient was diagnosed with influenza (index date). Measurements and Main Results. We identified previous vaccination status from the subjects' electronic medical records and evaluated the effect of timing of influenza vaccination and the number of previous annual vaccinations received. We estimated the relative risk of influenza in those who received the influenza vaccination compared with those who did not, conditional on the matching variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Age, sex, general practice, index date, and preexisting medical conditions were closely controlled for in the analysis. Vaccination conferred an important protective effect (OR 0.74, 95% CI 0.60-0.91) when given within 4 months before seasonal influenza outbreaks. This effect was similar for each calendar year and across all ages. Conclusion. Seasonal influenza vaccination provided substantial protection against clinically diagnosed influenza when given within 4 months of annual seasonal outbreaks in people at low risk. A review of the incidence of influenza over the 11-year period provides compelling indirect evidence that influenza vaccines were similarly effective in those who were at high risk. These results provide a useful background to current and future influenza outbreaks whose course is uncertain. [ABSTRACT FROM AUTHOR]

The article discusses a study made by the Youth Justice Board in Great Britain to assess racially motivated offending among youngsters, as well as the response of the Youth Justice System to the issue. Particular focus is given to the change of policies and laws regarding racial crimes due to the increase in occurrences of this type of juvenile offenses at the beginning of the 21st century.

Abstract: We identified all children in the UK General Practice Research Database diagnosed with measles from 1990 to 2008 and calculated annual incidence according to age and geographic region by dividing the number of cases per year by the number of children who were active in the population. We evaluated the effectiveness of the measles vaccines by comparing the vaccination histories of children who were diagnosed with measles (cases) to children who were not (controls). The annual incidence of measles fell after the introduction of the MMR vaccine in late 1988. However, a modest outbreak of measles occurred in 1994, leading to large nationwide programs to immunize children. Since 1996, the incidence of measles has fallen by more than 80%. Prior measles vaccination is highly effective and has substantially reduced the risk of measles. [Copyright &y& Elsevier]

Objectives: We estimated the effects of poor mental health among older family members on the labour supply and incomes of younger family members living in the same household. Due to policy differences, effects for Scotland were compared with other parts of the UK. Methods: Effects were estimated using the British Household Panel Survey (waves 1999-2006), with data from 621 older respondents and 800 younger family members. Mental health was assessed using the General Health Questionnaire (GHQ), together with self-reported presence of depression, anxiety, or other mental health problems. Results: The associations between labour supply and mental ill-health were found to vary by gender and region of the UK. For men, there were larger negative effects in Scotland relative to the rest of the UK. For women, mental ill-health was associated with increased labour supply in Scotland, while in the remainder of the UK, a negative association was observed. Income losses accrued across all groups except among Scottish females, with the largest significant negative effects observed among men living in the remainder of the UK. Conclusions: Mental health problems among older family members are associated with significant labour market effects for younger family members. To reduce the economic consequences, better assessment of mental health among older people may be warranted. Further employment support for younger family members, in the form of more flexible work policies, might also serve to ameliorate economic losses. [ABSTRACT FROM AUTHOR]