Search

BACKGROUND: Wearable technologies offer new opportunities to address in‐school physical inactivity. However, children are often excluded from discussing issues which directly impact them, including the use of wearable technologies in a school setting. Thus, the aim of this study is to understand primary school pupils' experiences and perceptions of using wearable physical activity monitoring technologies within schools. METHODS: Nine semi‐structured focus groups were conducted with 41 Year 5 and 6 pupils (19 girls, 22 boys) from 5 primary schools in the South West of England. Focus group transcripts were analyzed using a reflective thematic approach. RESULTS: Pupils made valuable contributions to discussions around wearable technologies, considering both advantages and disadvantages. Most importantly, when discussing use in schools, pupils were mindful that while they wanted to see their own activity and saw benefit in teachers knowing their activity, they felt comparisons in classes could lead to negative emotions for some pupils. CONCLUSION: The findings from this study can contribute to a more detailed understanding of pupils' perspectives, which can help inform school‐based interventions which aim to address physical inactivity and associated inequalities. Instead of using wearable devices for individual pupil ownership, schools should access data‐insights with the intention of changing school practices. [ABSTRACT FROM AUTHOR]

Background. Little is known about parents' experience of using water softeners to potentially prevent and alleviate infants' eczema. We used the context of a randomised controlled pilot trial to examine parents' experiences. Aims. This study explored and compared the experiences of parents of infants at risk of eczema either using a water softener or not, their infant's related skin care and participation in the SOFtened waTER for eczema prevention pilot trial (SOFTER NCT03270566). Methods. Qualitative method, Framework Analysis. Semi-structured interviews were conducted with trial participants, 21 families of infants. Thematic analysis utilised NVivo software. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting standard.1 Results. Three key themes emerged related to parents' lived experience of using a water softener (birth to six months of age): 1. Using and applying less skin product 2. Using 'unscented', 'natural', 'allergy friendly' (parental terms) products 3. Bathing frequency. Conclusions. Using a water softener may reduce the frequency of and influence the choice of skin care products used. It may also impact bathing frequency by parents of high-risk infants. [ABSTRACT FROM AUTHOR]

Though the 2011 'riots' attracted a huge amount of political, media and academic attention, the state's punitive reaction to the unrest received far less analysis, despite being characterised by exceptionally harsh practices at every stage from arrest to sentencing. Drawing on interviews with criminal justice professionals who were at the heart of this response, and focusing in particular on the Crown Prosecution Service's unusually punitive approach, this article examines the imaginations, assumptions and claims that allowed professionals to variously justify and problematise this vindictive backlash. The article shows how an imagination of the disturbances as an apolitical and unprecedented outbreak of violence was central to many professionals' accounts. Yet this imagination, I contend, requires significant erasure and elision. Forgetting England's long history of unrest, and ignoring or dismissing the police killing of Mark Duggan that immediately precipitated the disturbances, were vitally important in allowing professionals to ignore the vital connections between the unrest and entrenched structural racism that has consistently underpinned post-war urban unrest – and to position the harsh law and order response as reasonable, proportionate, necessary and adequate. In doing so, the article makes a significant contribution to scholarship on the unrest, and on the importance of amnesia and ignorance - conceived as active, collective and inherently political processes - in normalising punitive and discriminatory state practices, both in the wake of the riots and in their longer aftermath. [ABSTRACT FROM AUTHOR]

Background: In 2017, the Children and Young People's Improving Access to Psychological Therapies (CYP-IAPT) project was extended to deliver low-intensity Cognitive Behavioural Therapy (CBT), delivered by Children's Wellbeing Practitioners (CWPs), but to date evaluation is sparse. Aims: To evaluate low-intensity interventions delivered by trainee CWPs for the treatment of anxiety and depression in a child and adolescent mental health service (CAMHS). Method: The evaluation adopted a quantitative, within-subjects, cross-sectional design. The outcome measures of 98 service users aged 8–17 years were included in the evaluation. Service users were children and young people accessing CAMHS in the North East of England. Outcome measures included the Revised Children's Anxiety and Depression Scale (RCADS-47) and Goal Based Outcomes (GBOs). Descriptive data relating to the types of interventions used and outcomes following CWP involvement were also explored. Results: Analysis of pre and post intervention data highlighted significant reduction in symptomatology across all RCADS subscales and composite total scales, and significant goal progress as measures by GBO's. Effect sizes ranged from moderate to large (d = 0.75 – 0.90) across all subscales of the RCADS. Large effect sizes were found for depression, total anxiety and total RCADS scores (d = 0.86, d = 1.12, d = 1.14), and GBOs (d = −1.33). Conclusions: Findings support the potential value of low intensity CBT interventions delivered by CWPs in reducing anxiety and depression in this population. Recommendations for the development of the CWP role and CWP services are discussed. [ABSTRACT FROM AUTHOR]

Aim: It is important for patient safety to assess if international changes in perioperative care, such as the focus on venous thromboembolism (VTE) prevention and minimally invasive surgery, have reduced the high post colectomy VTE risks previously reported. This study assesses the impact of changes in perioperative care on VTE risk following colorectal resection. Method: This was a population‐based cohort study of colectomy patients in England between 2000 and 2019 using a national database of linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Within 30 days following colectomy, absolute VTE rates per 1000 person‐years and adjusted incidence rate ratios (aIRRs) using Poisson regression for the per year change in VTE risk were calculated. Results: Of 183 791 patients, 1337 (0.73%) developed 30‐day postoperative VTE. Overall, VTE rates reduced over the 20‐year study period following elective (relative risk reduction 31.25%, 95% CI 5.69%–49.88%) but not emergency surgery. Similarly, yearly changes in VTE risk reduced following minimally invasive resections (elective benign, aIRR 0.93, 95% CI 0.90–0.97; elective malignant, aIRR 0.94, 95% CI 0.91–0.98; and emergency benign, aIRR 0.96, 95% CI 0.92–1.00) but not following open resections. There was a per year VTE risk increase following open emergency malignant resections (aIRR 1.02, 95% CI 1.00–1.04). Conclusion: Yearly VTE risks reduced following minimally invasive surgeries in the elective setting yet in contrast were static following open elective colectomies, and following emergency malignant resections increased by almost 2% per year. To reduce VTE risk, further efforts are required to implement advances in surgical care for those having emergency and/or open surgery. [ABSTRACT FROM AUTHOR]

The concept of participation is now widely accepted in healthcare and social services, but is less apparent in the delivery of services for vulnerable people who encounter the Criminal Justice System and its associated agencies (Buck et al, 2020). This article considers the extent to which children and 'vulnerable' adults who have been detained in police custody are currently able to actively participate in the design and delivery of Appropriate Adult Schemes. This paper draws together responses from 43 services in England and Wales concerning levels of service user engagement to ascertain the current level of participation, and to make recommendations for the future. The paper applies Forbat, et al.'s (2009) models of service user involvement to conceptualise ideological drivers which underpin the Appropriate Adult Scheme's commitment to involvement. The data reveal that while there is a genuine desire to improve service user participation, that institutional, financial, and attitudinal barriers mean that participation either does not occur or is at a very cursory level. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore experiences of follow‐up after treatment and views on an electronic patient‐reported outcome (ePRO) pathway among ovarian cancer patients and clinicians. Methods: Semi‐structured qualitative interviews were conducted with clinicians and patients previously treated for ovarian cancer. Interviews explored experiences of the current follow‐up pathway, patients' needs and views on an ePRO pathway enabling patients to report symptoms online rather than attend clinic‐based appointments. Transcripts were analysed using framework analysis. Results: Sixteen patients and 10 clinicians participated from four hospitals in England. Four key themes were identified: transition into follow‐up, key features of effective follow‐up, issues in follow‐up and views of ePRO. Both patients and clinicians saw benefits of an ePRO pathway alongside continued access to specialist support and discussed various practicalities (e.g., frequency, introduction and communication). Technology concerns and feelings of abandonment were highlighted as barriers. The proposed impact on clinical and individual patient outcomes was discussed. Conclusion: Patient and clinician views on follow‐up and an ePRO pathway informed key recommendations on the development/introduction of ePRO follow‐up. Technology use in healthcare will continue to grow and may offer solutions to facilitate responsive and tailored care. Further research should explore the safety, experiences and acceptability of ePRO follow‐up. [ABSTRACT FROM AUTHOR]

Mothers' alcohol consumption has often been portrayed as problematic: firstly, because of the effects of alcohol on the foetus, and secondly, because of the association between motherhood and morality. Refracted through the disciplinary lens of public health, mothers' alcohol consumption has been the target of numerous messages and discourses designed to monitor and regulate women's bodies and reproductive health. This study explores how mothers negotiated this dilemmatic terrain, drawing on accounts of drinking practices of women in paid work in the early parenting period living in Northern England in 2017–2018. Almost all of the participants reported alcohol abstention during pregnancy and the postpartum period and referred to low‐risk drinking practices. A feature of their accounts was appearing knowledgeable and familiar with public health messages, with participants often deploying 'othering', and linguistic expressions seen in public health advice. Here, we conceptualise these as Assumed Shared Alcohol Narratives (ASANs). ASANs, we argue, allowed participants to present themselves as morally legitimate parents and drinkers, with a strong awareness of risk discourses which protected the self from potential attacks of irresponsible behaviour. As such, these narratives can be viewed as neoliberal narratives, contributing to the shaping of highly responsible and self‐regulating subjectivities. [ABSTRACT FROM AUTHOR]

There has been little previous research regarding the effectiveness of ethics education interventions for residential care‐givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care‐givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face‐to‐face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work‐related moral stress in the teaching arm compared with control group (p =.03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education. [ABSTRACT FROM AUTHOR]

Objectives: Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. Methods: Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. Results: In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. Conclusions: Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective. [ABSTRACT FROM AUTHOR]

Summary: Background: Several studies have identified an association between water hardness and atopic eczema (AE); however, there is a paucity of longitudinal data in early life. Objectives: To examine whether water hardness is associated with an increased risk of AE and skin barrier dysfunction in infants and to assess effect modification by filaggrin (FLG) loss‐of‐function variants. Methods: We performed a longitudinal analysis of data from infants in the Enquiring About Tolerance (EAT) study, who were enrolled at 3 months and followed up until 36 months of age. Results: Of 1303 infants enrolled in the EAT study, 91·3% (n = 1189) attended the final clinic visit and 94·0% (n = 1225) of participants' families completed the 36‐month questionnaire. In total, 761 (58·4%) developed AE by 36 months. There was no overall association between exposure to harder (> 257 mg L−1 CaCO3) vs. softer (≤ 257 mg L−1 CaCO3) water: adjusted hazard ratio (HR) 1·07, 95% confidence interval (CI) 0·92–1·24. However, there was an increased incidence of AE in infants with FLG mutations exposed to hard water (adjusted HR 2·72, 95% CI 2·03–3·66), and statistically significant interactions between hard water plus FLG and both risk of AE (HR 1·80, 95% CI 1·17–2·78) and transepidermal water loss (0·0081 g m−2 h−1 per mg L−1 CaCO3, 95% CI 0·00028–0·016). Conclusions: There is evidence of an interaction between water hardness and FLG mutations in the development of infantile AE. What's already known about this topic? Several cross‐sectional studies have found an association between domestic water hardness exposure and atopic eczema (AE) risk.Loss‐of‐function mutations in the skin barrier gene filaggrin (FLG) are the strongest genetic risk factor for AE. What does this study add? There was no overall association between AE risk and exposure to harder vs. softer domestic water in a large, well‐phenotyped cohort of infants living in England and Wales followed up at 3–36 months of age.However, infants with at least one FLG loss‐of‐function mutation exposed to harder water have a threefold increased risk of developing AE up to age 36 months compared with infants with wild‐type FLG exposed to softer water. Linked Comment: Arents and Leonardi-Bee. Br J Dermatol 2020; 183:203–204. Plain language summary available online [ABSTRACT FROM AUTHOR]

Objectives: The genetic prediction of phenotypic antibiotic resistance based on analysis of WGS data is becoming increasingly feasible, but a major barrier to its introduction into routine use is the lack of fully automated interpretation tools. Here, we report the findings of a large evaluation of the Next Gen Diagnostics (NGD) automated bioinformatics analysis tool to predict the phenotypic resistance of MRSA.Methods: MRSA-positive patients were identified in a clinical microbiology laboratory in England between January and November 2018. One MRSA isolate per patient together with all blood culture isolates (total n = 778) were sequenced on the Illumina MiniSeq instrument in batches of 21 clinical MRSA isolates and three controls.Results: The NGD system activated post-sequencing and processed the sequences to determine susceptible/resistant predictions for 11 antibiotics, taking around 11 minutes to analyse 24 isolates sequenced on a single sequencing run. NGD results were compared with phenotypic susceptibility testing performed by the clinical laboratory using the disc diffusion method and EUCAST breakpoints. Following retesting of discrepant results, concordance between phenotypic results and NGD genetic predictions was 99.69%. Further investigation of 22 isolate genomes associated with persistent discrepancies revealed a range of reasons in 12 cases, but no cause could be found for the remainder. Genetic predictions generated by the NGD tool were compared with predictions generated by an independent research-based informatics approach, which demonstrated an overall concordance between the two methods of 99.97%.Conclusions: We conclude that the NGD system provides rapid and accurate prediction of the antibiotic susceptibility of MRSA. [ABSTRACT FROM AUTHOR]

Background Klebsiella pneumoniae is a human, animal, and environmental commensal and a leading cause of nosocomial infections, which are often caused by multiresistant strains. We evaluate putative sources of K. pneumoniae that are carried by and infect hospital patients. Methods We conducted a 6-month survey on 2 hematology wards at Addenbrooke's Hospital, Cambridge, United Kingdom, in 2015 to isolate K. pneumoniae from stool, blood, and the environment. We conducted cross-sectional surveys of K. pneumoniae from 29 livestock farms, 97 meat products, the hospital sewer, and 20 municipal wastewater treatment plants in the East of England between 2014 and 2015. Isolates were sequenced and their genomes compared. Results Klebsiella pneumoniae was isolated from stool of 17/149 (11%) patients and 18/922 swabs of their environment, together with 1 bloodstream infection during the study and 4 others over a 24-month period. Each patient carried 1 or more lineages that was unique to them, but 2 broad environmental contamination events and patient–environment transmission were identified. Klebsiella pneumoniae was isolated from cattle, poultry, hospital sewage, and 12/20 wastewater treatment plants. There was low genetic relatedness between isolates from patients/their hospital environment vs isolates from elsewhere. Identical genes encoding cephalosporin resistance were carried by isolates from humans/environment and elsewhere but were carried on different plasmids. Conclusion We identified no patient-to-patient transmission and no evidence for livestock as a source of K. pneumoniae infecting humans. However, our findings reaffirm the importance of the hospital environment as a source of K. pneumoniae associated with serious human infection. [ABSTRACT FROM AUTHOR]

Background: This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD).Methods: All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014-March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 ('Abstinent'), 1-15 ('Low-High'), 16-30 ('High-Extreme') and over 30 DDD ('Extreme'). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression.Results: The majority reported DDD in the 'Low-High' (n = 17,698, 34%) and 'High-Extreme' (n = 21,383, 41%) range. Smaller proportions were categorised 'Extreme' (n = 7759, 15%) and 'Abstinent' (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and 'Extreme' drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the 'Low-High' groups with recovery support.Conclusions: Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support. [ABSTRACT FROM AUTHOR]

Background: This was a national English observational cohort study to estimate the effectiveness of inpatient withdrawal (IW) and residential rehabilitation (RR) interventions for alcohol use disorder (AUD) using administrative data.Methods: All adults commencing IW and/or RR intervention for AUD between April 1, 2014 and March 31, 2015 reported to the National Drug Treatment Monitoring System (n=3812). The primary outcome was successful completion of treatment within 12months of commencement, with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression.Results: The majority (70%, n=2682) received IW in their index treatment journey; one-quarter (24%, n=915) received RR; 6% (n=215) received both. Of treatment leavers, 59% achieved the SCNR outcome (IW: 57%; RR: 64%; IW/RR: 57%). Positive outcome for IW was associated with older age, being employed, and receiving community-based treatment prior to and subsequent to IW. Patients with housing problems were less likely to achieving the outcome. Positive outcome for RR was associated with paid employment, self/family/peer referral, longer duration of RR treatment, and community-based treatment following discharge. Community-based treatment prior to entering RR, and receiving IW during the same treatment journey as RR, were associated with lower likelihood of SCNR.Conclusions: In this first national effectiveness study of AUD in the English public treatment system for alcohol-use disorders, 59% of patients successfully completed treatment within 12months and did not represent for more treatment within six months. Longer duration of treatment and provision of structured continuing care is associated with better treatment outcomes. [ABSTRACT FROM AUTHOR]

Demand for emergency ambulance services has risen steeply over the recent years. This study examined differences in work-load of ambulance services across England and investigated factors linked to high demand. The number of emergency calls received by each ambulance service in 1997 and 2002 and population and area data were used to calculate call rates and population density for each of 27 service areas. Deprivation score and proportion of the population under age 15 and over age 65 were calculated for each service area. There was wide variation in emergency call rates across England, with London having the highest rate both in 1997 (125.6 calls per 1000 persons) and in 2002 (140.1 per 1000). Statistically significant positive associations were observed between call rates and deprivation (1997, r = 0.49; 2002, r = 0.53) and between call rates and population density (1997, r = 0.70; 2002, r = 0.68). Following multivariable regression, the effect of deprivation score was consistently weaker, but the effect of population density was virtually unchanged. We conclude that areas with higher population density have higher call rates, which is not explained by deprivation. Deprivation is associated with higher usage, but its effect is partly due to population density. There is no evidence that these relationships are confounded by age. [ABSTRACT FROM PUBLISHER]

Background: Efforts to improve end of life care (EoLC) have made tangible impacts on care in adults, including enabling more people to die at their preferred place of death (PoD), usually home or hospices. Little is known how the PoD in children and young people (CYP, ≤24 years) has changed over time, especially in the context of a series of national initiatives for EoLC improvement since the late 1990s. To inform evidence-based policy-making and service development, we evaluated the national trends of PoD and the associated factors in CYP who died with cancer.Methods: Population-based observational study in the National Health Service (NHS) England, 1993-2014. All non-accidental CYP deaths with cancer (N = 12,774) were extracted from the death registration database of the Office for National Statistics (ONS).Results: Hospital deaths reduced from >50 to 45 %, hospice deaths were rare but more than doubled from 6 % in 1993-2000 to 13 % in 2005-2014, and home deaths fluctuated at around 40 %. Those aged 0-19 years were more likely to die at home than young adults (adjusted proportion ratio (PRs): 1.23-1.62); haematological cancer patients or those with 2+ comorbid conditions had higher chances of hospital death (PRs for home: 0.18-0.75, hospice: 0.04-0.37); deprivation was associated with a reduced chance of home death (PRs: 0.76-0.84). The residential region affected hospice but not home deaths. The variations of PoD by cause of death, comorbid conditions and deprivation slightly decreased with time.Conclusions: Hospitals and home were the main EoLC settings for CYP with cancer. Home death rates barely changed in the past two decades; deaths in hospitals remained the most common but slightly shifted towards hospices. CYP with haematological malignancy or with comorbid conditions had persistently high hospital deaths; these cases had an even lower chance of deaths in hospices (50 %) than at home. There were deprivation- and area-related inequalities in PoD which may need service- and/or policy-level intervention. The findings highlight a need for CYP specific initiatives to enhance EoLC support and capacities both at home and in hospices. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade.Design: Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS.Setting: Birth cohort of 100 000 in southern England.Participants: 114 teenagers aged 13-19 years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6-10 years.Interventions: Birth in periods with and without UNHS; confirmation of PCHI before and after age 9 months.Main Outcome Measure: Reading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.Results: Confirmation of PCHI by age 9 months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI -0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI -0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.Conclusions: The benefit to reading comprehension of confirmation of PCHI by age 9 months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss.Trial Registration Number: ISRCTN03307358. [ABSTRACT FROM AUTHOR]

The Northumberland, a third-rate man-of-war was lost with all hands during the Great Storm of 26-27 November 1703 on the Goodwin Sands-famously known as 'the ship swallower'. It was rediscovered in 1980 by local divers following the location of a sister ship, the Stirling Castle. Since, the primary concern has been to record exposed structural remains, ordnance and artefacts, and interpret the wreck formation of the site. This paper describes the results of this work, and discusses in particular the size of the keel, the use of chocks, and standardization of ordnance in the Restoration Navy through reference to comparable ship-finds and historical records. [ABSTRACT FROM AUTHOR]

Summary: Concentrations of dissolved organic carbon (DOC) in soil and stream waters in upland catchments are widely monitored, in part due to the potential of DOC to form harmful by-products when chlorinated during treatment of water for public supply. DOC can be measured directly, though this is expensive and time-consuming. Light absorbance in the UV–vis spectrum is often used as a surrogate measurement from which a colour-carbon relationship between absorbance and DOC can be derived, but this relationship can be confounded by numerous variables. Through the analysis of data from eight sites in England and Wales we investigate the possibility of using the concentration of phenolic compounds in water samples as a proxy for DOC concentration. A general model using data from all the sites allowed DOC to be calculated from phenolics at an accuracy of 81–86%. A detailed analysis at one site revealed that a site-specific calibration was more accurate than the general model, and that this compared favourably with a colour-carbon calibration. We therefore recommend this method for use where estimates of DOC concentration are needed, but where time and money are limiting factors, or as an additional method to calculate DOC alongside colour-carbon calibrations. Tests demonstrated only small amounts of phenolic degradation over time; a loss of 0.92mgL−1 after 8months in storage, and so this method can be used on older samples with limited loss of accuracy. [ABSTRACT FROM AUTHOR]

This paper presents findings from a study of information technology implementation practices in National Health Service hospitals in England. The results suggest that there is a general direction of travel, which involves the progressive linking together of individual systems, so that they are interoperable. We argue that the findings are consistent with meta-governance arguments, but that it is necessary to complement this perspective with an understanding of the nature of information technologies in order to understand them properly. We suggest that ‘interim systems’ will be the reality on the ground for many health care organizations for the foreseeable future. [ABSTRACT FROM AUTHOR]

Prevention of delirium is an important part of looking after care home residents, however, it can be difficult to detect, especially in those who have dementia. This article explores the perceptions and experiences of care home staff integrating delirium prevention activity in their everyday work. As part of the Stop delirium! feasibility study interviews were carried out and when they were analysed five themes were identified: triggers and knowledge; detection and observation; effect of closest contact; changes in management of care; and communication and teamwork to overcome difficulties. Together these provide insight into how carers identified a potential episode of delirium and indicated the steps that might be taken to manage residents' care. Communication and teamwork were identified as important in delirium prevention and appropriate management. [ABSTRACT FROM AUTHOR]

The article presents a paper submitted during a Policy Seminar held at the National Children's Bureau, London, England on June 23, 2009 that attempted to introduce issues arising from the debate on personalisation in relation to pupils with special education needs (SEN). It indicates a connection between personalisation and a system where individual pupils' needs are assessed and individualised learning plan needs. It proposes that every pupil is special and questions the continuation of SEN.

Although the effects of elevated ozone on aboveground carbon (C) assimilation are well understood, its effects on soil C fluxes are less certain. Mesocosms taken from a lowland raised bog in northern England were exposed in open-top chambers for 2 years to ambient air or ambient air plus ozone elevated for 8 h day by an average of 49 ppb in summer and 10 ppb in winter. The effects of elevated ozone on methane emission and ecosystem dark respiration were measured throughout this period, along with soil and plant variables. Methane emissions were significantly reduced, by about 25%, by elevated ozone during midsummer periods of both years, but no significant effect of ozone was found during the winter periods. Dark ecosystem respiration was not significantly affected by elevated ozone. There was no evidence that effects of elevated ozone on methane emissions were mediated through changes in aboveground plant biomass or soil water dissolved organic C concentrations. Our results imply that the increased northern hemisphere background ozone concentrations over the 21st century that are predicted by most models may reduce the rate of increase in methane emissions as the region warms. [ABSTRACT FROM AUTHOR]

This paper addresses the question of interaction between home and international students using qualitative data from 100 home students at two 'teaching intensive' universities in the southwest of England. Stephan and Stephan's Integrated Threat Theory is used to analyse the data, finding evidence for all four types of threat that they predict when outgroups interact. It is found that home students perceive threats to their academic success and group identity from the presence of international students on the campus and in the classroom. These are linked to anxieties around 'mindful' forms of interaction and a taboo around the discussion of difference, leading to a 'passive xenophobia' for the majority. The paper concludes that Integrated Threat Theory is a useful tool in critiquing the 'internationalisation at home' agenda, making suggestions for policies and practices that may alleviate perceived threats, thereby improving the quality and outcomes of intercultural interaction. [ABSTRACT FROM AUTHOR]

Examination of stone artefacts from Maiden Castle, Dorset, led to the identification of a Neolithic saddle-quern which originated in central Normandy. While stone axes from Brittany and jadeitite axes from the Alps have long been known from central southern England, the quern is the largest and heaviest Neolithic import yet identified. It has a bearing on the debate about indigenous or immigrant origins for the Neolithic, but also re-opens the question of the type of boat that plied the Channel at this early period. It is argued that logboats, for which there is evidence, should not be overlooked in favour of skin-boats for which there is none. © 2009 The Authors [ABSTRACT FROM AUTHOR]

The article focuses on the history of lead mining. It says that lead is a good metal that is being used for various things including paints, leaded petrol and water pipes but its importance has declined because of its toxicity. It mentions that the first lead mining has occurred in the Yorkshire Dales, England. It mentions that lead mining is still being carried out in different parts of the world, but unfortunately, miners as well as their families are suffering from lead's toxic effects.

This qualitative study describes GPs' experiences of and needs for management of people from a South Asian community who have chronic pain. Semi-structured interviews were conducted with 18 GPs from practices in two PCTs in Leicester. The data was analysed using grounded theory. The results indicate that managing patients from a South Asian community with chronic pain can be challenging due to differing pain expression and presentation. Emerging themes refer to shortages of services for these patients including the need for CBT, counselling, community support and GP education and training. Potential implications of the results for service provision are discussed. [ABSTRACT FROM AUTHOR]

In 1989, the progressive introduction of a National Curriculum of subjects to all maintained schools in England and Wales brought compulsory science education into the primary sectors of these two countries for the first time. Such was its considered importance, science was placed alongside English and mathematics in what became known simply as 'the core'. As a result of its elevated profile and an immense amount of hard work and effort by teachers and other professionals responding to requirements, science education provision appeared to benefit enormously. Successive revisions of the national primary science curriculum have brought about many changes, however, each impacting on the primary profession individually in different ways and as a whole. Findings from a recently completed 'preparation to teach' survey across several geographically distinct regions of England are presented here which contribute to our ongoing understanding of the overall status of science teaching within primary schools. Twenty years on from when the national primary science curriculum was first introduced and independently evaluated, attention is drawn to the continued progress being made at the 'chalk-face' and to those factors widely perceived as continuing to inhibit delivery. [ABSTRACT FROM AUTHOR]

Dyeing wool for the thousands of kersey cloths produced annually at Newbury in Berkshire in the middle decades of the sixteenth century took place before export. Substantial statistical evidence reveals that dyeing took place on a proto-industrial scale in Newbury; Newbury clothiers John Winchcombe II and Thomas Dolman had their own dyehouses, and other Newbury clothiers were also producing dyed kersies. Woad, madder and weld were the most important dyes, and the scale of dyeing is indicated by the purchase of woad by the ton. This article uses the Newbury experience to challenge the common view that English cloth exports during the sixteenth century were exported undyed. [ABSTRACT FROM AUTHOR]

In this article, the author emphasizes the need to preserve children's sense of wonderment about the world. The author considers this kind of wonderment as the basis of all science. He shares his boating experience to the Farne Islands in England that made him wonder about the world. Moreover, the author holds on the value of early experiences and the joy and satisfaction of careful observation.

There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses. [ABSTRACT FROM AUTHOR]

In recent years there has been a marked change in our cultural relationship with information which has implications for our teaching and learning practices. Current concerns about the identification of, and responses to, plagiarism are grounded in that process of change. In this paper we take the position that it is better to address and respond to the causes of plagiarism and so avoid it, rather than to place the emphasis on its detection and punishment. This paper provides an account of an approach to assessment developed in the Faculty of Art & Design, University of Hertfordshire which has become known as the ‘i‐Map’ (short for information handling map) and can be used in conjunction with the conventional essay to document the enquiry process. Its key features are illustrated in a diagram and described in detail together with the pedagogic approach taken to introduce this new form of assessment task to students. Examples of student i‐Maps are given with some commentary on how students used the i‐Map to document information gathering and handling for their written assignments. Survey findings from this pilot phase are presented and conclusions drawn. As a tool for assessment, the i‐Map revealed an urgent need for the development of information literacy skills and it proved to be valuable for both formative and summative assessment. Furthermore it has seemed to enable a fairer assessment of some students learning experience and capabilities and has had benefits in counteracting plagiarism. [ABSTRACT FROM AUTHOR]

Background The effects of violence upon young people are relatively poorly understood. In 2001 the London Borough of Ealing conducted a large‐scale survey of primary school pupils, which included questions on levels of violence at home. The aim of this study was to measure the association of violence at home with measures of health, health care use and health‐related behaviours in primary school pupils aged 9 and 11 in West London. [ABSTRACT FROM PUBLISHER]

Primary teaching trainees were given a 1-week placement in environmental science centres, to learn about teaching children in non-school contexts. The placements were mainly in the South West of England, and included both residential and day-visit centres. Evaluation was through written and oral feedback from hosts and students, against a set of criteria. The article provides a rationale for such placements within a PGCE programme, describes how they operated in practice and analyses the feedback to make recommendations for future operation of the programme. It recommends provision of more documentation on placements at the planning stage, and proposes a more structured programme for working with children and materials development. The article makes recommendations for further research into the logistics of such placements, the impact of materials developed by trainees, their role and status during placement, and potential benefits of negotiating their own placements. It concludes by discussing the implications for placements more generally. [ABSTRACT FROM AUTHOR]

We performed a cross-sectional study of all Thames maternity units, 1994–96, including 540 834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, which could be a reflection of less experienced management of labour. Caesarean section rates were also associated positively with the levels of delivery beds, which could be a reflection of the closer monitoring of labour that may result from increased bed availability. Both caesarean section and instrumental vaginal delivery rates were associated with epidural rates, which was expected from the literature. Variations in epidural rates were mainly associated with variations in demographic case-mix, due possibly to patient demand. Demographic case-mix was also associated with instrumental vaginal deliveries but not the caesarean section rate. [ABSTRACT FROM AUTHOR]

This article discusses the views that education students in Zimbabwe, Canada and England hold about the nature of science and science education for children. The data stem from a 32 item questionnaire that was administered in each setting. Students' attitudes towards science lie in contradiction to their more contemporary, constructivist views about science education for children. The findings also reflect differences from one locale to another in cultural norms governing children's participation in science and other classrooms. Overall, the study suggests that teacher education programs have more work to do in deconstructing firmly entrenched views of science as something distinct and separate from everyday life, and of science education as untouched by particular world-views. Questions are raised about the feasibility of using Western-generated constructivist models for teaching science in all school settings. [ABSTRACT FROM AUTHOR]

Highlights the annual meeting of the Pacific Coast Obstetrical and Gynecological Society in the U.S. Theme of the event; Participants; Programs and activities.

Summary1.Planting of willow genotype mixtures for biomass production has been suggested as a non-chemical strategy for pest management. Basic information on spatial dynamics of important insects and pathogens is necessary for the effective deployment of host genotypes in a plantation. In 1998 and 1999 the degree and spatial distribution of damage by Melampsora spp. and Phratora vulgatissima were studied concurrently in a field trial containing monocultures of willow Salix genotypes with different willow rust and beetle susceptibilities, and two design mixtures (random or regular) of three or five genotypes. 2.For both years, there was more rust and beetle damage on plants in monocultures than in mixtures. There were significant differences in the vertical distribution of beetle damage along stems between plantation designs for the 2 years, yet only in 1999 for rust. Rust severity along stems was significantly correlated between leaves, indicating localized spread of disease. In contrast, beetle damage severity along stems was weakly correlated between alternate leaves and leaves farther apart, suggesting beetle movement from tree to tree. 3.In 1998, spatial distribution of rust was aggregated in 67% of plots studied and in 40% for beetles. There was no significant difference in the distribution of beetle damage between planting design, but rust was aggregated in 75% of mixtures and 33% of monocultures. While beetle damage distribution was similar between years, rust was aggregated in all monoculture plots but in only 8% of mixtures in 1999. The difference between years and design for rust was probably because of the later stage of rust development in 1999 and the delaying effect of mixtures on this development. 4.In 1998, there were significant negative correlations between the extent of rust and beetle damage on individual trees. However, only 20% of plots showed a significant spatial dissociation between these two types of damage. There were fewer discernible... [ABSTRACT FROM AUTHOR]

The study used a phenomenographic approach to elicit and describe in detail the categories of perceptions amongst 23 newly qualified primary teachers (NQTs) about their learning and use of science text during and since their training, including their text preferences and the role text plays in their science teaching. Considerable consensus existed amongst NQTs, in spite of a variety of training and subject backgrounds. The use of published science text was seen as peripheral to teaching and focused largely on their own planning needs. Texts were selected on the basis of easily accessible surface features, rather than subject content, and were felt to need adaptation before use with children. These outcomes are interpreted in terms of the teacher–learner–text (T–L–T) relationship and the implications for primary science teacher education. [ABSTRACT FROM AUTHOR]

Focuses on the painting `Continence of Scipio,' by seventeenth century painter Anthony Van Dyck in London, England. Use of animated objects to underscore the dramatic scene; Histrionic qualities and narrative characteristics of the painting; Integration of masque elements in the art work; Representation of the Jacobean court theater in the work.

Part IV. Presents information on the method and composition of the public financing of the arts and heritage services in England during the 1990s. Discussion of the administrative process of financing the arts; Reasons why the state allocates funds for the arts; Preference structure and cultural economics; Information on the Department of Culture, Media and Sport of Great Britain.

Explores the experience of the elite, private social clubs of London and suggests that they are a flourishing sector of the hospitality industry. The paper suggests that the traditional gentlemen's club is being joined by a new type of elite private social club with more modern conceptions of the "clubbable". The paper analyses the differences and similarities between the two types of clubs in the areas of gender, value for money, concepts of "elite" and the function of a club. The paper contends that private clubs are an increasingly-significant sector of the hospitality industry, because of the way they fulfil the needs of the late twentieth-century consumer. They provide high status "niches" for a fragmented social "elite" and they fill the space between automated work and leisure. Keywords Social clubs, Consumer behaviour [ABSTRACT FROM AUTHOR]

Explains the influences of using word processors on teaching authorship among secondary school students in England. Examination of the students' tendency to misplace optimistic assumptions on the subject; Patterns of writing behavior among processor users; Recommendation for further engagement on word processing skills to help students tackle complex writing tasks.

The article focuses on the paper "Players of Interludes in North Yorkshire in the Early Seventeenth Century," in which author G.W. Boddy admirably describes the perambulations of a group of players led by Robert and Christopher Simpson around North Yorkshire. He worked from the printed text of the "Quarter Session Records" and so had to note that the places of two of the men accused of harboring these players--Cuthbert Thompson and John Garbutt--were not clear. There are some transcription errors in the printed text and these, of course, are reproduced in Boddy's article.

This article describes how a team from the University of York used management science to develop a new formula for the distribution of hospital funds in England. The National Health Service delivers the majority of the country's health care. One of the problems confronting the organization is how its funds should be allocated to different parts of the country. To solve the problem, the team developed indices of health care needs based on empirical hospital utilization data. The national government now uses the indices as the basis for allocating funds to health authorities. Moreover, the study team is now extending the area of application to the broader public sector.

Examines the policy implications of allocating resources to health authorities in England. Use of inpatient services to analyze resource allocation; Principal determinants of the use of inpatient facilities; Derivation of estimates for resource use.

Focuses on the allocation of resources for health services in England. Development of a formula as basis for resource distribution; Criticisms on the formula; Determination of the health needs of people in small geographical areas.