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Meeting global targets that maintain temperatures at 1.5 °C above pre-industrial levels while adapting to the growing impacts of climate change requires significant and rapid societal change. Within this context, there has been growing interest in building community resilience to shocks and stressors and as a forward-looking process. Yet while there has been extensive attention to conceptual aspects, there has been much less on how this can be achieved in practice. This research worked with three communities in Scotland (UK) regularly exposed to flooding and other integrated challenges to learn from action about community resilience building. A carefully developed four-tiered transdisciplinary approach was applied that included: relationship-building; enhancing capacities to work with interconnections; enabling processes; and supportive action-oriented research. The findings of the analysis of the system dynamics that were occurring during the resilience-building process highlight that it is a complex and messy social process. Yet, it also shows that if quality and sufficient quantity of support and time to help surface and deliberate on underlying assumptions about communities and change is provided, it can be possible to stimulate emergence of beneficial reinforcing social dynamics that begin to support collaborative and systemic action. To further advance know how about resilience building, much greater focus will be needed on the 'how' of resilience. This, in turn, will require new framings of, and approaches for, community resilience and new framings of research, knowledge and knowing. [ABSTRACT FROM AUTHOR]

Treatment refusal was found to be associated with fear of "medical" people, intolerance for pain or discomfort, and difficulty in approaching novelty or adapting to change. In contrast to parents of controls, parents of treatment refusing children rated them as having greater difficulty in playing with unfamiliar children and negative in mood. (Author/RH)

Anaemia is associated with a reduction in quality of life, and is common in patients with colorectal cancer . We recently reported the findings of the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial comparing haemoglobin levels and transfusion requirements following intravenous or oral iron replacement in anaemic colorectal cancer patients undergoing elective surgery. In this follow-up study, we compared the efficacy of intravenous and oral iron at improving quality of life in this patient group. We conducted a multicentre, open-label randomised controlled trial. Anaemic colorectal cancer patients were randomly allocated at least two weeks pre-operatively, to receive either oral (ferrous sulphate) or intravenous (ferric carboxymaltose) iron. We assessed haemoglobin and quality of life scores at recruitment, immediately before surgery and at outpatient review approximately three months postoperatively, using the Short Form 36, EuroQoL 5-dimension 5-level and Functional Assessment of Cancer Therapy - Anaemia questionnaires. We recruited 116 anaemic patients across seven UK centres (oral iron n = 61 (53%), and intravenous iron n = 55 (47%)). Eleven quality of life components increased by a clinically significant margin in the intravenous iron group between recruitment and surgery compared with one component for oral iron. Median (IQR [range]) visual analogue scores were significantly higher with intravenous iron at a three month outpatient review (oral iron 70, (60-85 [20-95]); intravenous iron 90 (80-90 [50-100]), p = 0.001). The Functional Assessment of Cancer Therapy - Anaemia score comprises of subscales related to cancer, fatigue and non-fatigue items relevant to anaemia. Median outpatient scores were higher, and hence favourable, for intravenous iron on the Functional Assessment of Cancer Therapy - Anaemia subscale (oral iron 66 (55-72 [23-80]); intravenous iron 71 (66-77 [46-80]); p = 0.002), Functional Assessment of Cancer Therapy - Anaemia trial outcome index (oral iron 108 (90-123 [35-135]); intravenous iron 121 (113-124 [81-135]); p = 0.003) and Functional Assessment of Cancer Therapy - Anaemia total score (oral iron 151 (132-170 [69-183]); intravenous iron 168 (160-174 [125-186]); p = 0.005). These findings indicate that intravenous iron is more efficacious at improving quality of life scores than oral iron in anaemic colorectal cancer patients. [ABSTRACT FROM AUTHOR]

Background: Radiologically defined sarcopenia has been shown to predict negative outcomes after cancer surgery, however radiological assessment of sarcopenia often requires additional software and standardisation against anthropomorphic data. Measuring psoas density using hospital Picture Archiving and Communication Systems (PACS), universally available in the UK, may have advantages over methods requiring the use of additional specialist and often costly software. The aim of this study was to assess the association between radiologically defined sarcopenia measured by psoas density and postoperative outcome in patients having a colorectal cancer resection. Methods: All patients having a resection for colorectal cancer, discussed by the colorectal multi-disciplinary team in one institution between 1/1/15 and 31/12/15, were retrospectively identified. Mean psoas density at the level of the L3 vertebra was analysed from preoperative computed tomography (CT) scans to define sarcopenia using the Picture Archiving and Communication Systems (PACS). Postoperative complications and mortality were recorded. Results: One hundred and sixty-nine patients had a colorectal resection for cancer and 140 of these had a primary anastomosis. Ninety-day mortality and 1-year mortality were 1.1% and 7.1%, respectively. Eighteen (10.7%) patients suffered a Clavien–Dindo grade 3 or 4 complication of which 6 (33%) were anastomotic leaks. In the whole cohort, sarcopenia was associated with an increased risk of Clavien–Dindo grade 3 or 4 complications [adjusted OR 6.33 (1.65–24.23) p = 0.007]. In those who had an anastomosis, sarcopenia was associated with an increased risk of anastomotic leak [adjusted OR 14.37 (1.37–150.04) p = 0.026]. Conclusions: A quick and easy radiological assessment of sarcopenia by measuring psoas density on preoperative CT scan using software universally available in the UK is highly predictive of postoperative morbidity in colorectal cancer patients. [ABSTRACT FROM AUTHOR]

Aim Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. Design The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. Methods Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. Results Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. Conclusion This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care. [ABSTRACT FROM AUTHOR]

Background Little has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays. Methods Record linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders. Results The study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. Discussion There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause. [ABSTRACT FROM AUTHOR]

Aim To investigate the impact of glycaemic control on infection incidence in people with Type 2 diabetes. Methods We compared infection rates during 2014 in people with Type 2 diabetes and people without diabetes in a large primary care cohort in the UK (the Royal College of General Practitioners Research and Surveillance Centre database). We performed multilevel logistic regression to investigate the impact of Type 2 diabetes on presentation with infection, and the effect of glycaemic control on presentation with upper respiratory tract infections, bronchitis, influenza-like illness, pneumonia, intestinal infectious diseases, herpes simplex, skin and soft tissue infections, urinary tract infections, and genital and perineal infections. People with Type 2 diabetes were stratified by good [HbA1c < 53 mmol/mol (< 7%)], moderate [HbA1c 53-69 mmol/mol (7-8.5%)] and poor [HbA1c > 69 mmol/mol (> 8.5%)] glycaemic control using their most recent HbA1c concentration. Infection incidence was adjusted for important sociodemographic factors and patient comorbidities. Results We identified 34 278 people with Type 2 diabetes and 613 052 people without diabetes for comparison. The incidence of infections was higher in people with Type 2 diabetes for all infections except herpes simplex. Worsening glycaemic control was associated with increased incidence of bronchitis, pneumonia, skin and soft tissue infections, urinary tract infections, and genital and perineal infections, but not with upper respiratory tract infections, influenza-like illness, intestinal infectious diseases or herpes simplex. Conclusions Almost all infections analysed were more common in people with Type 2 diabetes. Infections that are most commonly of bacterial, fungal or yeast origin were more frequent in people with worse glycaemic control. [ABSTRACT FROM AUTHOR]

The article focuses on the service provision available for the effective management of gastrointestinal (GI) and hepatic disorders in Great Britain, and discusses their economic and personal burden. As stated, there is a lack of evidence related to service delivery for GI disorders due to lack of high technology assessment and evaluation. The burden of this ailment on the patient's quality of life is mentioned, and the role of National Health Service in its management is discussed.

Previous research suggesting that over-general memory (OGM) may moderate the effect of life events on depressive symptoms and suicidality has sampled older adolescents or adults, or younger adolescents in high-risk populations, and has been conducted over relatively short follow-up periods. The authors examined the relationship between OGM at age 13 and life events and mental health outcomes (depression, self-harm, suicidal ideation and planning) at age 16 years within a sample of 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), approximately 3800 of whom had also provided data on depression and self-harm. There was no clear evidence of either direct or interactive effects of OGM at age 13 on levels of depression at age 16. Similarly there was no clear evidence of either direct or interactive effects of OGM on suicidal ideation and self-harm. Although there was some evidence that over-general autobiographical memory was associated with reduced risk of suicidal planning and increased risk of self-harm, these associations were absent when confounding variables were taken into account. The findings imply that although OGM is a marker of vulnerability to depression and related psychopathology in high-risk groups, this cannot be assumed to generalise to whole populations. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Design Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Results Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. Conclusions There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families. [ABSTRACT FROM AUTHOR]

Nitrous oxide emissions ( N2O) from agricultural land are spatially and temporally variable. Most emission measurements are made with small (≪ 1 m2 area) static chambers. We used N2O chamber data collected from multiple field experiments across different geo-climatic zones in the UK and from a range of nitrogen treatments to quantify uncertainties associated with flux measurements. Data were analysed to assess the spatial variability of fluxes, the degree of linearity of headspace N2O accumulation and the robustness of using ambient air N2O concentrations as a surrogate for sampling immediately after closure ( T0). Data showed differences of up to more than 50-fold between the maximum and minimum N2O flux from five chambers within one plot on a single sampling occasion, and that reliability of flux measurements increased with greater numbers of chambers. In more than 90% of the 1970 cases where linearity of headspace N2O accumulation was measured (with four or more sampling points), linear accumulation was observed; however, where non-linear accumulation was seen this could result in a 26% under-estimate of the flux. Statistical analysis demonstrated that the use of ambient air as a surrogate for T0 headspace samples did not result in any consistent bias in calculated fluxes. Spatial variability has the potential to result in erroneous flux estimates if not taken into account, and generally introduces a far larger uncertainty into the calculated flux (commonly orders of magnitude more) than any uncertainties introduced through reduced headspace sampling or assumption of linearity of headspace accumulation. Hence, when deploying finite resources, maximizing chamber numbers should be given priority over maximizing the number of headspace samplings per enclosure period. [ABSTRACT FROM AUTHOR]

Background. The assessment of intervention integrity is essential in psychotherapeutic intervention outcome research and psychotherapist training. There has been little attention given to it in mindfulness-based interventions research, training programs, and practice. Aims. To address this, the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) was developed. This article describes the MBI:TAC and its development and presents initial data on reliability and validity. Method. Sixteen assessors from three centers evaluated teaching integrity of 43 teachers using the MBI:TAC. Results. Internal consistency (α = .94) and interrater reliability (overall intraclass correlation coefficient = .81; range = .60-.81) were high. Face and content validity were established through the MBI:TAC development process. Data on construct validity were acceptable. Conclusions. Initial data indicate that the MBI:TAC is a reliable and valid tool. It can be used in Mindfulness-Based Stress Reduction/Mindfulness-Based Cognitive Therapy outcome evaluation research, training and pragmatic practice settings, and in research to assess the impact of teaching integrity on participant outcome. [ABSTRACT FROM PUBLISHER]

Objectives To identify how services provided by child development teams ( CDTs) have changed over 20 years. To what extent have major government initiatives aiming to improve the lives of children with disability and their families been implemented by teams? Design Survey sent to every UK CDT in 2009/2010; comparison with data gathered in 1988 and 1999. Results Ninety-four per cent (225/240) of CDTs responded; data on 242 teams were available from 1999 and 125 teams from 1988. Despite policy recommendations advocating the value of interdisciplinary team working, there was a decline in numbers of professionals working within the CDT multidisciplinary team. One-third of all teams reported a reduction in their funding over the last 5 years. However, specialist clinics provided increased. Teams reported patchy adoption of national initiatives designed to improve provision. Transition services were underdeveloped. Conclusions This comprehensive survey of UK CDT service provision, as well as national studies of the healthcare experience of families with a disabled child, shows that improvements in provision are required. [ABSTRACT FROM AUTHOR]

Background Pre-school language impairment is common and greatly reduces educational performance. Population attempts to identify children who would benefit from appropriately timed intervention might be improved by greater knowledge about the typical profiles of language development. Specifically, this could be used to help with the early identification of children who will be impaired on school entry. Methods This study applied longitudinal latent class analysis to assessments at 8, 12, 24, 36 and 48 months on 1113 children from a population-based study, in order to identify classes exhibiting distinct communicative developmental profiles. Results Five substantive classes were identified: Typical, i.e. development in the typical range at each age; Precocious ( late), i.e. typical development in infancy followed by high probabilities of precocity from 24 months onwards; Impaired ( early), i.e. high probabilities of impairment up to 12 months followed by typical language development thereafter; Impaired ( late), i.e. typical development in infancy but impairment from 24 months onwards; Precocious ( early), i.e. high probabilities of precocity in early life followed by typical language by 48 months. The entropy statistic (0.84) suggested classes were fairly well defined, although there was a non-trivial degree of uncertainty in classification of children. That half of the Impaired ( late) class was expected to have typical language at 4 years and 6% of the numerically large Typical class was expected to be impaired at 4 years illustrates this. Characteristics indicative of social advantage were more commonly found in the classes with improving profiles. Conclusions Developmental profiles show that some pre-schoolers' language is characterized by periods of accelerated development, slow development and catch-up growth. Given the uncertainty in classifying children into these profiles, use of this knowledge for identifying children who will be impaired on school entry is not straightforward. The findings do, however, indicate greater need for language enrichment programmes among disadvantaged children. [ABSTRACT FROM AUTHOR]

The clinical signs, treatments used and spread of psoroptic mange in cattle from October 2007 until March 2011 are described. The disease was first diagnosed in South West Wales, having not been reported in Great Britain since the 1980s. The likely source was identified as a farm that had imported two animals from mainland Europe in the summer of 2006. Since that time, disease has been diagnosed on a further 22 premises, the majority in South West Wales but also in South East and Mid Wales and on one farm in England. Bought in animals harbouring the Psoroptes species mite but not showing clinical signs were considered the greatest risk of introducing the infestation into a herd. This, together with the difficulties of treatment to eliminate the parasite, means that it is unlikely that this outbreak has been controlled. There is also a continuing threat of importing the disease from abroad. The disease is not notifiable in the UK. [ABSTRACT FROM AUTHOR]

Although the Autobiographical Memory Test (AMT) is widely used its psychometric properties have rarely been investigated. This paper utilises data gathered from a 10-item written version of the AMT, completed by 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children, to examine the psychometric properties of the measure. The results show that the scale derived from responses to the AMT operates well over a wide range of scores, consistent with the aim of deriving a continuous measure of over-general memory. There was strong evidence of group differences in terms of gender, low negative mood, and IQ, and these were in agreement when comparing an item response theory (IRT) approach with that based on a sum score. One advantage of the IRT model is the ability to assess and consequently allow for differential item functioning. This additional analysis showed evidence of response bias for both gender and mood, resulting in attenuation in the mean differences in AMT across these groups. Implications of the findings for the use of the AMT measure in different samples are discussed. [ABSTRACT FROM AUTHOR]

Background Drooling is common in children with disordered oral-motor control. There is little evidence about the comparative effectiveness of different interventions used to reduce the impact of drooling. Anecdotal reports suggest clinicians' management of drooling varies widely. The aims of this survey were to establish which drooling interventions are currently used, how their effectiveness is monitored and how frequently adverse effects are reported. Methods 151 UK paediatricians completed a questionnaire about their management of drooling. Results Paediatricians saw one new child with problematic drooling and three follow-up children per month. The most common prescribing pattern was hyoscine first line (84.7%) followed by glycopyrronium bromide second line. The reported rate of adverse effects of medications was lower than expected (median 10% for hyoscine). Very few paediatricians used standardized methods of measuring the medication's effectiveness or adverse effects. Conclusion Paediatricians regularly see small numbers of children with problematic drooling. Their clinical management of drooling varies; this is most likely because of a lack of evidence about the most effective approach. Comparative trials of interventions and the development of evidence-based clinical guidelines would improve the management of children's drooling. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this research is to obtain a gridded hydrological runoff dataset for Great Britain (GB) that can be compared with other gridded climate data such as temperature, precipitation and satellite-derived vegetation parameters. The source data are an extended version of a network of relatively undisturbed river catchments identified by Bradford and Marsh. Gridded datasets with a 10km2 resolution were created using both ordinary and universal kriging methods; the latter with topography as a predictor variable. Cross-validation was used to evaluate the quality of the two prediction methods. The universal kriging method resulted in a better gridded GB wide runoff dataset, which also accounted for variation in catchment elevation, over the period of 1959-2008. Several comparisons of outputs by the two kriging methods are provided. This paper builds on a previous study by Hannaford and Marsh, who assessed trends in GB runoff using the same original network of undisturbed river catchment, by allowing additional spatial and temporal comparisons with climatic data to be examined that was not possible with their original work. [Copyright &y& Elsevier]

The article discusses how the government of Great Britain has balanced its global interests with those in south-east Asia during the 1950s. It claims that although the needs of the Malayan emergency were prioritized by the British government over the requirements of the Korean war, it has reluctantly provided ground troops to Korea. The article also examines how Great Britain worked for the defence of Hong Kong.

Previously published work has described the development of a hospital capacity simulation tool, PROMPT. PROMPT has now been adopted by a number of hospitals in the UK and is used for both strategic and operational planning and management of key hospital resources. The work, as presented here, extends the PROMPT functionality to consider in more detail workforce issues. In particular, working with some of the current hospital users, the research has focussed on detailed planning for calculating the size and skill-mix of inpatient nursing teams. The chosen methodology utilizes both simulation and optimization. Outputs from the PROMPT three-phase discrete event simulation are fed into a stochastic programme which suggests the optimal number of nurses to employ (whole time equivalents) by skill-mix and the corresponding numbers by shift. A novel feature of the tool is the ability to predict and compare nursing needs based on different methods of capturing patient-to-nurse ratios as currently adopted across the UK National Health Service. Illustrative results from one hospital demonstrate that although the overall sizes of nursing teams on different wards are of an acceptable level and comparable to the outputs from the simulation phase of the work, often the number of nurses employed at different grades is not well matched to patient needs and the skill-mix should be reconsidered. Results from the optimization phase of the work suggest that it is cost beneficial to increase the number of permanently employed nurses to account for fluctuations in demand and corresponding high costs of temporary (agency) nurses. The scenario functionality of the tool permits for the study of changing size and skill-mix as a consequence of changes in patient volumes, patient case-mix, numbers of beds and length of stay. [ABSTRACT FROM AUTHOR]

Background Sitting in new chairs or sofas has elicited dermatitis in numerous patients in Finland and in the U.K. since autumn 2006. The cause of the dermatitis seemed to be an allergen in the furniture materials. Objectives To determine the cause of the dermatitis in patients with furniture-related dermatitis. Methods Altogether 42 patients with furniture-related dermatitis were studied. First, 14 Finnish patients were patch tested with the standardized series and with the chair textile material. A thin-layer chromatogram (TLC) strip and an extract made from the same textile material were tested in seven Finnish patients. The test positive spot of the TLC and the content of a sachet found inside a sofa in the U.K. were analysed by using gas chromatography–mass spectrometry. All chemicals analysed were patch tested in 37 patients. Results A positive patch test reaction to the chair textile and to its extract was seen in all patients tested, one-third of whom had concurrent reactions to acrylates. Positive reactions to the same spot of the TLC strip were seen in five of seven patients and dimethyl fumarate was analysed from the spot as well as from the sachet contents. Dimethyl fumarate (0·01%) elicited positive reactions in all the patients. The other chemicals analysed did not elicit positive reactions, but one patient in the U.K. had a positive reaction to tributyl phosphate. Conclusions Sensitization to dimethyl fumarate was seen in all the patients with furniture-related dermatitis. Concurrent sensitization or cross-reactions were common among the sensitized patients. [ABSTRACT FROM AUTHOR]

Advances in recent treatments for HIV/AIDS patients have shown dramatic outcomes in extending the incubation period and AIDS survival time, while also providing significant improvements in the quality of patients' lives. A compartmental model is proposed to analyse the effects of the various treatment regimens which have been introduced. The results produced are in good agreement with routinely collected data relating to levels of HIV/AIDS incidence and prevalence in the UK homosexual population. Some parameter values within the model are obtained from surveys, census results, etc, but others are derived using a maximum likelihood estimation procedure. Finally, the model is used to project levels of incidence and prevalence over the next few years, and to investigate several possible scenarios. [ABSTRACT FROM AUTHOR]

Background: Malaria is currently diagnosed almost exclusively by microscopy in clinical laboratories. The introduction of rapid diagnostic tests (RDTs) may be useful in achieving rapid detection of malaria parasites, especially in situations where malaria is not often seen or where staff are inexperienced. Aim: To explore the use of RDT in UK laboratories. Methods: The current use of RDTs was surveyed in UK laboratories subscribing to the United Kingdom National External Quality Assessment Scheme blood parasitology and haematology schemes. Results: An overall survey response rate of 60.3% was seen. RDTs were found to be the preferred choice, either alone or in conjunction with microscopy in 31.2% of the samples examined during normal working hours and in 44.3% of the specimens examined on call. Conclusions: During on-call hours, the use of RDTs was observed to increase and RDTs changed the diagnosis in 12% of laboratories. No established protocol for RDT use was, however, observed in the UK. A protocol that needs to be validated in the laboratory setting is suggested. [ABSTRACT FROM AUTHOR]

Objectives. To compare the management of heart failure with the standards set out in the National Service Framework for Coronary Heart Disease. Study design. A cross-sectional study in 26 general practices, with a combined List size of 256,188, that are members of the Kent, Surrey and Sussex Primary Care Research Network. Methods. Information was extracted on the management of 2129 patients with heart failure, of whom 2097 were aged 45 years and over. Results. The prevalence of heart failure was 8.3 per 1000. Prevalence rates increased with age, from 0.2 per 1000 in people aged under 35 years of age to 125 per 1000 in those aged 85 years and over. Coronary heart disease (present in 47%) was the most common comorbid condition in men with heart failure, whereas hypertension (present in 46%) was the most common condition in women. Recording of cardiovascular risk factors was generally higher in younger patients than in odder patients, and in men than in women. Blood pressure (92% of men and 90% of women) and smoking status (84% of men and 77% of women) were generally the best-recorded cardiovascular risk factors. Blood electrolytes were recorded in about 83% of men and 75% of women. Only 17% of men and 11 % of women with heart failure had a record of undergoing an echocardiogram. Use of angiotensin-converting enzyme (ACE) inhibitors or antagonists was 76% in men with heart failure and 68% in women; Lowest rates were seen in older patients. Uptake of influenza immunization was generally high, at 85% in men and 84% in women. Conclusions. The use of ACE inhibitors in patients with heart failure was higher than in some previous studies. However, many patients have no documentation in their computerized medical records of having undergone key investigations, such as echocardiography. [ABSTRACT FROM AUTHOR]

The current UK government emphasizes the importance of mechanisms of accountability that involve the planning and public reporting of performance. One example of this is the Best Value performance plan. However, there has been little evaluation of the quality of the information provided in this type of document. This paper draws on literature on stakeholding and user needs to identify the data required for accountability. It then assesses whether the plans produced by Best Value pilot authorities in Wales provide appropriate information. The analysis shows that very few of the plans contained the relevant material. Interviews in the pilot authorities highlighted two key reasons for the poor level of data: a lack of performance indicators prior to Best Value and limited staff expertise in performance measurement. The evidence suggests that documents such as performance plans currently make little contribution to the accountability of public organizations. [ABSTRACT FROM AUTHOR]

Background: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. Methods: Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. Results: Median operating time was 225 (range 170–340) min and median hospital stay was 15 (range 8–48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22·5 (range 4–114) months. Median 24-h frequency before and after operation was 12 (range 4–20) and 6 (range 3–12) respectively, and median night-time frequency was 4 (range 0–8) and 0·5 (range 0–4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. Conclusion: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch–rectal anastomosis should be avoided. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between size and growth for a sample of banks from France, Germany, Italy and the UK over the period 1990 to 1996. Using several measures of bank size (total assets, equity and value of off balance sheet business), we test for size effects on growth, using models which incorporate the influences of previous growth, bank type and country of origin. The results of the analysis suggest that for Italy, small banks tend to grow faster than larger banks. No relationship is found between bank size and growth for France, Germany and the UK. This suggests a process of increasing concentration in these banking systems, even in the absence of bank specific strategic advantages. Small banks tend to have more variable growth rates than their larger counterparts. This suggests that large banks may enjoy advantages associated with diversified operations, which make them less susceptible to periods of extremely high or low growth. [ABSTRACT FROM AUTHOR]

This article, based on a 3 year study in East Anglian schools, draws on a range of evidence pointing to different attitudes of girls and boys to General Certificate of Secondary Education (GCSE) work. Suggestions are made to account for these differences, with particular emphasis being placed on peer pressure, image and social groupings. Although these are relevant to both sexes, it was found to be more acceptable for girls to work hard and still be part of the ‘in crowd’, whilst boys were under greater pressure to conform to a ‘cool’, masculine image, and were more likely to be ridiculed for working hard. The article concludes by suggesting that one approach to closing the current gender gap may be to enable boys in school to move beyond the stereotypical image of the macho male. [ABSTRACT FROM AUTHOR]

Background: In 1997 a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP), was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight specialty groups and were designed to act as flags to possible problems in surgical care. Methods: The development process took several years and included a literature review, field testing, and revision of the indicators prior to approval by the College council. In their first year 155 health-care organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. Results: The collected data for 1997 and 1998 for some of the indicators revealed rates which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7 and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5 and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5 and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9 and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6 and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7 and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level they are of limited value for broader comparison. Conclusion: The process of review established for the... [ABSTRACT FROM AUTHOR]

Presents several letters on medicine in Great Britain. Smoking withdrawal of patients with smoking related diseases; Difficulty of treating oesophageal carcinoma by resection; Necessity for seclusion in the caring professions. INSET: Points.

Presents updates on medicine in Great Britain as of July 1975. Details on medical examination of infants for adoption; Information on the treatment of asthmatic children with steroids; Discussion on the prophylaxis of post-operative deep vein thrombosis.

The article offers information on Chenopodium rubrum L., a biological flora of the British Isles. It offers a physical description of the plant and lists some of the varieties that can be found in Great Britain, including pseudo-botryoide and spathulatum. Information is also provided on the plant's geographical and altitudinal distribution, habitat, communities, response to biotic factors, gregariousness, morphology, phenology, flowering biology and history. Data on the mineral composition of C. rubrum compared with that of two other species of Chenopodium is provided.

This article focuses on the coal miners' lockout in Great Britain in 1893. Traditionally, the lockout in 1893 has been regarded as a great victory for the miners. This was the official view of the Miners' Federation of Great Britain at the time. The formation of the Miners' Federation of Great Britain in 1889 marked the opening of a new phase of militancy among the British coal miners. After the collapse of the Miners' Association of Great Britain and Ireland, in the depression years of the 1840s, the policy of the miners' unions became increasingly dominated by the Miners' National Union, formed in 1863. The Miners' National Union placed considerable emphasis on securing an adequate standard of living by means of legislative regulation of conditions of work. It also favoured conciliation as a means of determining wages. It was dissatisfaction with the results of these policies, in a period of falling prices, which led to the growth of militancy among the British coal miners, particularly those of the central coalfields. There is certainly evidence to support the view that the origins of industrial conciliation and arbitration in. the coal industry lay in a desire to contain the trade unions rather than to fight with them.

This article describes the British standard of living during the industrial revolution. The movement of real wages can be determined within acceptable limits of error only in the case of certain restricted occupational groups: for the working class as a whole the margin of error is such as to preclude any dependable calculation. There are similar objections to the attempts which have been made to measure the consumption of food. The forces which determined the general level of real wages during the Napoleonic Wars were the familiar ones of any war-time economy. It is a commonplace that wages are slow in following prices. When prices rise real wages tend to fall and there is a transfer of real income to rentiers and entrepreneurs. When prices fall there is a redistribution of real income in favour of those workers who remain in employment. Two factors were favourable to investment and therefore to income generation and employment. The first was the vast government war-time expenditure which gave a stimulus to economic expansion and technological change, hastening the process of industrialization. The second was the large growth in population.

Jo Williams shows how patients with hypertension can self-monitor. [ABSTRACT FROM AUTHOR]

Focuses on the management of piles in Great Britain. Production of symptoms associated with the disease; Efficacy of the general measures to prevent prolonged straining and constipation; Value of local applications.

The article focuses on the practice of autologous blood transfusion (ABT) in Great Britain. It is claimed that ABT has the ability to eliminate all the hazards of homologous blood. The convenience and availability of blood and blood components from the National Blood Transfusion Service is said to impede the development of ABT program in the region. The three methods of collecting blood for analogous transfusion are cited.

Adolescence is a key developmental window that may determine long-term mental health. As schools may influence mental health of students, this study aimed to examine the association of school-level characteristics with students' mental health over time. Longitudinal data from a cluster randomized controlled trial comprising 8,376 students (55% female; aged 11-14 years at baseline) across 84 schools in the United Kingdom were analyzed. Data collection started in the academic years 2016/2017 (cohort 1) and 2017/2018 (cohort 2), with follow-up at 1, 1.5, and 2 years. Students' mental health (risk for depression [Center for Epidemiologic Studies Depression Scale], social-emotional-behavioral difficulties [Strength and Difficulties Questionnaire]) and well-being (Warwick-Edinburgh Mental Well-Being Scale) and relationships with student- and school-level characteristics were explored using multilevel regression models. Mental health difficulties and poorer well-being increased over time, particularly in girls. Differences among schools represented a small but statistically significant proportion of variation (95% CI) in students' mental health at each time point: depression, 1.7% (0.9%-2.5%) to 2.5% (1.6%-3.4%); social-emotional-behavioral difficulties, 1.9% (1.1%-2.7%) to 2.8% (2.1%-3.5%); and well-being, 1.8% (0.9%-2.7%) to 2.2% (1.4%-3.0%). Better student-rated school climate analyzed as a time-varying factor at the student and school level was associated with lower risk of depression (regression coefficient [95%CI] student level: −4.25 [−4.48, −4.01]; school level: −4.28 [−5.81, −2.75]), fewer social-emotional-behavioral difficulties (student level: −2.46 [−2.57, −2.35]; school level: −2.36 [−3.08, −1.63]), and higher well-being (student level: 3.88 [3.70, 4.05]; school-level: 4.28 [3.17, 5.38]), which was a stable relationship. Student-rated school climate predicted mental health in early adolescence. Policy and system interventions that focus on school climate may promote students' mental health. [ABSTRACT FROM AUTHOR]

The article discusses the implications of gastrointestinal disease in the provision of care in Great Britain. The author reflects that gastrointestinal and liver diseases are common but have been given little attention from a policy perspective. He mentions that the National Health Service Cancer Plan will be disadvantageous to some patients but will improve services for others. He opines that development of future services is dependent upon good research and challenges to gastroenterologists.

Presents a letter to the editor of the "British Journal of Haematology," about an article on immunoplatelet counting for platelet transfusions in Great Britain.

We explored what predicts secondary school students' mindfulness practice and responsiveness to universal school-based mindfulness training (SBMT), and how students experience SBMT. A mixed-methods design was used. Participants were 4,232 students (11-13 years of age), in 43 UK secondary schools, who received universal SBMT (ie, ".b" program), within the MYRIAD trial (ISRCTN86619085). Following previous research, student, teacher, school, and implementation factors were evaluated as potential predictors of students' out-of-school mindfulness practice and responsiveness (ie, interest in and attitudes toward SBMT), using mixed-effects linear regression. We explored pupils' SBMT experiences using thematic content analysis of their answers to 2 free-response questions, 1 question focused on positive experiences and 1 question on difficulties/challenges. Students reported practicing out-of-school mindfulness exercises on average once during the intervention (mean [SD] = 1.16 [1.07]; range, 0-5). Students' average ratings of responsiveness were intermediate (mean [SD] = 4.72 [2.88]; range, 0-10). Girls reported more responsiveness. High risk of mental health problems was associated with lower responsiveness. Asian ethnicity and higher school-level economic deprivation were related to greater responsiveness. More SBMT sessions and better quality of delivery were associated with both greater mindfulness practice and responsiveness. In terms of students' experiences of SBMT, the most frequent themes (60% of the minimally elaborated responses) were an increased awareness of bodily feelings/sensations and increased ability to regulate emotions. Most students did not engage with mindfulness practice. Although responsiveness to the SMBT was intermediate on average, there was substantial variation, with some youth rating it negatively and others rating it positively. Future SBMT developers should consider co-designing curricula with students, carefully assessing the student characteristics, aspects of the school environment, and implementation factors associated with mindfulness practice and responsiveness. SBMT teacher training is key, as more observed proficiency in SBMT teaching is associated with greater student mindfulness practice and responsiveness to SBMT. [ABSTRACT FROM AUTHOR]

The specification of shielding for fluoroscopic facilities in the UK is based on the determination of scatter incident on a barrier using a simple formula linking kerma area product and scatter kerma. Over the last few years there has been a move to incorporate additional copper filtration in equipment used for high dose fluoroscopic and interventional examinations, and the existing formula does not take this into account. The spectral and transmission characteristics of the scattered radiation resulting from a primary x-ray beam filtered with additional copper are not known. In this study, the relationship between primary and scattered radiation in these beams has been investigated as have their transmission characteristics. The scatter kerma area product from filtered beams is shown to be greater than that from conventional x-rays and a simple numerical correction linking the two has been derived. The implications for shielding calculations have been assessed and the impact of the correction on calculated barrier thickness has been shown to be relatively small. The broad beam transmission characteristics of the radiation scattered from the filtered beams have been simulated using Monte Carlo methods and found to be adequately described by the standard transmission equation using conventional coefficients. [ABSTRACT FROM AUTHOR]

The specification of shielding for CT facilities in the UK and many other countries has been based on isodose scatter curves supplied by the manufacturers combined with the scanner’s mAs workload. Shielding calculations for radiography and fluoroscopy are linked to a dose measurement of radiation incident on the patient called the kerma–area product (KAP), and a related quantity, the dose-length product (DLP), is now employed for assessment of CT patient doses. In this study the link between scatter air kerma and DLP has been investigated for CT scanners from different manufacturers. Scatter air kerma values have been measured and scatter factors established that can be used to estimate air kerma levels within CT scanning rooms. Factors recommended to derive the scatter air kerma at 1 m from the isocentre are 0.36 µGy (mGy cm)−1 for the body and 0.14 µGy (mGy cm)−1 for head scans. The CT scanner gantries only transmit 10% of the scatter air kerma level and this can also be taken into account when designing protection. The factors can be used to predict scatter air kerma levels within a scanner room that might be used in risk assessments relating to personnel whose presence may be required during CT fluoroscopy procedures. [ABSTRACT FROM AUTHOR]