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Background The burden of chronic conditions associated with sugary beverages is increasing but little is known about the role of different types of sugary beverages in the co-occurrence of multiple chronic conditions ('multimorbidity'). To inform future sugar-reduction guidelines, we aimed to examine the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB) and natural juices (NJ) with multimorbidity. Methods This prospective cohort study included 184 093 UK Biobank participants aged 40–69 years at baseline who completed at least one occasion of 24-h dietary recall between 2009 and 2012. Daily consumptions of SSB, ASB and NJ were assessed using 24-h dietary recall. Participants were followed from the first 24-h assessment until the onset of two or more new chronic conditions, or the end of follow-up (31 March 2017), whichever occurred first. Logistic regression models, Cox proportional hazard models and quasi-Poisson mixed effects models were used to estimate the association of beverages intakes with chronic conditions and multimorbidity. Results A total of 19 057 participants had multimorbidity at baseline and 19 968 participants developed at least two chronic conditions during follow-up. We observed dose–response relationships of SSB and ASB consumptions with the prevalence and incidence of multimorbidity. For example, the adjusted hazard ratios (HRs) and 95% CIs of the incidence of developing at least two chronic conditions ranged from 1.08 (1.01–1.14) for SSB intake of 1.1–2 units/day to 1.23 (1.14–1.32) for >2 units/day compared with 0 units/day. Also, the adjusted HRs (95% CIs) of ASB consumption ranged from 1.08 (1.03–1.13) for 0.1–1 unit/day to 1.28 (1.17–1.40) for >2 units/day compared with non-consumers. Conversely, moderate consumption of NJ was associated with a smaller risk of the prevalence and incidence of multimorbidity. Moreover, higher intakes of SSB and ASB were positively associated whereas moderate intake of NJ was inversely associated with increased number of new-onset chronic conditions during follow-up. Conclusions Higher SSB and ASB intakes were positively associated whereas moderate NJ intake was inversely associated with the higher risk of multimorbidity and increased number of chronic conditions. Current and intended policy options to decrease the burden of chronic conditions and multimorbidity need a formulation of SSB and ASB reduction strategies. [ABSTRACT FROM AUTHOR]

This paper reports a study assessing a new computer tool for cartoon storytelling, created by the authors for a target audience in the upper half of the English and Welsh Key Stage 2 (years 5 and 6, covering ages 9-11 years). The tool attempts to provide users with more opportunities for expressive visualisation than previous educational software; its design was motivated by earlier work connecting "moving image literacy" with print literacy, and it was used here in storywriting preparation work: users first visualised a known story, then wrote their versions of it based on the cartoons they had made. The stories produced are compared with stories written using two other preparation activities, one a pencil-and-paper cartooning exercise and the other a teacher's normal planning session, which also resulted in a retelling of a known story. The study finds that no one preparation process had a noticeably different effect on the final written stories; however, the cartoons produced with the software are found to be quite different to their paper counterparts, showing a greater variety of character action, pose and interaction, slightly more variety of camera shot distance, and more pictures. Children's and teachers' reactions to the software tool are also discussed.

Background: People with intellectual disability (ID) experience a variety of health inequalities compared with the general population including higher mortality rates. This is the first UK population-based study to measure the extent of excess mortality in people with ID compared with the general population. Method: Indirectly standardized all-cause and disease mortality ratios (SMRs) and exact Poisson confidence intervals were calculated by age and sex for all adults, aged 20 years or over, with moderate to profound ID living in Leicestershire and Rutland, UK, between 1993 and 2005. The general population of Leicestershire and Rutland, which has a population of approximately 700 000 individuals in this age range, was used for comparison. To explore differences within the study population, overall SMRs were also calculated by presence of Down syndrome and last place of residence (city or county). Results: Of 2436 adults identified, 409 (17%) died during 23 000 person-years of follow-up. Both all-cause and disease-specific mortality were around three times higher than the general population but varied considerably with age. The largest differences were observed in people in their twenties, where all-cause mortality was almost nine times higher in men (SMR = 883; 95% CI = 560-1325) and more than 17 times higher in women (SMR = 1722; 95% CI = 964-2840). At a particular disadvantage were people with Down syndrome and women with ID living in the city. Conclusions: The relatively high SMRs observed in young people and in women, particularly those living in inner city areas and with Down syndrome, deserve further investigation for possible explanations, including socio-economic factors.

Sought to identify assessable variables which could be used by universities in the selection of faculty when they are faced with candidates who have not had the opportunity of demonstrating their ability to produce research output independently of senior mentors. Identified a quantifiable personal characteristic, the Kirton Adaption-Innovation measure, which, for the academics studied, appears associated with publication output. (EV)

The creation of the Scottish Parliament provided Scottish citizens with an additional layer of politicians to represent them. But to whom do constituents turn when seeking help with a problem—councillors, MSPs or MPs? We assess how partisanship, national identity and shared competences affect public perceptions of the governing responsibilities of the UK Parliament, Scottish Parliament and local councils. We find that an individual's national identity considerably affects perceptions of the political powers delegated to Scottish political institutions. We conclude by considering the implications for efforts to further devolve powers to the devolved legislatures in the UK. [ABSTRACT FROM AUTHOR]

Purpose: Genetic variants identified through population-based genome-wide studies are generally of high frequency, exerting their action in the central part of the refractive error spectrum. However, the power to identify associations with variants of lower minor allele frequency is greatly reduced, requiring considerable sample sizes. Here we aim to assess the impact of rare variants on genetic variation of refractive errors in a very large general population cohort. Methods: Genetic association analyses of non-cyclopaedic autorefraction calculated as mean spherical equivalent (SPHE) used whole-exome sequence genotypic information from 50,893 unrelated participants in the UK Biobank of European ancestry. Gene-based analyses tested for association with SPHE using an optimised SNP-set kernel association test (SKAT-O) restricted to rare variants (minor allele frequency < 1%) within protein-coding regions of the genome. All models were adjusted for age, sex and common lead variants within the same locus reported by previous genome-wide association studies. Potentially causal markers driving association at significant loci were elucidated using sensitivity analyses by sequentially dropping the most associated variants from gene-based analyses. Results: We found strong statistical evidence for association of SPHE with the SIX6 (p-value = 2.15 x 10−10, or Bonferroni-Corrected p = 4.41x10-06) and the CRX gene (p-value = 6.65 x 10−08, or Bonferroni-Corrected p = 0.001). The SIX6 gene codes for a transcription factor believed to be critical to the eye, retina and optic disc development and morphology, while CRX regulates photoreceptor specification and expression of over 700 genes in the retina. These novel associations suggest an important role of genes involved in eye morphogenesis in refractive error. Conclusion: The results of our study support previous research highlighting the importance of rare variants to the genetic risk of refractive error. We explain some of the origins of the genetic signals seen in GWAS but also report for the first time a completely novel association with the CRX gene. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on factors affecting critical decision making for horses with colic. This study's aim was to describe the assessment and decision making involved in horses referred for management of colic. Methods: An in‐depth case analysis was used to document case presentation, decision making and outcomes for horses referred for colic to two UK equine veterinary practices over a 12‐month period. The data recorded included previous history, presenting signs, response to treatment, case outcome and factors affecting decisions for further treatment or euthanasia. Results: Data were available for 60 cases: 55 were hospitalised for medical or surgical treatment and five horses were euthanased following initial assessment. The main factors affecting treatment decisions were severity of clinical signs (80%, 47/59), financial concerns (10%, 6/59) and ongoing health issues or previous history of colic (5%, 3/59). Factors associated with euthanasia decisions were postoperative complications (5/18), poor prognosis (4/18), deteriorating clinical signs (3/18) and financial concerns (3/18). Limitation: The limited study population may affect the extent to which the findings can be generalised. Conclusion: The severity of clinical signs was the key factor in treatment decision making. The main factors affecting euthanasia decisions were clinical deterioration, poor prognosis and financial constraints. These findings should be incorporated into clinical case recording to capture the multifactorial nature of decision making. [ABSTRACT FROM AUTHOR]

Summary: Objective: Testosterone and sex hormone‐binding globulin (SHBG) concentrations are reported to decline during male ageing, but whether these changes reflect physiological ageing or age‐related comorbidities remains uncertain. We examined longitudinal changes in serum testosterone and SHBG concentrations in middle‐aged to older men, concordance between baseline and follow‐up values and relationships with concomitant changes in lifestyle and medical factors. Design: Population‐based longitudinal cohort study. Participants: Community‐dwelling men aged 40–69 years. Measurements: Immunoassay serum total testosterone (n = 7812) and SHBG (n = 6491) at baseline (2006–2010) and follow‐up (2012–2013). Free testosterone (cFT) was calculated. Bland–Altman analyses and concordance correlation of repeated measurements were conducted. Associations of changes in hormone concentrations with lifestyle and medical factors were explored using Spearman's rank correlation. Results: Over 4.3 years follow‐up, there was a negligible mean change (±SE) in serum total testosterone concentration (+0.06 ± 0.03 nmol/L), whereas mean SHBG concentration increased (+3.69 ± 0.12 nmol/L) and cFT decreased (−10.7 ± 0.7 pmol/L). Concordance estimates were 0.67 (95% confidence interval [CI]: 0.66–0.69) for total testosterone, 0.83 (CI = 0.82–0.84) for SHBG and 0.56 (CI = 0.54–0.58) for cFT. Changes in serum total testosterone correlated with changes in SHBG (Spearman's rank ρ = 0.33, CI = 0.30–0.35), and inversely with changes in body mass index (BMI) (ρ = −0.18, CI = −0.20 to −0.16) and waist circumference (ρ = −0.13, CI = −0.15 to −0.11) and in SHBG with changes in BMI (ρ = −0.34, CI = −0.36 to −0.32) and waist circumference (ρ = −0.21, CI = −0.24 to −0.19). Conclusion: In relatively healthy middle‐aged to older men, mean serum total testosterone concentration is stable with ageing, while mean SHBG concentration increases. Both total testosterone and SHBG concentrations were highly concordant over time. [ABSTRACT FROM AUTHOR]

We describe a case of hemorrhagic fever with renal syndrome caused by Seoul virus in a woman in Scotland, UK. Whole-genome sequencing showed the virus belonged to a lineage characterized by recent international expansion, probably driven by trade in pet rats. [ABSTRACT FROM AUTHOR]

Optical Coherence Tomography (OCT) enables non-invasive imaging of the retina and is used to diagnose and manage ophthalmic diseases including glaucoma. We present the first large-scale genome-wide association study of inner retinal morphology using phenotypes derived from OCT images of 31,434 UK Biobank participants. We identify 46 loci associated with thickness of the retinal nerve fibre layer or ganglion cell inner plexiform layer. Only one of these loci has been associated with glaucoma, and despite its clear role as a biomarker for the disease, Mendelian randomisation does not support inner retinal thickness being on the same genetic causal pathway as glaucoma. We extracted overall retinal thickness at the fovea, representative of foveal hypoplasia, with which three of the 46 SNPs were associated. We additionally associate these three loci with visual acuity. In contrast to the Mendelian causes of severe foveal hypoplasia, our results suggest a spectrum of foveal hypoplasia, in part genetically determined, with consequences on visual function. Author summary: The thickness of the inner retinal layers is one of the biomarkers for glaucoma, the leading cause of irreversible blindness globally. Here we utilised the large-scale of the UK Biobank and the images of the retina it contains to look for genetic variants that effect the thickness of the inner retina. We find many variants associated with this variable, but surprisingly only one that also affects glaucoma. Further analysis shows that glaucoma and genetically determined inner retinal thickness are not on the same genetic pathway and it is rather the change of thickness over time that is indicative of the disease. This is important as it invites the potential for the discovered variants to be used as a representation of baseline thickness in the clinic in the future. We also show that foveal hypoplasia, the lack of the normal valley-like shape of the central retina, is present at a population level in a mild form and is affected by three variants that also affect visual acuity. This is an interesting discovery as foveal hypoplasia was previously thought of as an outcome of rare Mendelian disease. [ABSTRACT FROM AUTHOR]

Objective: Serum testosterone concentrations are affected by factors unrelated to hypothalamo‐pituitary‐testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone–binding globulin (SHBG) in men aged 40‐69 years. Design: Cross‐sectional analysis of 208,677 community‐dwelling men from the UK Biobank. Measurements: We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models and effect size estimates. Results: Median (interquartile range) for serum testosterone was 11.6 (9.4‐14.1) nmol/L, SHBG 36.9 (27.9‐48.1) nmol/L and cFT 213 (178‐255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age and inversely with BMI (all P <.001). Living with a partner, (South) Asian ethnicity, never or previous smoker and some medical conditions were associated with lower testosterone. Poultry or fish eater, and higher physical activity were associated with higher testosterone (all P <.001). Testosterone was lowered by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2, ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity and 0.3‐1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L and cFT by ~60 pmol/L. Conclusions: The identified modifiable risk factors support lifestyle‐based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalized interpretation of testosterone testing results with respect to existing reference ranges. [ABSTRACT FROM AUTHOR]

Aim: To describe the process and outputs of a workshop convened to identify key priorities for future research in the area of remission of type 2 diabetes, and provide recommendations to researchers and research funders on how best to address them. With the ultimate aim of enabling the remission of type 2 diabetes to become a possibility for more people. Methods: A 1‐day research workshop was conducted, bringing together 31 researchers, people living with diabetes, healthcare professionals and members of staff from Diabetes UK to identify and prioritize recommendations for future research into remission of type 2 diabetes. Results: Workshop attendees identified 10 key themes for further research. Four of these themes were prioritized for further focus: (i) understanding how to personalize lifestyle approaches based on biology, patient choice and subtypes; (ii) understanding the biology of remission; (iii) understanding the most effective approaches to implementation of lifestyle interventions; and (iv) understanding the best approaches to combining therapies (gut hormones, other drugs, lifestyle approaches and bariatric surgery). Conclusions: This paper outlines recommendations to address the current gaps in knowledge related to remission of type 2 diabetes. What's new?: It is known that type 2 diabetes can be put into remission; however, standard clinical treatment of type 2 diabetes does not currently aim to put the condition into remission.This is the first time that researchers and healthcare professionals from a wide range of specialist areas have come together to identify research priorities to increase understanding of remission of type 2 diabetes.The paper sets out key recommendations for further research that is needed in order to make remission an achievable aim for more people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

The European whitefish Coregonus lavaretus complex represents one of the most diverse radiations within salmonids, with extreme morphological and genetic differentiation across its range. Such variation has led to the assignment of many populations to separate species. In Great Britain, the seven native populations of C. lavaretus (two in Scotland, four in England, one in Wales) were previously classified into three species, and recent taxonomic revision resurrected the previous nomenclature. Here we used a dataset of 15 microsatellites to: (1) investigate the genetic diversity of British populations, (2) assess the level of population structure and the relationships between British populations. Genetic diversity was highest in Welsh (HO = 0.50, AR = 5.29), intermediate in English (HO = 0.41–0.50, AR = 2.83–3.88), and lowest in Scottish populations (HO = 0.28–0.35, AR = 2.56–3.04). Population structure analyses indicated high genetic differentiation (global FST = 0.388) between all populations but for the two Scottish populations (FST = 0.063) and two English populations (FST = 0.038). Principal component analysis and molecular ANOVA revealed separation between Scottish, English, and Welsh populations, with the Scottish populations being the most diverged. We argue that the data presented here are not sufficient to support a separation of the British European whitefish populations into three separate species, but support the delineation of different ESUs for these populations. [ABSTRACT FROM AUTHOR]

Background: Telephone triage is an integral part of modern patient care systems in human medicine, and a key component of veterinary practice care systems. There is currently no published research on telephone triage within the veterinary profession. Objective: To investigate current approaches to telephone triage of horses with abdominal pain (colic) in veterinary practice and develop new resources to support decision-making. Study design: Participatory action research using mixed-methods approach. Methods: An online survey assessed current approaches to telephone triage of horses with colic in UK veterinary practices. Structured group and individual interviews were conducted with four equine client care (reception) teams on their experiences around telephone triage of colic. Evidence-based resources, including an information pack, decision flow chart and recording form, were developed and implemented within the practices. Participant feedback was obtained through interviews six months after implementation of the resources. Results: There were 116 participants in the online survey. Management and client care staff (53/116) felt less confident giving owner advice (p<0.01) and recognising critical indicators (p = 0.03) compared to veterinary surgeons and nurses (63/116). Thirteen themes were identified in the survey relating to owner advice; exercise and owner safety were most frequently mentioned, but conflicting guidance was often given. Fourteen client care staff were interviewed. They were confident recognising colic during a telephone conversation with an owner and identified the most common signs of critical cases as sweating and recumbency. The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful. After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice. Main limitations: Limited sample population. Conclusions: This study described existing approaches to telephone triage, identified variations in advice given, and worked with client care teams to develop new resources to aid decision-making. [ABSTRACT FROM AUTHOR]

With an ageing global population, there is an urgent need to identify effective strategies to maintain brain health across the life course and therein minimise the risk of age‐related neurodegenerative disorders reaching a severe stage which may manifest as dementia. An increasing body of evidence indicates that nutrition is a modifiable lifestyle factor that can promote healthy brain ageing and reduce dementia risk. However, at present, little is known about which dietary patterns, foods and food bioactives influence brain function during ageing, and more research is required to identify at‐risk individuals and population subgroups who are most likely to benefit from future nutritional intervention intended to promote healthier brain ageing. This article introduces the newly established Medical Research Council‐funded NuBrain consortium, the vision of which is to provide a step change in research in the area by developing novel approaches and techniques to further understand the complex interactions between diet and brain health and how we can support appropriate behaviour changes in the population. NuBrain will form a new, sustainable and internationally field‐leading research consortium with multidisciplinary and complementary areas of expertise to address the fundamental research challenges in this area. [ABSTRACT FROM AUTHOR]

In this paper we describe a survey of the current use and effectiveness of key modern manufacturing practices within the UK. The findings from the survey are based upon a ten-percent sample of British manufacturing companies employing more than 150 people. The most common practices in use are supply-chain partnering, total quality management, team-based working and integrated computerbased technology. By contrast, the least used practices in Britain are total productive maintenance, outsourcing, concurrent engineering and manufacturing cells. In terms of effectiveness, in more than half of the companies the practices are perceived to be failing to meet their objectives in terms of quality, cost or responsiveness to customers. It was found that practices such as learning culture, integrated computer-based technology and empowerment are expected to be used more in the future, whereas outsourcing, manufacturing cells and concurrent engineering are predicted to experience less growth. These findings are discussed within the paper in terms of their consistency with previous studies, as well as their implications for the current and future use of individual practices. [ABSTRACT FROM AUTHOR]

Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990–2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine. [ABSTRACT FROM AUTHOR]

Background: Feedback of potentially serious incidental findings (PSIFs) to imaging research participants generates clinical assessment in most cases. Understanding the factors associated with increased risks of PSIFs and of serious final diagnoses may influence individuals’ decisions to participate in imaging research and will inform the design of PSIFs protocols for future research studies. We aimed to determine whether, and to what extent, socio-demographic, lifestyle, other health-related factors and PSIFs protocol are associated with detection of both a PSIF and a final diagnosis of serious disease. Methods and findings: Our cohort consisted of all UK Biobank participants who underwent imaging up to December 2015 (n = 7334, median age 63, 51.9% women). Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry images from the first 1000 participants were reviewed systematically by radiologists for PSIFs. Thereafter, radiographers flagged concerning images for radiologists’ review. We classified final diagnoses as serious or not using data from participant surveys and clinical correspondence from GPs up to six months following imaging (either participant or GP correspondence, or both, were available for 93% of participants with PSIFs). We used binomial logistic regression models to investigate associations between age, sex, ethnicity, socio-economic deprivation, private healthcare use, alcohol intake, diet, physical activity, smoking, body mass index and morbidity, with both PSIFs and serious final diagnoses. Systematic radiologist review generated 13 times more PSIFs than radiographer flagging (179/1000 [17.9%] versus 104/6334 [1.6%]; age- and sex-adjusted OR 13.3 [95% confidence interval (CI) 10.3–17.1] p<0.001) and proportionally fewer serious final diagnoses (21/179 [11.7%]; 33/104 [31.7%]). Risks of both PSIFs and of serious final diagnoses increased with age (sex-adjusted ORs [95% CI] for oldest [67–79 years] versus youngest [44–58 years] participants for PSIFs and serious final diagnoses respectively: 1.59 [1.07–2.38] and 2.79 [0.86 to 9.0] for systematic radiologist review; 1.88 [1.14–3.09] and 2.99 [1.09–8.19] for radiographer flagging). No other factor was significantly associated with either PSIFs or serious final diagnoses. Our study is the largest so far to investigate the factors associated with PSIFs and serious final diagnoses, but despite this, we still may have missed some associations due to sparsity of these outcomes within our cohort and small numbers within some exposure categories. Conclusion: Risks of PSIFs and serious final diagnosis are substantially influenced by PSIFs protocol and to a lesser extent by age. As only 1/5 PSIFs represent serious disease, evidence-based PSIFs protocols are paramount to minimise over-investigation of healthy research participants and diversion of limited health services away from patients in need. [ABSTRACT FROM AUTHOR]

Introduction: Effectiveness of oral anticoagulants (OACs) is critically dependent on patients’ adherence to intake regimens. We studied the relative impact of attributes related to effectiveness, safety, convenience, and costs on the value of OAC therapy from the perspective of patients with non-valvular atrial fibrillation.Methods: Four attributes were identified by literature review and expert interviews: effectiveness (risk of ischemic stroke), safety (risk of major bleeding, minor bleeding, gastrointestinal complaints), convenience (intake frequency, diet restrictions, international normalized ratio [INR] blood monitoring, pill type/intake instructions), and out-of-pocket costs. Focus groups were held in Spain, Germany, France, Italy and the United Kingdom (N = 48) to elicit patients’ preferences through the use of the analytical hierarchy process method.Results: Effectiveness (60%) and side effects (27%) have a higher impact on the perceived value of OACs than drug convenience (7%) and out-of-pocket costs (6%). As for convenience, eliminating monthly INR monitoring was given the highest priority (40%), followed by reducing diet restrictions (27%), reducing intake frequency (17%) and improving the pill type/intake instructions (15%). The most important side effect was major bleeding (75%), followed by minor bleeding (15%) and gastrointestinal complaints (10%). Furthermore, 71% of patients preferred once-daily intake to twice-daily intake.Discussion: Although the relative impact of convenience on therapy value is small, patients have different preferences for options within convenience criteria. Besides considerations on safety and effectiveness, physicians should also discuss attributes of convenience with patients, as it can be assumed that alignment to patient preferences in drug prescription and better patient education could result in higher adherence. [ABSTRACT FROM AUTHOR]

Objectives When urate lowering therapy is indicated in patients with gout, medication adherence is essential. This study assesses non-persistence and non-adherence in patients with newly diagnosed gout, and identifies factors associated with poor medication adherence. Methods A retrospective data analysis was performed within the UK Clinical Practice Research Datalink (1987–2014) among incident gout patients, aged ⩾40 years and starting allopurinol (n = 48 280). The proportion of patients non-persistent (a first medication gap of ⩾90 days) after 1 and 5 years, and median time until a first 90-day gap was estimated using Kaplan-Meier statistics in those starting allopurinol and restarting after a first interruption. Non-adherence (proportion of days covered <80%) over the full observation period was calculated. Multivariable Cox- or logistic regressions assessed factors associated with non-persistence or non-adherence, respectively. Results Non-persistence increased from 38.5% (95% CI: 38.1, 38.9) to 56.9% (95% CI: 56.4, 57.4) after 1 and 5 years of initiation. Median time until a first 90-day gap was 1029 days (95% CI: 988, 1078) and 61% were non-adherent. After a first gap, 43.3% (95% CI: 42.7, 43.9) restarted therapy within 1 year, yet only 52.3% (95% CI: 51.4, 53.1) persisted for 1 year. Being female and a current smoker increased the risk for non-persistence and non-adherence, while older age, overweight, receiving anti-hypertensive medication or colchicine and suffering from dementia, diabetes or dyslipidaemia decreased the risk. Conclusion Medication adherence among gout patients starting allopurinol is poor, particularly among females and younger patients and patients with fewer comorbidities. Medication adherence remains low in those reinitiating after a first gap. [ABSTRACT FROM AUTHOR]

Employing different meanings of classical concepts of saving, capital, investment, and money, and incorrectly attributing the assumption of full employment of labor and a world of certainty to classical analysis, John Maynard Keynes ([1936] 1974) faulted Say’s Law as irrelevant to the real world. Roy Grieve (2016) ignores previous clarifications of Keynes’s misrepresentations and misunderstandings of John Stuart Mill’s restatements of the law. He employs similar misrepresentations and misunderstandings of Mill’s explanations as Keynes did. His model of Mill’s analysis is incapable of explaining how variations in relative prices, the value of money, and interest rates coordinate production, consumption, and savings decisions in a monetary economy. [ABSTRACT FROM AUTHOR]

Objectives: To develop a core information set for informed consent to surgery for oral/oropharyngeal surgery. A core information set is baseline information rated important by patients and surgeons and is intended to improve patients' understanding of the intended procedure. Design: A mixed‐methods study. Systematic reviews of scientific and written healthcare literature, qualitative interviews and observations, Delphi surveys, and group consensus meetings identified information domains of importance for consent. Setting: A regional head and neck clinic in the United Kingdom. Questionnaire participants were recruited from around the UK. Participants: Patients about to undergo, or who had previously undergone, surgery for oral/oropharyngeal cancer. Healthcare professionals involved in the management of head and neck cancer. Main outcome measures: The main outcome was a core information set. Results: Systematic reviews, interviews and consultation observations yielded 887 pieces of information that were categorised into 87 information domains. Survey response rates were 67% (n = 50) and 71% (n = 52) for patient and healthcare professional groups in round one. More than 90% responded in each group in the second round. Healthcare professionals were more likely to rate information about short‐term or peri‐operative events as important while patients rated longer term issues about survival and quality of life. The consensus‐building process resulted in an agreed core information set of 13 domains plus two procedure‐specific domains about tracheostomy and free‐flap surgery. Conclusion: This study produced a core information set for surgeons and patients to discuss before surgery for oral/oropharyngeal cancer. Future work will optimise ways to integrate core information into routine consultations. [ABSTRACT FROM AUTHOR]

Background: The benefits of stroke volume optimization during surgery are unclear, with recent data not replicating the positive effects of earlier studies.Methods: This was a randomized controlled trial of standard fluid therapy with or without supplementary blinded intraoperative stroke volume optimization in 220 patients having major elective rectal resection or cystectomy with ileal conduit. All patients were treated using a contemporary enhanced recovery pathway. Interventional fluid challenges used Gelofusine (B Braun, Germany), guided by stoke volume variability measured by LiDCOrapid (LiDCO, UK). Participants were stratified by aerobic fitness (characterized by preoperative cardiopulmonary exercise test), surgical specialty, and intended surgical approach (open or laparoscopic). The primary outcome was the prevalence of moderate or severe complications on day 5 after surgery, defined using the postoperative morbidity survey (POMS) criteria.Results: Patients received ∼13 ml kg(-1) h(-1) of i.v. fluids during surgery. The intervention group received an additional mean (sd) 956 (896) ml Gelofusine. There were no statistically significant differences between groups in any primary or secondary end point. A positive POMS on postoperative day 5 was noted in 54 of 111 control subjects (48.6%) and 55 of 109 participants in the intervention group [50.5%; adjusted odds ratio 0.90 (95% confidence interval 0.52-1.57), P=0.717]. Mean (sd) hospital length of stay was 9.6 (6.8) days in the control group and 11.8 (11.5) days in the intervention group (adjusted difference -2.1 (-4.6 to 0.3) days, P=0.091). There was no statistical interaction between stroke volume optimization and aerobic fitness in terms of rate of complications or length of stay.Conclusions: Algorithm-driven stroke volume optimization is of no benefit when superimposed on a liberal baseline fluid regimen in patients having elective major abdominal surgery, when stratified to minimize differences in fitness and surgical approach between groups.Clinical Trial Registration: ISRCTN21597243. [ABSTRACT FROM AUTHOR]

Aim To investigate the relationship between birthweight and cardiometabolic traits in two cohorts: one of Chinese adolescents and one of Chinese adults. Methods Birthweight and clinical data, including anthropometric traits, fasting plasma glucose and fasting plasma insulin levels, blood pressure and lipid profiles were collected from 2035 adolescents and 456 adults. A subset of 735 subjects underwent an oral glucose tolerance test to measure the glucose and insulin concentrations at 0, 15, 30, 60 and 120 min. Results Among adolescents, birthweight showed U-shaped relationships with larger body size, obesity, abdominal obesity in girls, insulin resistance and worse lipid profiles (0.0013 < P quadratic < 0.0499), as well as an inverse association with fasting plasma glucose ( P linear = 0.0368). After further adjustment for adiposity, decreasing birthweight was associated with elevated fasting plasma glucose levels, greater insulin resistance and worse lipid profiles (3.1 × 10-5 < P linear < 0.0058). Among adults, high birthweight was associated with larger body size and abdominal obesity in men, while low birthweight was associated with elevated glucose levels at 15, 30, 60 and 120 min and a greater area under the curve at 0-120 min, as well as with β-cell dysfunction (6.5 × 10-5 < P linear < 0.0437). Adjustment for adult adiposity did not substantially change the relationships. There was significant interaction between birthweight and abdominal obesity in elevating fasting plasma insulin and homeostasis model assessment of insulin resistance ( P > 0.05), with abdominally obese adolescents in the lowest birthweight category ( ≤ 2.5 kg) having the highest risk of insulin resistance. Conclusions Both high and low birthweights are associated with an increased risk of cardiometabolic abnormalities including obesity, abdominal obesity, hyperglycaemia, dyslipidaemia and insulin resistance, as well as with β-cell dysfunction. [ABSTRACT FROM AUTHOR]

Objective To study the presentation, management and outcomes and to apply retrospectively the Pituitary Apoplexy Score ( PAS) (United Kingdom ( UK) guidelines for management of apoplexy) to a large, single-centre series of patients with acute pituitary apoplexy. Design Retrospective analysis of casenotes at a single neurosurgical centre in Liverpool, UK. Results Fifty-five patients [mean age, 52·4 years; median duration of follow-up, 7 years] were identified; 45 of 55 (81%) had nonfunctioning adenomas, four acromegaly and six prolactinomas. Commonest presenting features were acute headache (87%), diplopia (47·2%) and visual field ( VF) defects (36%). The most frequent ocular palsy involved the 3rd nerve (81%), followed by 6th nerve (34·6%) and multiple palsies (19%). Twenty-three patients were treated conservatively, and the rest had surgery either within 7 days of presentation or delayed elective surgery. Indications for surgery were deteriorating visual acuity and persistent field defects. Patients presenting with VF defects ( n = 20) were more likely to undergo surgery (75%) than to be managed expectantly (25%). There was no difference in the rates of complete/near-complete resolution of VF deficits and cranial nerve palsies between those treated conservatively and those who underwent surgery. Endocrine outcomes were also similar. We were able to calculate the PAS for 46 patients: for the group treated with early surgery mean, PAS was 3·8 and for those managed conservatively or with delayed surgery was 1·8. Conclusions Patients without VF deficits or whose visual deficits are stable or improving can be managed expectantly without negative impact on outcomes. Clinical severity based on a PAS ≥ 4 appeared to influence management towards emergency surgical intervention. [ABSTRACT FROM AUTHOR]

Background: the prevalence of all types of cognitive impairment, including dementia, is increasing but knowledge of aetiological factors is still evolving.Objective: this study aimed to evaluate the association between cardiovascular risk factors and cognitive function in older persons.Design, setting and subjects: a population-based cohort design involving 2,312 men and women (aged 50–75) enrolled in the University of Edinburgh Aspirin for Asymptomatic Atherosclerosis trial.Methods: cognitive tests included the Mill Hill Vocabulary Scale, auditory verbal learning test (AVLT), digit symbol test, verbal fluency test (VFT), Raven's Progressive Matrices and the trail making test. A ‘g’ score (measure of general intelligence) was computed for each subject. Regression analysis was used to evaluate the association between relevant variables.Results: higher diastolic BP was negatively associated with AVLT (β = −0.153, P < 0.01), and with an estimated decline on AVLT (β = −0.125, P < 0.01). Smoking was negatively associated with all the cognitive variables except VFT. The total cholesterol level was not associated with cognitive function or estimated decline.Conclusions: smoking and elevated blood pressure may be risk factors for cognitive decline, and thus potential targets for preventive and therapeutic interventions. [ABSTRACT FROM PUBLISHER]

An outline is given of the scale and nature of special wildlife designations in the UK river network, the general approach of the UK conservation agencies to their evaluation and management, and the specific way in which impacts of river flows are handled. The need for a holistic ecological and biodiversity view of water resource impacts on river systems is stressed, within which the specific needs of individual species, such as Atlantic salmon, Salmo salar L., can be framed. An approach founded on the provision of a natural flow regime within a natural physical channel not only provides the most suitable conditions for characteristic riverine wildlife to flourish but also provides the best local defence against global climate change. Arguments are made for a future focus on the generic evidence base for flow targets and its strengthening through strategic and demonstrably fit-for-purpose research. The practical constraints to an approach based on protection of the natural flow regime are discussed. Ultimately, transparent separation and consideration of what river ecosystems really need, and what can realistically be provided, is the key to shared ownership of the water resource dilemma. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) is a colourless and odourless poisonous gas formed from the incomplete combustion of substances containing carbon. In the United Kingdom, over 22 million homes have mains or liquefied petroleum gas and consequently there is particular concern regarding potential CO poisoning resulting from malfunctioning domestic gas appliances. Although the number of reported cases of CO poisoning in the United Kingdom is relatively small, there is a high probability of misdiagnosis of the condition due to the ambiguous clinical symptoms of CO poisoning; incidence may therefore be much higher than currently reported. This review discusses the current knowledge on human health and toxicological effects following exposure to CO, focusing particularly on the public health impacts associated with gas appliances in UK homes. In determining the possibility of an underlying threat, the biological plausibility of misdiagnosis, in combination with reported cases, is discussed. The implication of misdiagnosis for public health treatment is also briefly summarised. [ABSTRACT FROM PUBLISHER]

The article presents courts cases in Australia and Great Britain. The author mentions a case relating to the distribution of the immovable estate in England of a deceased man who was domiciled in Ghana. He discusses the approval of a five-judge Bench of the English Court of Appeal in England to the appeal against the murder conviction of a defendant who had a dispute with another man resulting to the killing of a bystander. He also discusses cases on negligence and sales of goods by machine.

The possible cause of disease and mortality in corvids on an outdoor pig unit in the north of England between August 2007 and March 2008 was investigated. Nine carrion crows (Corvus corone corone) and nine rooks (Corvus frugilegus), comprising five live-caught birds with clinical signs of respiratory disease, one live-caught bird without respiratory disease, and 12 birds submitted dead were examined. Clinical signs, gross and histopathological examination, microbiology and toxicology indicated that Pasteurella multocida infection was the cause of disease. Molecular and serotyping analyses showed that P. multocida isolates (obtained from live-caught birds with clinical respiratory disease) were all capsular type F with a mix of somatic serotypes 3, 4 and 7. Immunohistochemistry increased the diagnostic sensitivity of the analysis and detected P. multocida within the pulmonary lesions of all affected live-caught birds and 10 of 12 birds found dead. These findings suggest that wild corvids in the UK can suffer from lung pathology associated with P. multocida and, as potential vectors of P. multocida, may pose a risk to domestic poultry. [ABSTRACT FROM AUTHOR]

Over 11 000 UK patients each year develop pancreatic exocrine insufficiency - the major causes are not rare: cystic fibrosis (>300 new cases/year), pancreatic cancer (>7000 new cases/year) and chronic pancreatitis (>4000 new cases/year). Affected patients present in diverse ways, and for chronic pancreatitis, diagnosis is frequently made rather late in the course of the disease. To raise awareness of key clinical issues specific to patients with pancreatic exocrine insufficiency through experience from UK clinicians, and to offer advice regarding appropriate treatment with pancreatic enzymes. Three case studies describe clinical issues relating to pancreatic enzyme supplementation that may lead to underuse in patients with cystic fibrosis, pancreatic and periampullary cancer or chronic pancreatitis. The efficacy of the treatment of exocrine pancreatic insufficiency is dependent on adequate meal-time enzyme replacement therapy. Improvements in patients' weight and nutritional status are what is aimed for - an important reason for all doctors, nurses and dieticians to give this therapy close attention. Pancreatic exocrine insufficiency may result in malnutrition, but enzyme supplementation can greatly improve quality of life in these patients. Aliment Pharmacol Ther (Suppl. 1), 1-25 [ABSTRACT FROM AUTHOR]

The UK lies towards the southernmost distribution limit of the circumpolar Arctic charr ( Salvelinus alpinus), and native populations of high national conservation value occur in all four component countries. However, given the temperature requirements of this species and the already relatively mild UK climate, there is strong reason to expect a significant negative impact of climate change on local populations. Data were assembled from repeated Arctic charr population assessments using combinations of hydroacoustics, gill netting, entrapment records and fisheries catches at five Scottish populations, five English populations and one Welsh population. These data were then used to test the hypotheses that there has been a widespread decline of Arctic charr in the UK and that it can be attributed at least in part to climate change. Ten of the 11 studied populations exhibited significant 1990-onwards declines in abundance, while only the most northerly population showed a significant increase. Overall, there was a significant positive relationship between the observed population decline ranking and a vulnerability to climate change ranking based on water body latitude, altitude and mean depth. These observations support the hypothesis that this species has suffered a recent and widespread decline in the UK, and although additional factors are undoubtedly also involved in some specific cases, climate change is a significant factor. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional study. Objectives:(1) To assess the relationship between bladder management methods and the health-related quality of life (HRQL) in patients with spinal cord injury (SCI). (2) To identify any correlation between the two questionnaires used to assess the quality of life (one validated for SCI and one validated for bladder symptoms). Setting:Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Middlesex, UK. Methods:This study is based on two questionnaires with results collected from 142 people with SCI. The two questionnaires were based on information from the Short-Form 36-Item Health Survey (SF-36) and the King's Health Questionnaire and included demographic characteristics, bladder management methods and the frequency of incontinence. Results:There is a moderate correlation between the results of the SF-36 and the King's Health Questionnaire. Only 21% SCI patients report normal voiding without any other form of bladder management. The type of bladder management may influence the HRQL in patients with SCI. Clean intermittent catheterization by attendant, indwelling transurethral catheterization and indwelling suprapubic catheterization are the three groups with the worst mental status. In addition, the frequency of incontinence is a strong influence on HRQL.Conclusions:The results of this study may provide a general baseline HRQL for patients with SCI. Our findings show the relationships between bladder management methods and quality of life in patients with SCI. In addition, the impact of incontinence on quality of life was also confirmed. [ABSTRACT FROM AUTHOR]

Background: National guidance in the UK on nutrition support suggests that all patients should be screened on initial admission to hospital and, where appropriate, be referred to a healthcare professional. The present study aimed to investigate whether initial nutrition screening influenced the outcome of patients who received parenteral nutrition (PN). Methods: Data were prospectively evaluated on 100 consecutive patients referred to the multidisciplinary PN team in a teaching hospital. Information was obtained from medical notes, electronic patient records, completed PN prescription charts, dietetic record cards and nursing care plans. Patients who were treatable by nutritional supplements or enteral nutrition were not included. Patients were divided into two groups: guidance compliant and guidance noncompliant, in order to compare outcome measures such as the duration of PN treatment, total number of PN bags used per patient and length of hospital stay. Comparison of data between the two groups was carried out using either the independent samples t-test or the Mann–Whitney U-test. Results: There was no difference in outcome measures between the guidance compliant and noncompliant groups. Patients in the guidance noncompliant group were more likely to be in general (77%) than critical wards (23%). Patients who were in the guidance compliant group received nutrition support earlier. Conclusions: Compliance with the national guidance in the UK on screening did not improve outcomes in patients requiring parenteral nutrition in this cohort. Initial nutrition screening prior to PN administration warrants further investigation to ensure value is added to patient care. [ABSTRACT FROM AUTHOR]

The newly enacted federal Say on Pay rule will require public firms to periodically provide shareholders with an opportunity to cast an advisory vote regarding its most recent year's executive compensation. Like other efforts to increase shareholder power, Sat on Pay has attracted criticism from those who fear that so empowering shareholders will harm firms. There may be much to be said for those criticisms, but this Article instead offers a critique of Say on Pay internal to the shareholder empowerment movement. The problem with Say on Pay is that its ex post nature neuters its ability to influence executive pay at high--performing firms. This hypothesis has been borne out by the experience with Say on Pay in the UK where a mandatory, version has been in effect for seven years. There, Say on Pay resulted in compensation-related discipline at poorly-performing firms, but not at high-performing firms. This disparity appears to be not entirely or even significantly driven by shareholder preferences or monitoring costs. Alternatively, this Article suggests that Say on Par suffers from the bundling of perceived collateral costs insofar as shareholders reasonably fear offending executives via an adverse Say on Pay vote. Those problems are naturally more significant at high-performing firms where the potentially offended executives are believed to be more valuable. This Article suggests that the bundling problems can be mitigated by switching from an ex post to an ex ante vote and provides a first attempt at a CEO Compensation Plan approval requirement. [ABSTRACT FROM AUTHOR]

The article focuses on the management strategies that could biologically control the population of signal crayfish in Great Britain, such as Pacifastacus leniusculus. It states that invasive crayfish is competing with white-clawed fish and is considered to have caused the spread of crayfish plague. It reveals that despite the susceptibility of crayfish to different biocides and microbial pathogens, the development of biological control methods and integrated pest management is still needed.

Objective: To investigate differential intestinal gene expression in patients with ulcerative colitis and in controls. Design: Genome-wide expression study (41 058 expression sequence tags, 215 biopsies). Setting: Western General Hospital, Edinburgh, UK, and Genentech, San Francisco, USA. Patients: 67 patients with ulcerative colitis and 31 control subjects (23 normal subjects and 8 patients with inflamed non-inflammatory bowel disease biopsies). Interventions: Paired endoscopic biopsies were taken from 5 specific anatomical locations for ANA extraction and histology. The Agilent microarray platform was used and confirmation of results was undertaken by real time polymerase chain reaction and immunohistochemistry. Results: In healthy control biopsies, cluster analysis showed differences in gene expression between the right and left colon. (χ2 = 25.1, p<0.0001). Developmental genes, homeobox protein A13 (HOXA13), (p = 2.3×10-16), HOXB13 (p<1 × 10-45), glioma-associated oncogene 1 (GLI1) (p = 4.0 × 10-24), and GLI3 (p = 2.1 × 10-28) primarily drove this separation. When all ulcerative colitis biopsies and control biopsies were compared, 143 sequences had a fold change of >1.5 in the ulcerative colitis biopsies (0.01 >p>10-45) and 54 sequences had a fold change of <-1.5 (0.01 >p>10-20). Differentially upregulated genes in ulcerative colitis included serum amyloid A1 (SAA1) (p<10-45) the alpha defensins 5 and 6 (DEFA5 and 6) (p = 0.00003 and p = 6.95 × 10-7, respectively), matrix metalloproteinase 3 (MMP3) (p = 5.6 × 10-10) and MMP7 (p = 2.3 × 10-7). Increased DEFA5 and 6 expression was further characterised to Paneth cell metaplasia by immunohistochemistry and in situ hybridisation. Sub-analysis of the inflammatory bowel disease 2 (IBD2) and IBD5 loci, and the ATP-binding cassette (ABC) transporter genes revealed a number of differentially regulated genes in the ulcerative colitis biopsies. Conclusions: Key findings are the expression gradient in the healthy adult colon and the involvement of novel gene families, as well as established candidate genes in the pathogenesis of ulcerative colitis. [ABSTRACT FROM AUTHOR]

The article comments on several court cases in Great Britain related to terrorism. It notes that the Belmarsh case constituted obstructions to the anti-terrorism strategies of the government. It discusses the reasons why executive powers remain attractive to the Home Office. It also mentions that Part IV of the Counter-Terrorism Bill 2007-2008 contains a collection of notification restraints which can be imposed post-sentence.

In this paper we explore the dependence of vehicle emission profiles over a twenty-five year period on three factors: the rate of traffic growth (g), the fleet renewal rate (Ι), and the technology 'gain' (θ) following a step change in emission standards. Using analytic and numerical methods we determine the conditions relating to g, Ι, and θ which result in three types of emission profile. These consist of: type-I profiles, in which emissions continue to rise but at a reduced rate; type-Il profiles which fall, attain a minimum, and subsequently rise from a lower base; and type-Ill profiles which continue to fall over a forecasting period. For all profiles we determine the total reduction in vehicle emissions arising from revised standards, and the sensitivity of the total emissions to changes in their determining factors. Data from the UK are used to illustrate the approach which is extended in a wide range of sensitivity tests to explore differences in emission profiles between advanced industrialised and rapidly developing countries. We show that while it may be necessary for all countries to rely on both technological and behavioural policy instruments to reduce emissions, in advanced industrialised countries it may be more effective to improve emission standards, while, in contrast, moderating the rate of traffic growth may be relatively more effective in the rapidly industrialising world. The profiles resulting from the change in emission standards accompanying the introduction of catalytic converters are used to illustrate the general approach. [ABSTRACT FROM AUTHOR]

Objective: To determine the level of pre-employment, pre-season, and post-injury medical evaluation of players undertaken within UK professional team sports. Design: A postal, whole population survey. Setting: Elite professional sports teams in England. Population: Six groups comprising the following clubs: professional football (Premiership, 15 of 20; Championship, 22 of 24), rugby union (Premiership, 9 of 1 2; Division 1, 11 of 14), rugby league (Super League, 6 of 11) and cricket (County, 12 of 18). Main outcome measures: Number (percentage) of clubs recording players' medical history and undertaking medical examinations of players' cardiovascular, respiratory, neurological, and musculoskeletal systems at pre-employment, pre-season and post-injury. Results: The overall response to the survey was 74%, with a range from 55% to 92% among groups. Almost 90% of football (Premiership and Championship) and rugby union (Premiership) clubs took a pre-employment history of players' general health, cardiovascular, respiratory, neurological, and musculoskeletal systems, but fewer than 50% of cricket and rugby union (Division 1) clubs recorded a history. The majority of football (Premiership and Championship) and rugby union (Premiership) clubs implemented both cardiovascular and musculoskeletal examinations of players before employment. Fewer than 25% of clubs in any of the groups implemented neurological examinations of players at pre-employment, although 100% of rugby union (Premiership) and rugby league clubs implemented neurological testing during pre-season. Conclusions: None of the sports implemented best practice guidelines for the preparticipation evaluation of players at all stages of their employment. Departures from best practice guidelines and differences in practices between clubs within the same sport leave club physicians vulnerable if their players sustain injuries or ill health conditions that could have been identified and avoided through the implementation of a preparticipation examination. [ABSTRACT FROM AUTHOR]

Background Colposcopy forms an essential part of National Health Service Cervical Screening Programme (NHSCSP). With an increased emphasis on accountability and improved performance, there is a need to identify the performance criteria that are essential to be satisfied by the colposcopists at the time of appraisal. Objective To identify the performance criteria essential for appraisal of colposcopists by two-generational Delphi survey. Design Delphi survey. Setting Annual British Society for Colposcopy and Cervical Pathology conference (BSCCP 2005, Edinburgh, UK). Population Four hundred and ninety-nine delegates attending the above conference. Method A two-generational Delphi survey was undertaken to identify the criteria needed for appraisal. The participants were asked to rate the relevance of quality items that might be considered necessary for appraisal of performance of colposcopists. After the first round, the results were presented, and the respondents were given the chance to reflect on their response and change it if necessary. Main outcome measures Criteria considered to be essential for appraisal of colposcopists in areas of training, diagnostic and therapeutic aspects and communication. Results In the first round, 306/499 (61%) participants returned the completed questionnaire. Sixty percent (187/306) of participants returned their questionnaire in the second round. In addition to BSCCP certification, four other criteria were identified, which were quality of recorded findings, biopsy rate when atypia noted, proportion of biopsies histologically adequate and proportion of normal initial posttreatment follow-up smears. Conclusion This Delphi survey has been the first to identify criteria to be used in the annual appraisal of professionals. It has resulted in a number of criteria that could be considered for the appraisal and possible revalidation of colposcopists practising in UK. [ABSTRACT FROM AUTHOR]

In the United Kingdom the National Health Service only provides dental implant treatment to patients who fulfil stringent clinical criteria outlined by the Royal College of Surgeons. Such treatment is normally in a hospital setting. The majority of dental implant work is otherwise carried out in the private sector. Concern about the quality of implant dentistry and training led the General Dental Council to convene a working group that set out to set training standards in implant dentistry for general dental practitioners (GDPs). The Faculty of General Dental Practitioners published this guidance in March 2006. This questionnaire based study set out to examine GDP attitudes to implant treatment and training and aims to contribute to the debate and review of appropriate training in dental implantology for GDPs. [ABSTRACT FROM AUTHOR]

Identity (identities indeed) constitutes the inner core of a person which Article 8 of the United Nations Convention on the Rights of the Child rightfully acknowledges. Given the illustrative and not exhaustive nature of Article 8, the right of a child, which includes an adolescent under the age of 18, to identity covers respect for his or her sexual minority identity. Empirical research findings will be utilised extensively in support of this proposition, together with a critique of the now repealed section 2A of the Local Government Act 1986 then applicable in the entire United Kingdom (save Northern Ireland) which disparaged homosexuality as a ‘pretended family relationship’. Jurisprudence from various legal systems, particularly the European Convention on Human Rights, will also be drawn upon to affirm the importance of an individual's right to identity, which includes sexual minority identity. [ABSTRACT FROM AUTHOR]

This paper is concerned with the impact of food scares, principally the BSE crisis in the UK, and focuses on price transmission in vertically related markets. We show that if market power has an effect on the farm–retail margin, this determines the specification of the cointegrating relationship and thus provides a test of market power. The results for the UK beef chain suggest that we cannot reject the importance of market power. The impact of the BSE crisis on farm prices is found to be more than double that on retail prices, thus corroborating public concerns regarding a differential impact of food scares on retailers and producers. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) involvement in non-Hodgkin lymphoma (NHL) is a well-recognised complication. There is no consensus regarding indications for prophylaxis or a standard CNS chemoprophylaxis regimen. Current UK practice was evaluated using a questionnaire. A total of 223 questionnaires were sent to clinicians who administered chemotherapy to patients with NHL; 158 (71%) evaluable questionnaires were returned. The overwhelming majority of respondents used prophylaxis in all cases of lymphoblastic lymphoma (97%) and Burkitt lymphoma (96%). Ninety-six per cent of respondents required risk factors to be present before prophylaxis was initiated in cases of diffuse large B-cell lymphoma. The commonest risk factor was site of involvement (paranasal sinus 88%, testicular 85%, orbital cavity 78%, bone marrow 65% and bone 28%). Other risk factors included stage IV, high International Prognostic Index score, >1 extranodal site and raised lactate dehydrogenase levels (34%, 21%, 16% and 10%). A total of 82% did not give prophylaxis in follicular lymphoma and 90% used intrathecal chemotherapy as their preferred method of prophylaxis. The most popular regimen was 12·5 mg methotrexate with each cycle of chemotherapy for six courses. Thirty-nine per cent used systemic chemotherapy for CNS prophylaxis either alone (4%) or as an adjunct to intrathecal prophylaxis (35%). These variations in the indications and methods of prophylaxis indicate that this subject deserves further review. [ABSTRACT FROM AUTHOR]