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Background: Current research has identified how ethnic minority women experience poorer health outcomes during the perinatal period. In the United Kingdom, specialist perinatal mental health services provide mental health treatment for women throughout the perinatal period. Service users have previously highlighted that perinatal services are hard to access and lack cultural sensitivity, whereas healthcare professionals have described limited opportunities and resources for developing cultural competency. Objectives: We explored the experiences of ethnic minority women with National Health Service (NHS) specialist perinatal teams and identified what culturally sensitive perinatal mental health care means to this group. Design: Individual semi‐structured interviews were conducted, and an interpretative phenomenological analysis framework was used to analyse the interview transcripts. Setting and Participants: Participants were recruited from NHS specialist perinatal teams and online via social media. Results: Six women were interviewed. Four group experiential themes central to the experiences of participants emerged: (1) strengthening community networks and peer support; (2) valuing cultural curiosity; (3) making sense of how culture, ethnicity, race and racism impact mental health; and (4) tailoring interventions to ethnic minority women and their families. Discussion and Conclusions: The findings capture how ethnic minority women experience specialist perinatal teams and offer insights into practising culturally sensitive care. Perinatal mental health professionals can support ethnic minority women by strengthening their access to community resources and peer support; being curious about their culture; helping them to make sense of how culture, ethnicity, race and mental health interact; and applying cultural and practical adaptations to interventions. Patient or Public Contribution: A Lived Experience Advisory Group (LEAG) of women from ethnic minority groups contributed to the design and conduct of this study. The LEAG had lived experience of perinatal mental health conditions and accessing specialist perinatal teams. The LEAG chose to co‐produce specific aspects of the research they felt fit with their skills and available time throughout five group sessions. These aspects included developing the interview topic guide, a structure for debriefing participants and advising on the social media recruitment strategy. [ABSTRACT FROM AUTHOR]

Background: The Live Well with Parkinson's Self-Management Toolkit is designed for use in the NHS to support people with Parkinson's, their carers and health professionals in managing motor and non-motor symptoms and promoting well-being. The Toolkit was developed based on theory-based behaviour change and self-management techniques in consultation with people living with Parkinson's and health and social care practitioners. There are digital (e-Toolkit) and paper (manual) versions. Methods: Single-blind two-arm randomised controlled trial RCT of clinical effectiveness and cost-effectiveness of the Toolkit, facilitated by up to six sessions with a trained non-specialist supporter, in improving quality of life. People with Parkinson's will be assessed at baseline, 6 and 12 months. Assessors will be blind to the treatment group. The primary outcome measure is the Parkinson's Disease Questionnaire (PDQ-39, Parkinson's related quality of life) score at 12 months. Secondary outcome measures include the MDS Unified Parkinson's Disease Rating Scale (Part I, II, III, IV), EQ-5D, and a Client Service Receipt Inventory shortened, adapted for Parkinson's. Carer outcomes include the Zarit Carer Burden Inventory and Carer Quality of Life Questionnaire for Parkinsonism. A total of 338 people with Parkinson's, and their carers if appropriate, will be recruited from diverse settings across England. Those with advanced dementia, at end-of-life or with atypical Parkinsonism will be excluded. A parallel mixed methods process evaluation will explore the factors promoting or inhibiting implementation, uptake, use, effectiveness and cost-effectiveness of the Toolkit and sessions. Discussion: If successful, the Live Well with Parkinson's Toolkit could be used as a model for other complex long-term disorders, including dementia. This would bridge existing gaps in the NHS (as shown by the national Parkinson's audit data), by enabling patients and carers to access personalised information, advice and support on symptom management and 'living well' with Parkinson's. Trial registration: ISRCTN92831552. Registered on 26th Oct 2021. [ABSTRACT FROM AUTHOR]

Objective: An estimated 15 million patients in England have at least 1 long-term condition, with the prevalence of chronic kidney disease rising. Understanding educational support can help navigate between health sectors. Methodology: This research used Qualitative Methodology, and an Inductive Content Analysis (ICA) approach which is particularly effective in linking theory, or framework. Two workshops took place in May and June (2019) wherein topic tagging activities were co-developed between the Renal Patient Support Group (RPSG) and the Kidney Disease and Renal Support Groups (KDARs) for Kids platforms. 19 participants between 4 cohorts, that included 6 General Practitioner (GPs), 4 Healthcare Scientists (HS), 3 Nephrologists/ Clinicians (N/Cs), and 6 CKD Patients (CKDPs) were recruited and participated in telephone interviews. Topic guides were developed for participant cohorts with several themes to collect data through one-to-one telephone interviews. NViVo-12 software provided opportunity to code and glean insight to develop overall conclusions Results: Nine main themes and several sub-themes were identified when coding for health professionals, and 9 main themes and several sub-themes identified when coding qualitative data for chronic kidney disease patients. Conclusion: There needs to be a coordinated effort between patients and professionals, to understand how chronic kidney disease education should be more integrated at point of care, and in line with public health. [ABSTRACT FROM AUTHOR]

Background: Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. Methods: A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results: Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions: Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients' individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration: PROSPERO: CRD42020184458. [ABSTRACT FROM AUTHOR]

The article explores lessons from the Making Wound Care Work report and ways to drive higher standards for wound care in England to help build a better future for people living with chronic wound. It describes the state of wound care in England and considers co-creation as the foundation of wound care service delivery. Core issues facing redesign of wound care are cited. Recommendations to effect changes to wound care include training, shared decision making and supported shared care needs.

Context: Agri-environment schemes support land management interventions that benefit biodiversity, environmental objectives, and other public goods. Process-based model simulations suggest the English scheme, as implemented in 2016, increased wild bee pollination services to pollinator-dependent crops and non-crop areas in a geographically heterogeneous manner. Objectives: We investigated which interventions drove the scheme-wide predicted pollination service increase to oilseed rape, field beans and non-cropped areas. We determined whether the relative contribution of each intervention was related to floral and/or nesting resource quality of the intervention, area of uptake, or placement in the landscape. Methods: We categorised interventions into functional groups and used linear regression to determine the relationship between predicted visitation rate increase and each category's area within a 10 km grid tile. We compared the magnitude of the regression coefficients to measures of resource quality, area of uptake nationally, and placement to infer the factors underpinning this relationship. Results: Hedgerow/woodland edge management had the largest positive effect on pollination service change, due to high resource quality. Fallow areas were also strong drivers, despite lower resource quality, implying effective placement. Floral margins had limited benefit due to later resource phenology. Interventions had stronger effects where there was less pre-existing semi-natural habitat. Conclusions: Future schemes could support greater and more resilient pollination service in arable landscapes by promoting hedgerow/woodland edge management and fallow interventions. Including early-flowering species and increasing uptake would improve the effect of floral margins. Spatial targeting of interventions should consider landscape context and pairing complimentary interventions to maximise whole-scheme effectiveness. [ABSTRACT FROM AUTHOR]

Background: Responding to the COVID‐19 pandemic, Health Education England (HEE) mobilised a group of expert searchers from NHS libraries in England to develop a platform for librarians to share peer reviewed search strategies and results on the Knowledge for Healthcare website. Objectives: (1) To document the origins of the COVID‐19 search bank, (2) evaluate attitudes of NHS librarians in England towards the search bank and (3) identify lessons learned and consider whether the initiative might be developed further. Methods: Structured interviews with the peer reviewers (n = 10) were conducted, and a questionnaire survey of the NHS library community using the search bank was undertaken. Results: The interviews confirmed the value of collaboration. Expert searchers worked in pairs to peer review submitted search strategies. The survey (85 responses) indicated that a majority had used the search bank, and approved of the project, with some differences of opinion on functionality and future developments. Discussion: Collaborative working for the search bank probably saved time for individual NHS librarians. The quality of the searches submitted was variable as were librarians' approaches to presentation and development of search strategies. Peer review benefits from a buddy approach among expert searchers and agreement about feedback provided to contributors. Conclusion: Search strategies are the most useful element of a search bank. Peer review can be challenging and would benefit from a formal structure, but it is professionally rewarding. [ABSTRACT FROM AUTHOR]

Background: The deployment of (Trainee) Associate Psychological Practitioners (T/APPs) to deliver brief psychological interventions focusing on preventing mental health deterioration and promoting emotional wellbeing in General Practice settings is a novel development in the North West of England. As the need and demand for psychological practitioners increases, new workforce supply routes are required to meet this growth. Aims: To evaluate the clinical impact and efficacy of the mental health prevention and promotion service, provided by the T/APPs and the acceptability of the role from the perspective of the workforce and the role to T/APPs, patients and services. Methods: A mixed-methods design was used. To evaluate clinical outcomes, patients completed measures of wellbeing (WEMWBS), depression (PHQ-9), anxiety (GAD-7) and resilience (BRS) at the first session, final session and at a 4–6 week follow-up. Paired-samples t-tests were conducted comparing scores from session 1 and session 4, and session 1 and follow-up for each of the four outcome measures. To evaluate acceptability, questionnaires were sent to General Practice staff, T/APPs and patients to gather qualitative and quantitative feedback on their views of the T/APP role. Quantitative responses were collated and summarised. Qualitative responses were analysed using inductive summative content analysis to identify themes. Results: T-test analysis revealed clinically and statistically significant reductions in depression and anxiety and elevations in wellbeing and resiliency between session 1 and session 4, and at follow-up. Moderate–large effect sizes were recorded. Acceptability of the T/APP role was established across General Practice staff, T/APPs and patients. Content analysis revealed two main themes: positive feedback and constructive feedback. Positive sub-themes included accessibility of support, type of support, patient benefit and primary care network benefit. Constructive sub-themes included integration of the role and limitations to the support. Conclusions: The introduction of T/APPs into General Practice settings to deliver brief mental health prevention and promotion interventions is both clinically effective and acceptable to patients, General Practice staff and psychology graduates. [ABSTRACT FROM AUTHOR]

Psychoanalysis can advance our understanding of responses from the hierarchy of mainstream religious denominations to disclosures of abuse by clergy. This paper takes analytic insights to discuss how and why the Anglican institutional church has responded so callously to disclosures of child sexual abuse within the church. Inhumane responses have led to feelings of institutional betrayal in survivor groups. The subject is explored firstly in the context of organizational and group dynamics, and, secondly, by analysing defences that underly the interaction between the person who has been abused and the member of the church hierarchy who is hearing the disclosure. Defences and deceptions have been consciously and unconsciously used within the organization that have obstructed contact with reality, and so hindered it both in fulfilling its task in responding appropriately to what has taken place, and in adapting to changing circumstances. Churches have been active agents in re-traumatising individuals. Examples to illustrate are taken from hearings on the Anglican Church by the Independent Inquiry into Child Sexual Abuse in England, UK. The idea of organizational redemption is presented. [ABSTRACT FROM AUTHOR]

Purpose: Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction worldwide. However, the current incidence of DCM is poorly understood. The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise surgical activity for DCM in England. Methods: The HES database was interrogated for all cases of DCM between 2012 and 2019. DCM cases were identified from 5 ICD-10 codes. Age-stratified values were collected for 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital admission under a lead clinician. Data was analysed to explore current annual activity and longitudinal change. Results: 34,903 FCEs with one or more of the five ICD-10 codes were identified, of which 18,733 (53.6%) were of working age (18–64 years). Mean incidence of DCM was 7.44 per 100,000 (SD ± 0.32). Overall incidence of DCM rose from 6.94 per 100,000 in 2012–2013 to 7.54 per 100,000 in 2018–2019. The highest incidence was seen in 2016–2017 (7.94 per 100,000). The median male number of FCEs per year (2919, IQR: 228) was consistently higher than the median female number of FCEs per year (2216, IQR: 326). The rates of both emergency admissions and planned admissions are rising. Conclusions: The incidence of hospitalisation for DCM in England is rising. Health care policymakers and providers must recognise the increasing burden of DCM and act to address both early diagnoses and access to treatment in future service provision plans. [ABSTRACT FROM AUTHOR]

Current carbon cycle models attribute rising atmospheric CO2 as the major driver of the increased terrestrial carbon sink, but with substantial uncertainties. The photosynthetic response of trees to elevated atmospheric CO2 is a necessary step, but not the only one, for sustaining the terrestrial carbon uptake, but can vary diurnally, seasonally and with duration of CO2 exposure. Hence, we sought to quantify the photosynthetic response of the canopy-dominant species, Quercus robur , in a mature deciduous forest to elevated CO2 (eCO2) (+150 μmol mol−1 CO2) over the first 3 years of a long-term free air CO2 enrichment facility at the Birmingham Institute of Forest Research in central England (BIFoR FACE). Over 3000 measurements of leaf gas exchange and related biochemical parameters were conducted in the upper canopy to assess the diurnal and seasonal responses of photosynthesis during the 2nd and 3rd year of eCO2 exposure. Measurements of photosynthetic capacity via biochemical parameters, derived from CO2 response curves, (V cmax and J max) together with leaf nitrogen concentrations from the pre-treatment year to the 3rd year of eCO2 exposure, were examined. We hypothesized an initial enhancement in light-saturated net photosynthetic rates (Asat) with CO2 enrichment of ≈37% based on theory but also expected photosynthetic capacity would fall over the duration of the study. Over the 3-year period, Asat of upper-canopy leaves was 33 ± 8% higher (mean and standard error) in trees grown in eCO2 compared with ambient CO2 (aCO2), and photosynthetic enhancement decreased with decreasing light. There were no significant effects of CO2 treatment on V cmax or J max, nor leaf nitrogen. Our results suggest that mature Q. robur may exhibit a sustained, positive response to eCO2 without photosynthetic downregulation, suggesting that, with adequate nutrients, there will be sustained enhancement in C assimilated by these mature trees. Further research will be required to understand the location and role of the additionally assimilated carbon. [ABSTRACT FROM AUTHOR]

Pollinators experience large spatiotemporal fluctuations in resource availability when mass‐flowering crops are rotated with resource‐poor cereal crops. Yet, few studies have considered the effect this has on pollinator population stability, nor how this might be mitigated to maintain consistent crop pollination services.We assess the potential of boundary features (standard narrow 1 m grassy margins, hedgerows and wide 4 m agri‐environment margins) to support and stabilise pollinator populations and pollination service in agricultural landscapes under crop rotation. Assuming a 6‐year rotation, we use a process‐based pollinator model to predict yearly pollinator population size and in‐crop visitation rates to oilseed rape and field bean across 117 study landscapes in England with varying amounts of boundary features. We model both ground‐nesting bumblebees and solitary bees and compare the predictions including and excluding boundary features from the landscapes.Ground‐nesting bumblebee populations, whose longer‐lifetime colonies benefit from continuity of resources, were larger and more stable (relative to the no‐features scenario) in landscapes with more boundary features. Ground‐nesting solitary bee populations were also larger but not significantly more stable, except with the introduction of wide permanent agri‐environment margins, due to their shorter lifetimes and shorter foraging/dispersal ranges.Crop visitation by ground‐nesting bumblebees was greater and more stable in landscapes with more boundary features, partly due to increased colony growth prior to crop flowering. Time averaged crop visitation by ground‐nesting solitary bees was slightly lower, due to females dividing their foraging time between boundary features and the crop. However, despite this, the minimum pollination service delivered was higher, due to the more stable delivery.Synthesis and applications. Field boundary features have an important role in stabilising pollinator populations and pollination service in rotational systems, although maintenance of larger semi‐natural habitat patches may be more effective for stabilising less mobile solitary bee populations. We recommend using combinations of boundary features, accounting for pollinator range when spacing features/rotating crops, and synchronising boundary feature management with crop rotation to maximise their stabilising benefits. [ABSTRACT FROM AUTHOR]

Economic policies tend to downplay social and community considerations in favour of market-led and business-focussed support. The COVID-19 pandemic underscored the need for greater and deeper social cohesion and local social support networks while highlighting that an overreliance on market forces can create social problems at times of need. Community businesses (CBs) are not for profit organisations that provide services and produce goods where the profit (or surplus) is reinvested back into that community. This article explores why CBs in England responded in a variety of ways to the COVID-19 pandemic, assesses what government policy did to help and hinder their place-based operations, and explores the observed socioeconomics of their age-related volunteer staff churn. Some CBs were ravaged by the consequences of the pandemic and associated government policies with many becoming unsustainable, while others evolved and augmented their support for and services to their communities, thereby enhancing their community's resilience. We highlight how adjustments to government policies could enhance the sustainability of CBs, making them and the communities they serve more resilient. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach: Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings: All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value: To the best of the authors' knowledge, this is the first paper to compare dementia assessment provision between different services in England. [ABSTRACT FROM AUTHOR]

Aims: To investigate diabetic retinopathy screening attendance and trends in certified vision impairment caused by diabetic eye disease. Methods: This was a retrospective study of attendance in three urban UK diabetic eye screening programmes in England. A survival analysis was performed to investigate time from diagnosis to first screen by age and sex. Logistic regression analysis of factors influencing screening attendance during a 15‐month reporting period was conducted, as well as analysis of new vision impairment certifications (Certificate of Vision Impairment) in England and Wales from 2009 to 2019. Results: Of those newly registered in the Routine Digital Screening pathway (n = 97 048), 80% attended screening within the first 12 months and 88% by 36 months. Time from registration to first eye screening was longer for people aged 18–34 years, and 20% were unscreened after 3 years. Delay in first screen was associated with increased risk of referable retinopathy. Although 95% of participants (n = 291 296) attended during the 15‐month reporting period, uptake varied considerably. Younger age, social deprivation, ethnicity and duration of diabetes were independent predictors of non‐attendance and referable retinopathy. Although the last 10 years has seen an overall reduction in vision impairment certification attributable to diabetic eye disease, the incidence of vision impairment in those aged <35 years was unchanged. Conclusions: Whilst the majority of participants are screened in a timely manner, there is considerable variation in uptake. Young adults, have sub‐optimal attendance, and levels of vision impairment in this population have not changed over the last 10 years. There is an urgent need to explore barriers to/enablers of attendance in this group to inform policy initiatives and tailored interventions to address this issue. [ABSTRACT FROM AUTHOR]

Background: Heart failure affects 26 million people globally, and the optimal management of medicines is crucial for patients, particularly when their care is transferred between hospital and the community. Optimising clinical outcomes requires well-calibrated cross-organisational processes with staff and patients responding and adapting to medicines changes. The aim of this study was to assess the feasibility of implementing a complex intervention (the Medicines at Transitions Intervention; MaTI) co-designed by patients and healthcare staff. The purpose of the intervention was to optimise medicines management across the gaps between secondary and primary care when hospitals handover care. The study objectives were to (1) assess feasibility through meeting specified progression criteria to proceed to the trial, (2) assess if the intervention was acceptable to staff and patients, and (3) determine whether amendment or refinement would be needed to enhance the MaTI. Methods: The feasibility of the MaTI was tested in three healthcare areas in the North of England between July and October 2017. Feasibility was measured and assessed through four agreed progression to trial criteria: (1) patient recruitment, (2) patient receipt of a medicines toolkit, (3) transfer of discharge information to community pharmacy, and (4) offer of a community pharmacy medicines review/discussion or medicines reconciliation. From the cardiology wards at each of the three NHS Acute Trusts (sites), 10 patients (aged ≥ 18 years) were recruited and introduced to the 'My Medicines Toolkit' (MMT). Patients were asked to identify their usual community pharmacy or nominate a pharmacy. Discharge information was transferred to the community pharmacy; pharmacists were asked to reconcile medicines and invited patients for a medicines use review (MUR) or discussion. At 1 month following discharge, all patients were sent three questionnaire sets: quality-of-life, healthcare utilisation, and a patient experience survey. In a purposive sample, 20 patients were invited to participate in a semi-structured interview about their experiences of the MaTI. Staff from hospital and primary care settings involved in patients' care were invited to participate in a semi-structured interview. Patient and staff interviews were analysed using Framework Analysis. Questionnaire completion rates were recorded and data were descriptively analysed. Results: Thirty-one patients were recruited across three sites. Eighteen staff and 18 patients took part in interviews, and 19 patients returned questionnaire sets. All four progression to trial criteria were met. We identified barriers to patient engagement with the intervention in hospital, which were compounded by patients' focus on returning home. Some patients described not engaging in discussions with staff about medicines and lacking motivation to do so because they were preoccupied with returning home. Some patients were unable or unwilling to attend a community pharmacy in person for a medicines review. Roles and responsibilities for delivering the MaTI were different in the three sites, and staff reported variations in time spent on MaTI activities. Staff reported some work pressures and staff absences that limited the time they could spend talking to patients about their medicines. Clinical teams reported that recording a target dose for heart failure medicines in patient-held documentation was difficult as they did not always know the ideal or tolerable dose. The majority of patients reported receiving the patient-held documentation. More than two-thirds reported being offered a MUR by their community pharmacists. Conclusions: Delivery of the Medicines at Transitions Intervention (MaTI) was feasible at all three sites, and progression to trial criteria were met. Refinements were found to be necessary to overcome identified barriers and strengthen delivery of all steps of the intervention. Necessary changes to the MaTI were identified along with amendments to the implementation plan for the subsequent trial. Future implementation needs to take into account the complexity of medicines management and adaptation to local context. [ABSTRACT FROM AUTHOR]

Ticks are blood-feeding parasites with limited locomotion, known for transmitting multiple pathogens to vertebrates. England et al. suggest that ticks can be easily pulled, via electrostatic induction, toward charged hosts with fluffy coats that are prone to accumulate higher electrostatic potentials. Thus, static electricity may influence ticks' ecology and management. [ABSTRACT FROM AUTHOR]

The Global Education Reform Movement (GERM), emerged in the 1980s and has influenced the education systems of the USA, England and, increasingly, Australia (Sahlberg 2012). Perhaps the GERM juggernaut has been a little slower to arrive in Australia, but it is now coming down the road at breakneck speed and it looks remarkably like the one witnessed in England, following the 'Rose Report' (2006). Needless to say, the 'primacy' of synthetic phonics is emblazoned in large capital letters down the side of the vehicle. At the steering wheel are drivers who look remarkably like those driving the English counterpart: a Minister of Education of a newly elected neo-liberal government and appointed 'reading experts', some of whom have pecuniary interests in commercial synthetic phonic programmes. [ABSTRACT FROM AUTHOR]

Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi‐structured interviews with 16 older people with mild frailty who received a pilot home‐based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio‐recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well‐being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients' ePHR use is important to increase adoption rates and improve the implementation success of ePHRs.Objective: This study aimed to examine factors associated with patients' use of ePHRs in England.Methods: The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling.Results: Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB.Conclusions: This study identified the main factors that affect patients' use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients' preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors. [ABSTRACT FROM AUTHOR]

Background Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports. Aims This study aimed to examine office workers' impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour. Methods Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a 'think-aloud' narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts. Results Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them. Conclusions Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour. [ABSTRACT FROM AUTHOR]

• The performance of Low Cost Baffles for upstream cyprinid passage was measured. • Fish passed the weir under a range of flow conditions post-LCB installation. • Larger fish were less likely to be successful than smaller fish. • No difference in the passage performance or behaviour between wild and stocked fish. • High potential for LCBs to be used as a retrofit fishway for steep sloping weirs. Weir construction has fragmented many rivers, resulting in the exclusion of some fish populations from suitable habitat. A cheap retrofit fishway for small, sloping weirs is the Low Cost Baffle (LCB) solution – A series of notched baffles perpendicular to flow on the downstream weir face, generating an angled passage route across the weir face. To test the degree to which LCBs can pass upstream-moving, lowland-river fish at steep weirs, LCBs were fitted onto a 1:3.3-sloping gauging-weir face, in an urban tributary of the River Thames, England. The study also compared the passage of wild and stocked fish (the latter are employed to facilitate population recovery in restored English rivers). Passive Integrated Transponder (PIT) antennas were positioned on the weir to record the upstream movement of PIT-tagged barbel (Barbus barbus ; n stock = 120), chub (Squalius cephalus ; n stock = 119; n wild = 194), dace (Leuciscus leuciscus ; n wild = 50), and roach (Rutilus rutilus ; n wild = 30). Over six months, more stocked fish attempted passage (58.9%) than wild (14.6%; χ 2 1 = 26.7, p < 0.001), but there was no difference in successful passage of those that attempted (stock = 34.0%; wild = 40.0%; χ 2 1 = 0.5, p = 0.49). Successful passage was achieved under a range of flow conditions. This study finds that LCBs have the potential to facilitate passage for cyprinid fishes at steep urban weirs that cannot readily be removed, but there is need for design improvements. This study also indicates that stocked and wild fish exhibited similar passage success, a finding with important management implications for achieving dispersal of stocked fish as a rehabilitation measure. [ABSTRACT FROM AUTHOR]

A comparative analysis of English in the primary curricula of England and Australia reveals markedly different policy perspectives of the functions and purposes of language, literacy and literature in these two Anglophone countries. Whilst the Australian curriculum incorporates 'the basics' with broader socio-linguistic views of language in an attempt to construct breadth and balance, the English curriculum is predominantly a didactic adherence to 'the old basics'. Using discourse and content analysis, a systematic review of the two curricula is undertaken and evaluated by applying Cox's five models of English and Kalantzis et al.'s four paradigms of literacy. The results of this study have important implications for teachers, academics and policy-makers in all Anglophone countries, especially the two countries that are the focus of the study. [ABSTRACT FROM AUTHOR]

Background Prisoners with intellectual disabilities are known to be disadvantaged in prisons and to be more susceptible to bullying, segregation, depression and anxiety than other prisoners. Method In this study, nearly 3000 new prisoners entering three English prisons were offered screening for intellectual disabilities, using the LDSQ. Results On average, 75% of all new prisoners entering prison were offered screening, and only 14% refused screening. Overall, just less than 7% were screened positive on the LDSQ and prisons made some reasonable adjustments as a result. Conclusions It is argued that it is feasible to screen for intellectual disabilities in prisons and, given the inequalities to which prisoners with intellectual disabilities are subject in prison, it is time for such screening to be rolled out to all prisons. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer.Design: Multicentre, randomised, non-inferiority trial.Setting: Five centres in the North West of England.Sample: A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up.Methods: Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU.Main Outcome Measures: Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence.Results: The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005).Conclusions: The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups.Tweetable Abstract: ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer. [ABSTRACT FROM AUTHOR]

Land use policy in England is encouraging tree planting on farms to meet decarbonisation targets. This could be delivered through woodland creation, hedgerow planting or agroforestry. All three approaches could provide co-benefits for wild bee populations and crop pollination services, by increasing nesting and floral resources, but their relative effectiveness has not been studied at a landscape scale. We simulated six tree planting scenarios and used a validated process-based model to predict their effect on bumblebee abundance and pollination service to two common mass-flowering crops (oilseed rape and field beans) in a representative 10x10km agricultural landscape in England, UK. Two levels of planting intensity were studied: one representing the tree cover that would be achieved by 2035 if the 2020 woodland creation rate continues and another reflecting UK Government ambitions (threefold increase in planting rate). Hedgerow planting and woodland were predicted to give the biggest increase bumblebee abundance. Silvoarable agroforestry using fruit trees or willow was predicted, on average, to give the biggest increase in crop pollination service. However, the magnitude of increase was highly variable and hedgerow creation (which is more dispersed across the landscape) provided a more consistent increase in crop pollination services. Agroforestry with poplar (which offers less floral resource) and woodland creation (which concentrates tree planting in fewer locations) were only effective at enhancing landscape-level crop pollination at high planting intensity. Future land management policy should promote fruit tree and willow-based agroforestry as multifunctional tree planting measures in arable contexts, whilst continuing to encourage hedgerow planting and woodland creation for their role in promoting abundance and diversity of pollinators. Hedgerow planting may be needed alongside agroforestry to help stabilise pollination service through a crop rotation cycle. • We modelled the impact of different farmland tree-planting scenarios on bumblebees. • We simulated planting intensities based on current rates and UK Government ambitions. • Hedgerows and woodland produced the greatest increase in bumblebee abundance. • Fruit tree and willow agroforestry produced the greatest increase in crop visitation. • Hedgerows produced a smaller increase in crop visitation but over a larger area. [ABSTRACT FROM AUTHOR]

The article presents the biography of medical doctor William Close in England. Close was born on May 25, 1775 in the Lake District of north-west England. On April 18, 1797, Close received his diploma and immediately started medical and surgical practice in the small town of Dalton where he spent the remaining 16 years of his life. In 1803, Close married his wife and had two children. Close was diagnosed with tuberculosis in 1811 and died two years later.

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14% (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = -0.220, p < 0.002), triglycerides (r = -0.160, p = 0.024), total cholesterol (r = -0.144, p = 0.043), fasting glucose (r = -0.191, p = 0.007), HbA1c (r = -0.183, p = 0.01), and serum CRP levels (r = -0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

BackgroundThe aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment.MethodBaseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18–65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria.ResultsHigh rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS.ConclusionsIn the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis. [ABSTRACT FROM AUTHOR]

Key Practitioner Messages SafeCare is a structured training programme for parents, developed in America for families where there were concerns about possible neglect or abuse., SafeCare has been implemented in six NSPCC sites. An evaluation is considering whether and how it can contribute to the prevention and amelioration of child neglect in the UK., The service development and early implementation experiences are outlined, including the varying practitioner responses to the implementation of a structured, manualised programme. [ABSTRACT FROM AUTHOR]

People with serious mental illness (SMI) such as schizophrenia, schizoaffective disorders and bipolar disorder are at increased risk of developing diabetes, cardiovascular disease and respiratory disease, contributing to significantly reduced life expectancies. As a result, emphasis has been placed on developing Health Promotion Programmes (HPPs) to modify the risk of poor physical health in SMI. We examined how many and what types of HPPs are available for or inclusive of people with SMI across four borough in South London, UK. A cross-sectional mapping study was carried out to identify the number of HPPs available to people with SMI. We found 145 HPPs available to people with SMI existed across the four boroughs but with an inequitable distribution, which in some boroughs we anticipate may not meet need. In some cases, HPPs set admission conditions which were likely to further impede access. We recommend that accurate and readily available information on the provision of HPPs for or inclusive of people with SMI is needed. [ABSTRACT FROM AUTHOR]

Background Alcohol consumption ( AC) and alcohol problems ( AP) are complex traits. How many factors reflecting parental AC and AP are present in the large prospectively followed Avon Longitudinal Study of Parents and Children cohort? Would these factors be uniquely associated with various temperamental and alcohol-related outcomes in the children? Methods We factor-analyzed multiple items reflecting maternal and paternal AC and AP measured over a 12-year period from before the birth of the child ( n = 14,093 families). We examined, by linear regression controlling for socioeconomic status, the relationship between scales derived from these factors and offspring early childhood temperament, externalizing traits, and adolescent AC and AP ( ns ranging from 9,732 to 3,454). Results We identified 5 coherent factors: typical maternal AC, maternal AC during pregnancy, maternal AP, paternal AC, and paternal AP. In univariate analyses, maternal and paternal AC and AP were modestly and significantly associated with low shyness, sociability, hyperactivity, and conduct problems in childhood and early adolescence; delinquent behavior at age 15; and AC and AP at ages 15 and 18. AC and AP at age 18 were more strongly predicted by parental factors than at age 15. Maternal AC during pregnancy uniquely predicted externalizing traits at ages 4, 13, and 15. Conclusions Parental AC and AP are complex multidimensional traits that differ in their association with a range of relevant measures in their children. Controlling for background AC and AP, self-reported levels of maternal AC during pregnancy uniquely predicted externalizing behaviors in childhood and adolescence. [ABSTRACT FROM AUTHOR]

Habit formation is thought to aid maintenance of physical activity, but little research is available into determinants of habit strength aside from repeated performance. Previous work has shown that intrinsically motivated physical activity, underpinned by inherent satisfaction derived from activity, is more likely to be sustained. We explored whether this might reflect a tendency for self-determined activity to become more strongly habitual. A sample of 192 adults aged 18-30 completed measures of motivational regulation, intention, behaviour, and habit strength. Results showed that self-determined regulation interacted with past behaviour in predicting habit strength: prior action was more predictive of habit strength among more autonomously motivated participants. There was an unexpected direct effect of self-determined regulation on habit strength, independently of past behaviour. Findings offer possible directions for future habit formation work. [ABSTRACT FROM AUTHOR]

Research largely shows that religion and spirituality have a positive correlation to psychological well-being. However, there has been a great deal of confusion and debate over their operational definitions. This study attempted to delineate the two constructs and categorise participants into different groups based on measured levels of religious involvement and spirituality. The groups were then scored against specific measures of well-being. A total of 205 participants from a wide range of religious affiliations and faith groups were recruited from various religious institutions and spiritual meetings. They were assigned to one of four groups with the following characteristics: (1) a high level of religious involvement and spirituality, (2) a low level of religious involvement with a high level of spirituality, (3) a high level of religious involvement with a low level of spirituality, and (4) a low level of religious involvement and spirituality. Multiple comparisons were made between the groups on three measures of psychological well-being: levels of self-actualisation, meaning in life, and personal growth initiative. As predicted, it was discovered that, aside from a few exceptions, groups (1) and (2) obtained higher scores on all three measures. As such, these results confirm the importance of spirituality on psychological well-being, regardless of whether it is experienced through religious participation. [ABSTRACT FROM AUTHOR]

Acoustic telemetry was used to investigate the longitudinal and lateral movements and distribution of adult common bream, Abramis brama (L.), over 43 months in a heavily modified lowland river in eastern England. A positive relationship between activity and temperature was found, with bream moving greater cumulative distances during the warmer months and distributed over a greater longitudinal proportion of the main channel. The occupancy of tributaries was related to temperature, with bream entering shallow tributaries during rising temperatures in the spring, whilst a deeper, slow-flowing tributary was used more frequently during the cooler autumn/winter months. During the autumn, occupancy of this deeper tributary was positively related to flow rate in the main channel, suggesting that bream use this tributary for flow refuge. The functions of these behaviours are discussed along with potential management of heavily modified lowland rivers. [ABSTRACT FROM AUTHOR]

Participation in health care is an important element of self-management in chronic illness, and policy emphasises patient’s choice. Evidence suggests that this may be inequitable and inadequate, since active participation is strongly associated with socio-demographic variables. This qualitative study explores the perceptions of participation in people with differing socio-economic status with themes related to health literacy and relationship with health-care professionals. Patients perceive participation in different ways, related to their prior expectations of a health-care consultation, cultural expectations and social position. Policies aimed at simply improving ‘health literacy’ and choice will not be successful if these broader disparities are not addressed. [ABSTRACT FROM PUBLISHER]

Objective. Patients’ beliefs regarding the cause of illness may influence treatment adherence and long-term outcome. Little is known of adolescents’ beliefs regarding the cause of JIA. This study aims to identify adolescents’ beliefs about the underlying cause of their arthritis at first presentation to the paediatric rheumatology department.Methods. One hundred and twenty-two adolescents aged &geq;11 years participating in the larger prospective Childhood Arthritis Prospective Study, an inception cohort of childhood-onset inflammatory arthritis, were asked to complete a questionnaire regarding underlying beliefs about their arthritis. The top-listed causes were identified, and associations between beliefs and characteristics of the adolescents and their arthritis were compared across the different causal beliefs.Results. The most common causal beliefs were genetics (27.1%), the immune system (21.3%), accident or injury (15.6%) and infection (13.1%). Association between causal beliefs and gender, disease duration, International League Against Rheumatism subtype and source of referral was observed, although small numbers prevented robust statistical comparisons.Conclusion. This first report on adolescents’ beliefs about the cause of their juvenile arthritis found the most common causal beliefs to be related to genes or the immune system. Brief assessments of adolescents’ beliefs at presentation will enable providers to modify or adapt potentially unhelpful beliefs and provide age-appropriate information regarding arthritis. [ABSTRACT FROM PUBLISHER]

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre–post changes in Body Mass Index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008–2009; N = 4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change. [ABSTRACT FROM PUBLISHER]

Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research. [ABSTRACT FROM AUTHOR]

Purpose - With the introduction of the personalisation agenda (Department of Health, 2008) within social care (and health), this paper aims to discursively explore two themes: improving the lives of people with acquired brain injury through the introduction of more personalised services and support; and the impact of the culture shift on Headway Cambridgeshire as a service provider.Design/methodology/approach - The paper presents examples to illustrate how it is possible to plan in a way that is broad enough to meet the needs of the majority whilst being flexible enough to deal with differing individualised circumstances.Findings - The paper highlights the challenges faced by individuals and service provider organisations when introducing personalised services and suggests some approaches that can be taken to overcome them.Practical implications - Recommendations for good practice in personalised services.Originality/value - This paper sets out a framework for organisations working with people with acquired brain injury in a social care setting in the community and how the principles embodied by the personalisation agenda can be introduced into existing service provision. [ABSTRACT FROM AUTHOR]

This study explores the experiences of health professionals in managerial roles at various levels in child and adult hospice care in northern England, studying perspectives around managing medical error, the issues that arise, and the challenges faced. A multicentred, descriptive, exploratory design was adopted. The sample comprised 10 hospice managers (five deputy and five senior managers) from four hospices (two adult and two children's) in the north of England. Participants took part in individual semi-structured interviews, which lasted between 45-60 minutes each. Interviews were transcribed and analysed by a team of three researchers, including two health psychologists and one nurse using a qualitative analytic framework. Emerging themes appeared to be inter-related and were ultimately linked to two meta-concepts; underpinning and fundamental to the data, these issues were intrinsically tied to all emerging themes. Primary themes were defined by their explanatory power and regularity. Primary themes highlighted the impact of managing error on management teams at a professional and personal level, the challenges for error management in hospice settings, the use of error management tools, and the conceptualization of blame in these settings. The strong influence of the health-care setting in which an error takes place on the outcomes of an error event for the health professional, managers, health-care organizations, and ultimately patients was evident. [ABSTRACT FROM AUTHOR]

The article focuses on history of Cornwall, England's rich tin and mineral resources. It states that the county became the major source of tin and other minerals when Saint Piran, tin miners' patron saint, discovered white molten tin from his fire according to a legend which is also the symbol of the county's flag. It says that Cornwall used to smelt tin with the use of granite during the 14th and 19th centuries. It adds that Cornish are known worldwide for their tin-smelting stories.

a. Objective To identify differences between heterosexual black Africans (HBA) and men who have sex with men (MSM) in their perception of general practitioner (GP) care for HIV. b. Methods HIV positive patients attending an HIV clinic completed a selfadministered anonymous questionnaire about access to general practitioner and other services for HIV care. c. Results Compared to MSM, HBA were less likely to receive their HIV diagnosis in the UK (P= 0.09), more likely to prefer both an earlier HIV diagnosis (P<0.001) and polyclinic attendance to hospital (p=0.02), and in those with GPs, were less likely that their GP was aware of their HIV diagnosis (P=0.004), more likely to have confidentiality concerns about their GP (P=0.0003), less happy both for letters to be sent to their GPs (P=.0001) and for them to manage their HIV care (P=0.03). The most common reason for not having a current GP was concern about confidentiality. d. Conclusions Although similar proportions of HBA and MSM currently had a GP, barriers exist for HBA to identify their HIV status to GPs. Further work is required to encourage HBA to divulge their HIV status to GPs and improve patients' perception of confidentiality in the surgery setting. [ABSTRACT FROM AUTHOR]

Agri-environment schemes are programmes where landholders enter into voluntary agreements (typically with governments) to manage agricultural land for environmental protection and nature conservation objectives. Previous work at local scale has shown that these features can provide additional floral and nesting resources to support wild pollinators, which may indirectly increase floral visitation to nearby crops. However, the effect of entire schemes on this important ecosystem service has never previously been studied at national scale. Focusing on four wild pollinator guilds (ground-nesting bumblebees, tree-nesting bumblebees, ground-nesting solitary bees, and cavity-nesting solitary bees), we used a state-of-the-art, process-based spatial model to examine the relationship between participation in agri-environment schemes across England during 2016 and the predicted abundances of these guilds and their visitation rates to four pollinator dependent crops (oilseed rape, field beans, orchard fruit and strawberries). Our modelling predicts that significant increases in national populations of ground-nesting bumblebees and ground-nesting solitary bees have occurred in response to the schemes. Lack of significant population increases for other guilds likely reflects specialist nesting resource requirements not well-catered for in schemes. We do not predict statistically significant increases in visitation to pollinator-dependent crops at national level as a result of scheme interventions but do predict some localised areas of significant increase in bumblebee visitation to crops flowering in late spring. Lack of any significant change in visitation to crops which flower outside this season is likely due to a combination of low provision of nesting resource relative to floral resource by scheme interventions and low overall participation in more intensively farmed landscapes. We recommend future schemes place greater importance on nesting resource provision alongside floral resource provision, better cater for the needs of specialised species and promote more contiguous patches of semi-natural habitat to better support solitary bee visitation. • We have modelled the impact of England's agri-environment schemes on wild bees. • We predict only ground-nesting bee populations have increased nationally. • Current schemes produce no significant increase in national crop pollination service. • We find only localised pollination service increases to late-spring flowering crops. • Insufficient provision of nesting resources may be a key limitation in scheme design. [ABSTRACT FROM AUTHOR]