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Background: Innovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse. Methods: We mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively. Results: One hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves). Conclusions: We found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread. [ABSTRACT FROM AUTHOR]

Reverse zoonotic transmission events of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been described since the start of the pandemic, and the World Organisation for Animal Health (WOAH) designated the detection of SARS-CoV-2 in animals a reportable disease. Eighteen domestic and zoo animals in Great Britain and Jersey were tested by APHA for SARS-CoV-2 during 2020–2023. One domestic cat (Felis catus), three domestic dogs (Canis lupus familiaris), and three Amur tigers (Panthera tigris altaica) from a zoo were confirmed positive during 2020–2021 and reported to the WOAH. All seven positive animals were linked with known SARS-CoV-2 positive human contacts. Characterisation of the SARS-CoV-2 variants by genome sequencing indicated that the cat was infected with an early SARS-CoV-2 lineage. The three dogs and three tigers were infected with the SARS-CoV-2 Delta variant of concern (B.1.617.2). The role of non-human species in the onward transmission and emergence of new variants of SARS-CoV-2 remain poorly defined. Continued surveillance of SARS-CoV-2 in relevant domestic and captive animal species with high levels of human contact is important to monitor transmission at the human−animal interface and to assess their role as potential animal reservoirs. [ABSTRACT FROM AUTHOR]

Background: The Manual of dietetic practice ('Manual') is the core textbook for qualified and student dietitians. A survey was conducted to explore views on the scope, content and presentation of the Manual to inform the forthcoming edition. Methods: The survey comprised of questions on demographics, structure, content, access (print/digital), missing topics, strengths and weaknesses. It was distributed to members of the British Dietetic Association (BDA) and other relevant groups in August 2022. Responses are presented as frequencies and free text as themes. Results: Of 1179 responses, 91% were from professionals, of whom 72% were registered dietitians with a mean of 12.7 years (range: 1–44) in practice: 60% worked in the United Kingdom with 52% based in a clinical setting. The printed version was preferred: 59% professionals, 60% students, 94% professionals and 88% students were satisfied with the structure; however, 26% professionals and 22% students identified content that was lacking or outdated, including mental health and sustainability. The strengths were its comprehensive coverage and respected contributing authors. Weaknesses included the cost, size, lack of visual aids and currency. Professionals indicated the seventh edition should focus on more practical information required for clinical practice, whereas students wanted more emphasis on summarised information and visual formats. Conclusions: The survey proved a valuable method to engage with the readership to ensure the next edition reflected their requirements. Although nearly all respondents were satisfied with the scope and content, the results highlighted those topics lacking and/or outdated. Results also showed that the next edition should focus on practical information required for clinical practice, with more summarised and visual formats. Key points: This article presents the results of an online survey to explore views on the scope, content and presentation of the UK Dietetic profession's core text, Manual of dietetic practice.The survey was initiated by the editorial team who felt it important to explore ways in which the new edition of the Manual could be updated to meet the emerging needs of readers, namely qualified dietitians and students of dietetics.Over 1100 respondents completed the survey comprising 91% professionals, 72% of whom were registered dietitians who had been practicing in the UK healthcare system for an average 12 years.Thematic analysis revealed readers felt the Manual to be a highly respected text, regarded as the 'go‐to' source for guidance on the practice of clinical dietetics with comprehensive coverage and extremely knowledgeable contributing authors.However, despite its positive qualities, the Manual suffered from cumbersome updating processes meaning that its content lagged behind real‐life clinical practice.The survey proved a valuable method to engage with the readership to ensure the next edition reflected readers' requirements for updated Manual content, style and format.The editors will ensure the forthcoming seventh edition focuses on practical information required for clinical practice, with more summarised form and visual formats.Further, moving forward it is hoped that there will be more aggressive promotion of the online version of the Manual as it is a format which facilitates content update and is likely to become more widely accessed in the future. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused major disruption in community support for vulnerable older people and is thought to have exacerbated existing issues within UK adult social care. This study aims to examine the legacy of that disruption on how meeting centres for people affected by dementia have been impacted in continually evolving circumstances. Design/methodology/approach: Semi-structured interviews and focus group discussions were conducted at three meeting centre case study sites. Ninety-eight participants, including people living with dementia, family carers, staff, volunteers, trustees and external partners, were asked about the impact and legacy of the pandemic upon meeting centres. A thematic analysis was carried out on the data. Findings: Ten themes were identified: ability to re-open venues; increased health decline and loss of members due to isolation; closure or halting of linking services and dementia community support; disruption to diagnosis and referrals; increase in outreach, building communities and overall reach; digital access and use of technology (boom and decline); changes to carer involvement and engagement; continued uncertainty and changes to funding, resources and governance; staff and volunteer recruitment issues; and relief at/wish for return to pre-pandemic norms. Originality/value: This paper offers new insight into a still-developing situation, namely, the legacy effects of the pandemic upon third-sector community support for people affected by dementia and the health and social care services that support it. The reduction in maintenance of pandemic-era technological innovations is a key finding. [ABSTRACT FROM AUTHOR]

This research aims to explore how police officers responded to cyberstalking during the unprecedented period of the Covid-19 pandemic (March 2020–April 2021). More specifically, it aims to report the police experience of responding to cases of stalking, including cyberstalking, during this period; to explore officer confidence in identifying cyberstalking and to explore the challenges faced by frontline police. One hundred and two frontline police officers from two British forces took part in the online survey and, subsequently, ten officers and six key stakeholders each participated in a one-hour qualitative interview. The data indicate that the Covid-19 pandemic has prompted an increase in cyberstalking, and this has been attributed, by both the police and stakeholders, to the lockdown whereby people worked from home, had more time to become tech savvy and, as a result, developed digital skills that facilitate cyberstalking. Furthermore, it emerged that there is professional uncertainty among officers surrounding cyberstalking and how to deal with the problem effectively. However, this uncertainty is unquestionably not related to the lack of officers' motivation, but to absence of a stalking screening tool that addresses cyberstalking, accompanied by effective multiagency training that would assist officers to understand the nature of the issue and to respond to it effectively. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does use of remote self-monitoring and physician-guided titration of antihypertensive medications using a Bluetooth-enabled app provide better long-term blood pressure control than usual outpatient care during the first 9 months postpartum? Findings: In this randomized clinical trial involving 220 participants, physician-guided self-management of outpatient postnatal blood pressure, following hypertensive pregnancy, was associated with a 6/5-mm Hg lower ambulatory blood pressure at 9 months postpartum. Meaning: A physician-guided remote telemonitoring program was used to guide self-management of blood pressure and was associated with improved blood pressure control during the postnatal period after a hypertensive pregnancy compared with usual antihypertensive management. Importance: Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. Objective: To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum. Design, Setting, and Participants: Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months. Interventions: Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. Main Outcomes and Measures: The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure. Results: Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was −5.80 mm Hg (95% CI, −7.40 to −4.20; P <.001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was −6.51 mm Hg (95% CI, −8.80 to −4.22; P <.001). Conclusions and Relevance: In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK. Trial Registration: ClinicalTrials.gov Identifier: NCT04273854 This clinical trial assesses whether physician-guided self-management of antihypertensive medication results in persistently lower blood pressure after a hypertensive pregnancy compared with usual care. [ABSTRACT FROM AUTHOR]

Children and young people's (CYP) life chances depend heavily on family resources. This paper reports a rapid review of qualitative/mixed method studies about Universal Credit undertaken with CYP in the UK; subsequently expanded to include additional descriptors of economic disadvantage. Sixteen studies were reviewed; narrative synthesis was used to explore themes. Most recruited CYP with experience of economic disadvantage; none explicitly reported perspectives of CYP experiencing disability or rurality. Findings show growing up in poverty has significant, negative impacts on health and well‐being, causing feelings of exclusion, shame and unfairness; raising important questions about the adequacy of welfare support in the UK. [ABSTRACT FROM AUTHOR]

The author comments on the diet and health Open Innovation Research Club (OIRC) innovation hubs designed to identify solutions to the key diet, health and nutrition challenges facing the United Kingdom. Cited are how the innovation hubs will reinvigorate and strengthen nutrition research, how the hubs are structured to engage the food industry in recognition of their role in progressing shared challenges, and the innovative opportunity the hubs provide to advance nutrition research.

This article argues for a particular conceptualisation of teacher leadership; one that enables us to overcome the limitations of established approaches to continuing professional development as a strategy for school improvement by mobilising the massive untapped potential of teachers as leaders of innovation. In this article, teacher leadership is conceived as a key dimension of the role of teachers regardless of special roles and responsibilities in the organisational structures of their schools. Evidence to support this argument is drawn from the International Teacher Leadership project, which has partners in 15 countries as diverse as Kosovo and New Zealand. The International Teacher Leadership project builds on a model developed in the United Kingdom (The HertsCam Network) to develop support for teacher leadership as an educational reform strategy. The article explores the professional learning arising for the teachers and offers a theory of educational innovation within which it is located. (Contains 1 table and 4 figures.)

This article by Nick Frost of Leeds Metropolitan University, Sue Elmer of Leeds Trinity University, and Lesly Best and Sue Mills, who are both Independent Researchers, looks at the experience of marginalised children in extended services. The authors conducted research into access to, and inclusion in, extended services based within schools and children's centres. A wide range of research methods were used, including both qualitative and quantitative approaches. The views of children and young people, their parents and a range of professionals were gathered to inform the study. The study identifies barriers that limit childrens' opportunities for access and inclusion. An important aspect of the research was identifying solutions to overcome these barriers in order to promote improved access, inclusion and choice. Following completion of the research, a toolkit was developed to enable extended services to assess and improve their practice.

This article focuses on teacher leadership, an important dimension of the work of the Leadership for Learning network which is the focus of this special issue. More specifically, the article focuses on the launch of a journal--"Teacher Leadership"--as a strategy for promoting key values: shared leadership, teachers' leadership of development work, teachers' knowledge building and teachers' voice. Material published in the first two issues of this new journal is used to illustrate how these values are realised in action enabling teachers to lead innovation and contribute to the development of professional knowledge. The article begins with an exploration of the place of teacher leadership within the wider context of shared or distributed leadership. (Contains 1 figure.)

Develops conceptual framework to explore the impact of teacher-led development work, defined as strategic action initiated and sustained by teachers to improve instruction and student learning. Discusses impact of the framework on teachers, on the school as an organization, and on student learning. Includes evidence of impact and applications for the conceptual framework. (Contains 14 references.) (PKP)

Background: The importance of involving members of the public in the development, implementation and dissemination of research is increasingly recognised. There have been calls to share examples of how this can be done, and this paper responds by reporting how professional and lay researchers collaborated on a research study about falls prevention among older patients in English acute hospitals. It focuses on how they worked together in ways that valued all contributions, as envisaged in the UK standards for public involvement for better health and social care research. Methods: The paper is itself an example of working together, having been written by a team of lay and professional researchers. It draws on empirical evidence from evaluations they carried out about the extent to which the study took patient and public perspectives into account, as well as reflective statements they produced as co-authors, which, in turn, contributed to the end-of-project evaluation. Results: Lay contributors' deep involvement in the research had a positive effect on the project and the individuals involved, but there were also difficulties. Positive impacts included lay contributors focusing the project on areas that matter most to patients and their families, improving the quality and relevance of outcomes by contributing to data analysis, and feeling they were 'honouring' their personal experience of the subject of study. Negative impacts included the potential for lay people to feel overwhelmed by the challenges involved in achieving the societal or organisational changes necessary to address research issues, which can cause them to question their rationale for public involvement. Conclusions: The paper concludes with practical recommendations for working together effectively in research. These cover the need to discuss the potential emotional impacts of such work with lay candidates during recruitment and induction and to support lay people with these impacts throughout projects; finding ways to address power imbalances and practical challenges; and tips on facilitating processes within lay groups, especially relational processes like the development of mutual trust. Plain English summary: Involving members of the public in all stages of research as equal partners is a powerful way to make research more relevant. This paper shares an example of such involvement, from a study about falls prevention in English hospitals. Developed by a team of lay people and professional researchers, the paper looks at how we worked together, drawing on evaluations we carried out about how the study took patient and public perspectives into account, and on personal reflections we wrote. Public involvement had a positive effect on the project and the individuals involved, but there were also difficulties. Positive impacts included lay people ensuring the study focused on what mattered most to patients and their families and feeling they had done right by their personal experience of the study's subject. Negative impacts included the potential for people to feel overwhelmed by the changes in organisations or in wider society needed to address the issues being explored by a research study, which could cause them to question why they became involved in the first place. The paper ends with practical recommendations about working together, covering things such as helping lay people with the emotional impact of involvement from the beginning to the end of projects; finding ways to ensure everybody is treated in the same way and solving practical problems; and tips on leading and supporting groups of this kind, especially with personal issues like trusting each other. [ABSTRACT FROM AUTHOR]

Objectives: Depression and anxiety are common in frail older people and are associated with high levels of morbidity and mortality, yet they typically face greater barriers to accessing mental health treatments than younger people and express preferences for self-managing their symptoms. This study aims to explore frail older adults' experiences of self-managing symptoms of depression and/or anxiety. Design: Qualitative semi-structured interviews, exploring experiences of depression and/or anxiety, ways participants self-managed these and the contexts within which this took place. Interviews were audio-recorded and transcribed verbatim. Participants: 28 frail older adults in the United Kingdom, purposively sampled for neighbourhood, frailty and symptoms of anxiety/depression. Analysis: Thematic analysis to inductively derive themes from the data. Results: Our findings suggest that frail older adults find maintaining independence, engaging in meaningful activities, and socialising and peer support important for self-managing depression and anxiety. These could all be adapted to the level of frailty experienced. Drawing on life experiences, addressing the perceived cause and faith were helpful in some situations and for some personalities. Distraction and avoidance were helpful for more severe symptoms or where the causes of symptoms could not be resolved. Self-management strategies were less well-established for anxiety symptoms, especially when linked to newer health fears and worries about the future. Conclusions: Developing services and sources of information that support and facilitate key therapeutic components of self-management, which align with older adults' preferred coping styles and take into account levels of frailty, may be a way of supporting frail older people waiting for mental health treatments or those who prefer not to access these. Greater awareness of anxiety and how it can be self-managed in frail older people is needed. [ABSTRACT FROM AUTHOR]

Visitors are a prominent feature of the zoo environment and lives of zoo animals. The COVID-19 pandemic led to repeated and extended closure periods for zoos worldwide. This unique period in zoological history enabled the opportunity to investigate the consistency of behavioural responses of zoo animals to closures and subsequent reopenings. Bennett's wallabies (Notamacropus rufogriseus), meerkats (Suricata suricatta), macaws (red and green: Ara chloropterus; blue and yellow: Ara ararauna; military: Ara militaris) and rabbits (Oryctolagus cuniculus domesticus) held at four zoological collections in the United Kingdom were studied during COVID-19 closures and subsequent reopening periods. Facilities were closed for three time periods during 2020 and 2021: March–June/July 2020; November–December 2020; January–April/May 2021. Behavioural data were captured during closures (maximum n = 3) and reopening periods (maximum n = 3) during five-min scans using instantaneous scan sampling with a one-minute inter-scan interval. General linear models (GLMs) and general linear mixed models (GLMMs) were used to investigate the relationship between observed behaviours and open/closed periods. Changes were observed in behaviour between open and closure periods in all species, and in some instances changes were also observed over time, with animals responding differently to different closure and reopening periods. However, no overt positive or negative impacts of the closures or reopening periods were identified for these species. The study species may have different relationships with zoo visitors, but no clear differences were seen across the species studied. The unique opportunity to study animals over a long period of time during repeated closure periods enabled a greater understanding of the impact of zoo visitors on animals. As with other work in this sphere, these data support the adaptability of zoo animals to zoo visitors. This work contributes to the growing field of research undertaken during the COVID-19 periods and enhances our understanding of the impact that these zoological closures had on a wider body of species in a number of facilities. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions—such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need—and recognised research priority—for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS—requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing—and examining the feasibility of trialling—a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning. Methods: The primary objective of this study aims to conduct a feasibility study to inform the development of a definitive trial of SMART for improving cognitive functioning in people with MS. The secondary objective is to develop the framework for a cost-effectiveness analysis alongside a definitive trial, and the exploratory objective is to assess the signal of efficacy. Discussion: As a feasibility trial, outcomes are unlikely to immediately effect changes to NHS practice. However, this is a necessary step towards developing a definitive trial—and will give us a signal of efficacy, a prerequisite for progression to a definitive trial. If found to be clinically and cost-effective, the latter trial could create a step-change in MS cognitive rehabilitation—improving service delivery and optimising support with limited additional resources. Trial registration: Registration ID: ClnicalTrials.gov: NCT04975685—registered on July 23rd, 2021. Protocol version: 2.0, 25 November 2021 [ABSTRACT FROM AUTHOR]

Background Occupational epidemiological studies on pesticide use commonly rely on self-reported questionnaire or interview data to assess exposure. Insight into recall accuracy is important, as misclassification of exposures due to imperfect recall can bias risk estimates. Methods We assessed the ability of workers in three UK cohorts (Prospective Investigation of Pesticide Applicators' Health [PIPAH], Pesticide Users' Health Study [PUHS], and Study of Health in Agricultural Work [SHAW]) to remember their working history related to pesticide exposure over time periods ranging from 3 to 14 years prior. During 2019–2020, cohort participants were re-surveyed using a similar questionnaire to that used previously. We compared recall of responses at follow-up to those reported at baseline related to crops/areas of work, use of personal protective equipment (PPE) items, hygiene habits, frequency of pesticide use, and application method. To assess the extent of recall, we used sensitivity, specificity, the percentage of overall agreement, and area under the curve (AUC) values. We also examined the presence of over or underestimation of recalled years, and days and hours per year, of working with pesticides using geometric mean ratios (GMR) and regression analysis to investigate any trends based on demographic characteristics. Results There were 643 individuals who completed both the baseline and follow-up surveys in the three cohorts with response rates ranging from 17 to 46%. There was a strong correlation (rho = 0.77) between the baseline and recalled years working with pesticides, though higher values were reported at follow-up (GMR = 1.18 [95% confidence interval: 1.07–1.30]) with no consistent differences by demographic characteristics. There was stronger agreement in the recalled days compared to hours per year in two of the cohorts. Recall for a number of exposure determinants across short and longer periods entailed overall agreement of >70%, though with some differences: for example, sensitivity for long-term recall of crops was poor (<43% in PUHS), whereas short-term recall of hygiene practices was good (AUC range = 0.65–1.00 in PIPAH). Conclusion Results indicate that recall ability may deteriorate over a longer period. Although low-response rates may require these findings to be interpreted with caution, recall for a number of exposure determinants appeared reliable, such as crops and hygiene practices within 3 years, as well as days per year working with pesticides. [ABSTRACT FROM AUTHOR]

Mycoprotein is a fungal-based ingredient rich in fibre and protein used in meat substitutes called Quorn. Fibre and protein positively regulate glycaemia, lipidaemia and energy intake which are non-communicable diseases' (NCD) markers. We performed a cross-sectional study to investigate the association of mycoprotein intake with diet quality, nutrient, energy intake and NCD risk within 5507 UK free-living adults from the National Diet and Nutrition Survey from years 2008/2009 to 2016/2017. Dietary approaches to stop hypertension (DASH) and healthy diet index (HDI) were calculated to estimate diet quality. Comparison between mycoprotein consumers (>1 % kcal) and non-consumers, and associations between consumers and nutrient intakes, NCD's risk markers and diet quality were investigated using a survey-adjusted general linear model adjusted for sex, age, BMI, ethnicity, socio-economic, smoking status, region of residency, total energy, energy density, HDI and non-mycoprotein fibre intake. Mycoprotein consumers (3·44 % of the cohort) had a higher intake of dietary fibre (+22·18 %, P < 0·001), DASH score (+23·33 %) and HDI (+8·89 %) (P < 0·001, both) and lower BMI (−4·77 %, P = 0·00) v. non-consumers. There was an association (P = 0·00) between mycoprotein consumers and diet quality scores (+0·19 and +0·26), high fibre (+3·17 g), total and food energy (+3·09 and +0·22 kcal), but low energy density intakes (−0·08 kcal/g, P = 0·04). Consumers were negatively associated with fasting blood glucose (−0·31 mmol/l, P = 0·00) and glycated HbA1c (−0·15 %, P = 0·01). In conclusion, mycoprotein intake is associated with lower glycaemic markers and energy density intake, and high fibre, energy intake and diet quality scores. [ABSTRACT FROM AUTHOR]

Background: Globally, pioneers in children's palliative care influenced this speciality's development through individual initiatives leading to diverse models of care. Children's and young adults' hospices have now been established around the world. However, service provision varies widely leading to inequities both within countries and internationally. Aim: To describe and classify existing approaches to paediatric palliative medicine in children's and young adults' hospices across the UK. Design: A mixed methods study conducted by telephone interview. Setting/participants: Thirty-one leaders of children's hospice care, representing 28 services, 66% of UK children's and young adults' hospice organisations. Results: A geographic-specialist classification was developed through integration of findings, enabling hospices to be classified as Regional specialist, Regional non-specialist, Local specialist and Local non-specialist. Both qualitative and quantitative data demonstrated diversity and inequity in paediatric palliative medicine provision. Of 159 doctors (63.5% of whom were general practitioners) working in participating hospices only 27.5% had specialist training in paediatric palliative medicine. The majority of participating hospices (67.9%) did not have involvement from a paediatric palliative medicine consultant. Conclusions: Internationally, the integration of specialist children's palliative care teams with existing services is a current challenge. Despite differing approaches to children's palliative care world-wide, models of care which facilitate integration of specialist children's palliative care could benefit a range of countries and contexts. The geographic-specialist classification could be used to inform recommendations for a networked approach to paediatric palliative medicine within children's and young adults' hospices to promote equity for children with life-limiting and life-threatening conditions. [ABSTRACT FROM AUTHOR]

Background: Observational studies suggest an increased risk of eczema in children living in hard versus soft water areas, and there is, therefore, an interest in knowing whether softening water may prevent eczema. We evaluated the feasibility of a parallel‐group assessor‐blinded pilot randomized controlled trial to test whether installing a domestic ion‐exchange water softener before birth in hard water areas reduces the risk of eczema in infants with a family history of atopy. Methods: Pregnant women living in hard water areas (>250 mg/L calcium carbonate) in and around London UK, were randomized 1:1 antenatally to either have an ion‐exchange water softener installed in their home or not (ie to continue to receive usual domestic hard water). Infants were assessed at birth and followed up for 6 months. The main end‐points were around feasibility, the primary end‐point being the proportion of eligible families screened who were willing and able to be randomized. Clinical end‐points were evaluated including frequency of parent‐reported doctor‐diagnosed eczema and visible eczema on skin examination. Descriptive analyses were conducted, and no statistical testing was performed as this was a pilot study. Results: One hundred and forty‐nine families screened were eligible antenatally and 28% (41/149) could not have a water softener installed due to technical reasons or lack of landlord approval. Eighty of 149 (54%) were randomized, the primary end‐point. Two participants withdrew immediately after randomization, leaving 39 participants in each arm (78 total). Attrition was 15% (12/78) by 6 months postpartum. All respondents (n = 69) to the study acceptability questionnaire reported that the study was acceptable. Fifty‐six of 708 (7.9%) water samples in the water softener arm were above the hard water threshold of 20 mg/L CaCO3. At 6 months of age 27/67 infants (40%) developed visible eczema, 12/36 (33%) vs. 15/31 (48%) in the water softener and control groups, respectively, difference −15% (95% CI −38, 8.3%), with most assessments (≥96%) remaining blinded. Similarly, a lower proportion of infants in the water softener arm had parent‐reported, doctor‐diagnosed eczema by 6 months compared to the control arm, 6/17 (35%) versus 9/19 (47%), difference −12% (95% CI −44, 20%). Conclusion: A randomized controlled trial of water softeners for the prevention of atopic eczema in high‐risk infants is feasible and acceptable. Trial registration: NCT03270566 (clinicaltrials.gov) [ABSTRACT FROM AUTHOR]

Why do nurses in training continue to draw on the ideal of compassion when responding to their experiences of nursing work in the UK National Health Service (NHS), despite the difficulties that they face in developing compassionate, long-term relationships with patients in practice? To answer this question, we draw from a psychosocial analysis of focus group data from 49 trainee nurses in the NHS. First, we show how this ideal leads them to blame qualified nurses for failures in patient care. We suggest this is an unconscious defence against the anxiety evoked both by the vulnerability of their position as those who need to gain access to the profession, and of being unable to conduct compassionate nursing work. Second, we emphasize that less powerful occupational groups, such as trainee nurses, may adopt defences that underpin dominant organizational policy, such as idealization, despite further disadvantaging their group and benefitting those in power. We conclude by questioning the particular emphasis on compassion in nurses' training, which can prevent occupational solidarity and the ability to reflect on the structural and organizational factors required to conduct patient-centred nursing work. [ABSTRACT FROM AUTHOR]

• This the first study to investigate AZLI in the acute exacerbation setting. • We found AZLI use was associated with positive clinical outcomes. • Neither IV antibiotics nor AZLI consistently reduced P. aeruginosa load. • AZLI appeared to disturb the core lung microbiota less than IV antibiotics. • AZTEC-CF will inform the design of larger trials of inhaled antibiotics in the acute setting The objective of this study was to explore the clinical and microbiological outcomes associated with substituting inhaled aztreonam lysine for an intravenous antibiotic in the treatment of acute pulmonary exacerbations of CF. An open-label randomised crossover pilot trial was conducted at a UK CF centre among 16 adults with CF and P. aeruginosa infection. Median [IQR] age was 29.5 [24.5-32.5], mean ± SD forced expiratory volume in 1 second (FEV1) was 52.4 ± 14.7 % predicted. Over the course of two exacerbations, participants were randomised to sequentially receive 14 days of inhaled aztreonam lysine plus IV colistimethate (AZLI+IV), or dual IV antibiotics (IV+IV). Primary outcome was absolute change in % predicted FEV1. Other outcomes evaluated changes in quality of life, bacterial load and the lung microbiota. The difference between mean change in lung function at day 14 between AZLI+IV and IV+IV was +4.6% (95% CI 2.1-7.2, p =0.002). The minimum clinically important difference of the Cystic Fibrosis Revised Questionnaire (CFQ-R) was achieved more frequently with AZLI+IV (10/12, 83.3%) than IV+IV (7/16, 43.8%), p =0.05. No differences were observed for modulation of serum white cell count, C-reactive protein or sputum bacterial load. Microbiome compositional changes were observed with IV+IV (Bray-Curtis r2=0.14, p=0.02), but not AZLI+IV (r2=0.03, p=0.64). In adults with CF and P. aeruginosa infection experiencing an acute pulmonary exacerbation, AZLI+IV improved lung function and quality of life compared to the current standard treatment. These findings support the need for larger definitive trials of inhaled antibiotics in the acute setting. EudraCT 2016-002832-34 ClinicalTrials.org NCT02894684 [ABSTRACT FROM AUTHOR]

Background: Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence skills via a mobile app may be an effective, scalable and acceptable way to do this. A particular risk factor for anxiety and depression is elevated worry and rumination (repetitive negative thinking, RNT). An app designed to reduce RNT may prevent future incidence of depression and anxiety. Method/design: The Emotional Competence for Well-Being in Young Adults study developed an emotional competence app to be tested via randomised controlled trials in a longitudinal prospective cohort. This off-shoot study adapts the app to focus on targeting RNT (worry, rumination), known risk factors for poor mental health. In this study, 16–24 year olds in the UK, who report elevated worry and rumination on standardised questionnaires are randomised to (i) receive the RNT-targeting app immediately for 6 weeks (ii) a waiting list control who receive the app after 6 weeks. In total, the study will aim to recruit 204 participants, with no current diagnosis of major depression, bipolar disorder or psychosis, across the UK. Assessments take place at baseline (pre-randomisation), 6 and 12 weeks post-randomisation. Primary endpoint and outcome for the study is level of rumination assessed on the Rumination Response Styles Questionnaire at 6 weeks. Worry, depressive symptoms, anxiety symptoms and well-being are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. Discussion: This trial aims to better understand the benefits of tackling RNT via an mobile phone app intervention in young people. This prevention mechanism trial will establish whether targeting worry and rumination directly via an app provides a feasible approach to prevent depression and anxiety, with scope to become a widescale public health strategy for preventing poor mental health and promoting well-being in young people. Trial registration: ClinicalTrials.gov, NCT04950257. Registered 6 July 2021 – Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background The UK salt reduction program started in 2003, consisting of education campaigns to raise awareness about the risks associated with a high-salt diet and of a reformulation strategy for food manufacturers. This program is often cited as an example of a successful public health program. Objectives This study aimed to assess: 1) the impacts of changes in food composition and changes in consumer behavior on sodium intakes; and 2) whether changes were similar across socioeconomic groups. Methods Food intakes for the UK population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (year 1; n  = 1334) and 2016/17 (year 9; n  = 995). Year-specific sodium densities of foods were used to calculate the average sodium density of all food and beverage consumed. Changes in sodium density between the 2 years were explained by changes in food composition (change in sodium density of products) and/or changes in behavior (type and quantity of food consumed) using a decomposition approach. Results The program was linked to a 16% (95% CI: −21% to −12%) decrease in sodium intake between years 1 and 9, while the sodium density of foods consumed decreased by 17% (95% CI: −21% to −12%). This decrease was largely driven by reformulation (−12.0 mg/100 g). Changes in food choices reinforced the effects of the program, but had a smaller impact (−1.6 mg/100 g). These effects were similar across socioeconomic groups, whether stratified by education or income, with a consistent effect of reformulation across groups and no differences between groups in behavioral responses to the program. Conclusions A multi-component sodium reduction strategy deployed in the United Kingdom starting in 2003 corresponded to an important reduction in sodium intakes for the population. This reduction was mostly driven by changes in the food environment (reformulated food products to reduce the sodium density of foods) and, to a smaller extent, by changes in food choices. Impacts were consistent across socioeconomic groups. [ABSTRACT FROM AUTHOR]

This paper aims to utilize social theory to inform relationship-based social work practice with children, young people and families. We see 'direct relationship-based working' drawing on theory and evidence as best placed to take forward high quality, humanistic social work practice. We outline the problems with policy and practice development led by the latest high profile 'scandal' or by the overemphasis on experimental design and systematic reviews. This issue was highlighted during a recent debate about appropriate methodologies for exploring Family Group Conferences: the debate is explored as illustrative of our concerns. A flexible model is proposed, which draws on eclectic sources of evidence, social theory and professional knowledge. We propose some principles for a reflective, humanistic and responsive form of social work professionalism. [ABSTRACT FROM AUTHOR]

Background: During the global COVID‐19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID‐19 infection prior to and after discharge. Methods: Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. Results: Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID‐19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first‐line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were 'very or reasonably confident' in their team's nutritional management of COVID‐19. Less than half (42%) reported on training needs. Conclusions: Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID‐19 infection. Further work is needed to develop strategies for evaluation of their impact. [ABSTRACT FROM AUTHOR]

Archeological artifacts can be analyzed after neutron irradiation at the pulsed ISIS neutron and muon source, UK, using a newly installed high purity germanium gamma ray spectrometer to perform neutron activation analysis. In this work, the details of the measurement methods and data analysis are presented. In particular, it is explained how Monte Carlo calculations are necessary to evaluate the detection efficiency, taking into account self-shielding effects. The results for two certified bronze standards are presented. The good agreement between expected and measured compositions is promising for the use of this technique for archeological artifacts where the elemental concentration is often unknown. As an example, the analysis of a Chinese sword from the first or second century BC is presented. [ABSTRACT FROM AUTHOR]

The development of better and more robust measures of dietary intake in free living situations was identified as a priority for advancing nutrition research by the Office of Strategic Coordination for Health Research (OSCHR) Review of Nutrition and Human Health Research in 2017. The UK Nutrition Research Partnership (NRP) sponsored a workshop on Dietary Intake Assessment methodology alongside its series of 'Hot Topic' workshops designed to accelerate progress in nutrition research by bringing together people from a range of different disciplines. The workshop on Dietary Intake Assessment methodology took place via Zoom over two half‐days in January 2021 and included 50 scientists from a wide range of disciplines. The problems with current methods of dietary assessment and how emerging technologies might address them were set out in pre‐recorded presentations and explored in panel discussions. Participants then worked in breakout groups to discuss and prioritise the research questions that should be addressed to best further the field and lead to improvements in dietary assessment methodology. Five priority research questions were selected. Participants were asked to brainstorm potential approaches for addressing them and were then asked to focus on one approach and develop it further. At the end of these sessions, participants presented their project ideas to the rest of the workshop and these will be reported back to the Medical Research Council. It is hoped that potential collaborative projects arising from these discussions will be taken forward in response to future funding calls. [ABSTRACT FROM AUTHOR]

Summary: Models that predict outcomes, aid prognostication and inform the assessment of urgency for lung transplantation (LT) in CF are in demand. A prognostic score derived from the French adult CF registry to predict death or LT over 3‐year follow‐up was described in 2017 and validated using Canadian CF registry data. We assessed its performance in the UK CF population. The French prognostic score was applied to untransplanted adults with CF. The index year (2014) and outcomes (Death or LT) were evaluated to 2017. Receiver operator characteristics plots and area under curve (AUC) was computed. 4407 adults with CF met the inclusion criteria. After 3 years, 7.1% (P < 0.001) were dead or had received LT compared to the French (12.8%) and Canadian (9.4%) cohorts. The French score deemed 592 (26.2%) 'High‐risk' ‐ death/LT occurred in 189/592 (30.2%), less than previously reported in France and Canada (P < 0.0001). The discriminatory power of the French score was lower (AUC 0.830) than reported. Recalibration yielded only marginal improvement in model performance (AUC 0.833). The French prognostic score does not perform as well in the UK as reported elsewhere. Bespoke UK scores are needed to aid prognostication and inform LT decision‐making. [ABSTRACT FROM AUTHOR]

Depression and anxiety are common in later life, particularly when people are frail. This leads to reduced quality of life, faster decline in physical health and increased health/social care use. Available treatments are commonly not tailored to people with frailty. We explored frail older peoples' experiences of depression and/or anxiety and how services could be adapted to their needs. Semi-structured interviews with 28 older people in the UK purposively sampled for practice location and severity of frailty and anxiety/depression. We asked about symptoms, interactions with physical health, help-seeking, treatments and what might help in future. We audio-recorded and transcribed interviews, using thematic analysis to inductively derive themes. Frail older people had low expectations of their wellbeing at this point in life due to multiple physical health issues and so anxiety and mild depressive symptoms were normalised. There was a particular reluctance and uncertainty regarding help-seeking for anxiety. Treatments were considered appropriate where they aligned with coping skills developed over their lifetime, and facilitated independence and problem-solving skills. Most older people felt their knowledge of mental health was limited and relied upon information about and endorsement of therapies from an expert. This was usually their GP, but access was often problematic. Online methods of accessing information and therapies were not popular. Mental health support for frail older people needs to address late-life anxieties as well as depression, account for physical health issues, align with older people's need for independence and facilitate coping skills. [ABSTRACT FROM AUTHOR]

A BRCA2 prostate cancer cluster region (PCCR) was recently proposed (c.7914 to 3′) wherein pathogenic variants (PVs) are associated with higher prostate cancer (PCa) risk than PVs elsewhere in the BRCA2 gene. Using a prospective cohort study of 447 male BRCA2 PV carriers recruited in the UK and Ireland from 1998 to 2016, we estimated standardised incidence ratios (SIRs) compared with population incidences and assessed variation in risk by PV location. Carriers of PVs in the PCCR had a PCa SIR of 8.33 (95% confidence interval [CI] 4.46–15.6) and were at a higher risk of PCa than carriers of other BRCA2 PVs (SIR = 3.31, 95% CI 1.97–5.57; hazard ratio = 2.34, 95% CI 1.09–5.03). PCCR PV carriers had an estimated cumulative PCa risk of 44% (95% CI 23–72%) by the age of 75 yr and 78% (95% CI 54–94%) by the age of 85 yr. Our results corroborate the existence of a PCCR in BRCA2 in a prospective cohort. In this report, we investigated whether the risk of prostate cancer for men with a harmful mutation in the BRCA2 gene differs based on where in the gene the mutation is located. We found that men with mutations in one region of BRCA2 had a higher risk of prostate cancer than men with mutations elsewhere in the gene. BRCA2 pathogenic variants located in a recently proposed prostate cancer cluster region confers higher risks of prostate cancer than other BRCA2 variants. This report corroborates the existence of this prostate cancer cluster region in a large prospective cohort study. [ABSTRACT FROM AUTHOR]

The figure of form-of-life is a life lived as a 'how' or a mode of living, beyond every relation. Form-of-life is a form of impotent, destituent power that seeks to deactivate the biopolitics that continuously divides and separates life itself. Agamben's work is remarkably silent on the question of reproductive rights. The pregnant woman's life is regulated continuously by biopolitics, yet Agamben does not discuss this regulation. The woman's relationship with her foetus is difficult to reconcile with Agamben's philosophy that seeks to think beyond every relation. In addition, the right to abortion is difficult to reconcile with form-of-life. It is not clear how a woman seeking an abortion is not exercising a sovereign decision to create bare life. I use the UK's abortion laws as a way to interrogate Agamben's figure of form-of-life, and to illustrate how, by not accounting for reproductive rights, Agamben's thought remains incomplete. [ABSTRACT FROM AUTHOR]

Key content: High‐quality training environments may increase job satisfaction, reduce attrition and promote excellence in education and training.Data on training are collected through the General Medical Council Survey, Training Evaluation Form and Workforce Survey.Attrition rates in obstetrics and gynaecology are high (30%) – among the highest across all specialties – and reasons for this include morale and undermining, training processes and paperwork, support and supervision, work–life balance, National Health Service environment and job satisfaction.High attrition rates affect the remaining workforce and can have a negative impact on the working environment.Learning from excellence may be more helpful than focusing on negative aspects of poor training. Learning objectives: To understand the fundamental features of highly performing units.To identify contributors to poor training performance.To implement a simple structure for analysing training performance.To learn simple interventions that can improve training. [ABSTRACT FROM AUTHOR]

Background: Current quantitative methods for personalising psychotherapies for depression are unlikely to be able to inform clinical decision-making for hundreds of years. Novel alternative methods to generate hypotheses for prospective testing are therefore required, and we showcase mixed methods as one such approach. By exploring patients' perspectives in depth, and integrating qualitative and quantitative data at the level of the individual, we may identify new potential psychosocial predictors of psychotherapy outcomes, potentially informing the personalisation of depression treatment in a shorter timeframe. Using Morita therapy (a Japanese psychotherapy) as an exemplar, we thus explored how Morita therapy recipients' views on treatment acceptability explain their adherence and response to treatment.Methods: The Morita trial incorporated a pilot randomised controlled trial of Morita therapy versus treatment as usual for depression, and post-treatment qualitative interviews. We recruited trial participants from general practice record searches in Devon, UK, and purposively sampled data from 16 participants for our mixed methods analysis. We developed typologies of participants' views from our qualitative themes, and integrated these with quantitative data on number of sessions attended and whether participants responded to treatment in a joint typologies and statistics display. We enriched our analysis using participant vignettes to demonstrate each typology.Results: We demonstrated that (1) participants who could identify with the principles of Morita therapy typically responded to treatment, regardless of how many sessions they attended, whilst those whose orientation towards treatment was incompatible with Morita therapy did not respond to treatment, again regardless of treatment adherence and (2) participants whose personal circumstances impeded their opportunity to engage in Morita therapy attended the fewest sessions, though still benefitted from treatment if the principles resonated with them.Conclusions: We identified new potential relationships between "orientation" and outcomes, and "opportunity" and adherence, which could not have been identified using existing non-integrative methods. This mixed methods approach warrants replication in future trials and with other psychotherapies to generate hypotheses, based on typologies (or profiles) of patients for whom a treatment is more or less likely to be suitable, to be tested in prospective trials.Trial Registration: Current Controlled Trials, ISRCTN17544090. Registered on 23 July 2015. [ABSTRACT FROM AUTHOR]

Objective: The extent to which the outcome of the European Union referendum ("Brexit") has affected the mental health of migrants living in the United Kingdom has been the subject of much speculation. However, no empirical attempts to examine the mental health impact of the Brexit vote have been made. Through the combination of structural stigma and minority stress theories, this study examined the extent to which the outcome of the Brexit referendum was associated with the mental health of migrants in the United Kingdom as a result of increased discrimination. Method: Adult migrants living in the United Kingdom (N = 311) participated in a longitudinal survey containing measures of discrimination and symptoms of generalized anxiety disorder (GAD) at baseline and at 1-month and 6-month follow-ups. Participant data were matched to official voting records at the electorate level. Results: The percentage of "leave" voters where participants lived was associated with increased discrimination, which was in turn associated with increased GAD symptoms, including the likelihood of experiencing clinically significant GAD symptoms over the course of the study (OR = 3.01, 95% confidence interval [CI: 1.25, 7.33]). The percentage of leave voters where participants lived was associated with increased GAD symptoms indirectly via increased discrimination (standardized indirect effect = .12; 95% bias-corrected CI [.07, .19]). Conclusions: This study demonstrates that voter referenda can have a detrimental impact on migrants' mental health. Findings illustrate how aspects of structural stigma can produce experiences of minority stress, which can lead to negative mental health outcomes for members of marginalized populations. [ABSTRACT FROM AUTHOR]

BRCA1 and BRCA2 mutations have been associated with prostate cancer (PCa) risk but a wide range of risk estimates have been reported that are based on retrospective studies. To estimate relative and absolute PCa risks associated with BRCA1/2 mutations and to assess risk modification by age, family history, and mutation location. This was a prospective cohort study of male BRCA1 (n = 376) and BRCA2 carriers (n = 447) identified in clinical genetics centres in the UK and Ireland (median follow-up 5.9 and 5.3 yr, respectively). Standardised incidence/mortality ratios (SIRs/SMRs) relative to population incidences or mortality rates, absolute risks, and hazard ratios (HRs) were estimated using cohort and survival analysis methods. Sixteen BRCA1 and 26 BRCA2 carriers were diagnosed with PCa during follow-up. BRCA2 carriers had an SIR of 4.45 (95% confidence interval [CI] 2.99–6.61) and absolute PCa risk of 27% (95% CI 17–41%) and 60% (95% CI 43–78%) by ages 75 and 85 yr, respectively. For BRCA1 carriers, the overall SIR was 2.35 (95% CI 1.43–3.88); the corresponding SIR at age <65 yr was 3.57 (95% CI 1.68–7.58). However, the BRCA1 SIR varied between 0.74 and 2.83 in sensitivity analyses to assess potential screening effects. PCa risk for BRCA2 carriers increased with family history (HR per affected relative 1.68, 95% CI 0.99–2.85). BRCA2 mutations in the region bounded by positions c.2831 and c.6401 were associated with an SIR of 2.46 (95% CI 1.07–5.64) compared to population incidences, corresponding to lower PCa risk (HR 0.37, 95% CI 0.14–0.96) than for mutations outside the region. BRCA2 carriers had a stronger association with Gleason score ≥7 (SIR 5.07, 95% CI 3.20–8.02) than Gleason score ≤6 PCa (SIR 3.03, 95% CI 1.24–7.44), and a higher risk of death from PCa (SMR 3.85, 95% CI 1.44–10.3). Limitations include potential screening effects for these known mutation carriers; however, the BRCA2 results were robust to multiple sensitivity analyses. The results substantiate PCa risk patterns indicated by retrospective analyses for BRCA2 carriers, including further evidence of association with aggressive PCa, and give some support for a weaker association in BRCA1 carriers. In this study we followed unaffected men known to carry mutations in the BRCA1 and BRCA2 genes to investigate whether they are at higher risk of developing prostate cancer compared to the general population. We found that carriers of BRCA2 mutations have a high risk of developing prostate cancer, particularly more aggressive prostate cancer, and that this risk varies by family history of prostate cancer and the location of the mutation within the gene. Male BRCA2 mutation carriers have a high risk of developing prostate cancer, particularly high-grade disease. However, the risk is heterogeneous and varies with family history and the location of the mutation within the gene. BRCA1 mutations may have a similar but weaker association. [ABSTRACT FROM AUTHOR]

This comparative study examines survey data from 464 call centers in the United States, 167 in the United Kingdom, and 387 in Canada to explore two questions: whether institutional differences shape employers' choices of ways to improve work force flexibility, both numerical and functional; and whether strategies for numerical flexibility and functional flexibility are related. The results suggest that institutional differences across these liberal market economies--specifically, in dismissal regulations and union strength--did affect how employers chose to achieve work force flexibility. For example, the use of part-time workers was more common in countries with more stringent rules regulating dismissals. Organizational characteristics also mattered, with outsourced firms being more likely than in-house firms to use part-time workers. Evidence also suggests that managers used numerical flexibility and functional flexibility strategies as substitutes: higher employee job discretion was associated with both lower dismissal rates and a lower likelihood of temporary use. [ABSTRACT FROM AUTHOR]

Definitions of neighbourhood in the Social Sciences are complex, varying in their characteristics (for example, perceived boundaries and content) and between residents of that neighbourhood (for example, by class and ethnicity). This study employs an under-utilised methodology offering strong potential for overcoming some of the difficulties associated with neighbourhood definitions. A mental mapping exercise involving local residents is showcased for an ethnically diverse working-class neighbourhood in south Liverpool. The results demonstrate distinctions between residents in the geographical demarcation of the area and the features included, with important implications for how neighbourhood is best measured and understood. We suggest that one size does not fit all in definitions of neighbourhood, and that mental mapping should form a more common part of a neighbourhood researcher's toolkit. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat is common after general anesthesia. The incidence in pediatric anesthesia is variable, and the etiology unclear. Establishing risk factors would enable prevention and could improve quality of care. Aims: We performed a prospective single‐center cohort study aiming to establish the incidence of postoperative sore throat in children undergoing GA with an endotracheal tube or laryngeal mask airway. Secondary aims were to identify independent risk factors for sore throat and the incidence of other postoperative complications including stridor, laryngospasm, nausea and vomiting, and delayed oral intake. Methods: Between November 2017 and April 2018, perioperative data were collected from children aged 5‐16 years undergoing general, plastic, urology, renal, and orthopedic surgery. Patients completed a postoperative questionnaire within 24 hours of surgery. Results: We screened 334 children for inclusion at a tertiary pediatric hospital in the United Kingdom. One hundred and ninety‐seven patients were included in the final analysis. The frequency of postoperative sore throat was 36.5%. Stridor occurred in 1.5%, laryngospasm 1.0%, postoperative nausea 59.4%, vomiting in recovery 4.6%, and delayed oral intake due to postoperative sore throat 30%. Nausea, vomiting, thirst, and pain were associated with a sore throat. Univariate analysis showed anesthesia longer than 2 hours, and use of an endotracheal tube was statistically associated with higher risk of sore throat. Over 50% of children with an endotracheal tube cuff pressure <20 cmH2O had a postoperative sore throat. Conclusion: Postoperative sore throat is common in children. Endotracheal intubation is associated with a greater incidence than laryngeal mask airway use. A high rate of postoperative sore throat in children with endotracheal tube cuff pressures within the recommended range suggests multifactorial etiology. To confirm validity of the identified risk factors, we would recommend a larger prospective multi‐center study. [ABSTRACT FROM AUTHOR]

Background: Caregivers frequently provide support to people living with long-term conditions. However, there is paucity of evidence of interventions that support caregivers in their role. Rehabilitation EnAblement in Chronic Heart Failure (REACH-HF) is a novel home-based, health-professional-facilitated, self-management programme for patients with heart failure (HF) and their caregivers. Methods: Based on the random allocation of individual adult patients with reduced ejection fraction (HFrEF) and left ventricular ejection fraction <45% within the past five years, the caregiver of patients was allocated to receive the REACH-HF intervention over 12 weeks (REACH-HF group) or not (control group). Caregiver outcomes were generic health-related quality of life (EQ-5D-5L), Family Caregiver Quality of Life Scale questionnaire (FamQol), Caregiver Burden Questionnaire HF (CBQ-HF), Caregiver Contribution to Self-care of HF Index questionnaire (CC-SCHFI) and Hospital Anxiety and Depression Scale (HADS). Outcomes were compared between groups at 4, 6 and 12 months follow-up. Twenty caregivers receiving REACH-HF were purposively selected for qualitative interviews at 4 and 12 months. Results: Compared with controls (44 caregivers), the REACH-HF group (53 caregivers) had a higher mean CC-SCHFI confidence score at 12 months (57.5 vs 62.8, adjusted mean difference: 9.3, 95% confidence interval: 1.8–16.8, p = 0.016). No significant between group differences were seen in other caregiver outcomes. Qualitative interviews showed that most caregivers who received the REACH-HF intervention made positive changes to how they supported the HF patient they were caring for, and perceived that they had increased their confidence in the caregiver role over time. Conclusion: Provision of the REACH-HF intervention for caregivers of HF patients improved their confidence of self-management and was perceived for some to be helpful in supporting their caregiver role. [ABSTRACT FROM AUTHOR]

Background: Co-occurrence of psychosis and posttraumatic stress disorder (PTSD) symptoms has been demonstrated, but the ICD-11 marks a significant divergence in the formulation of PTSD with a focus on the core symptoms and the addition of complex PTSD (CPTSD). Objective: To evaluate the distribution of psychosis and traumatic stress symptoms using the ICD-11 conceptualisation of PTSD and CPTSD. Method: A latent class analysis was conducted on psychosis symptoms, PTSD and CPTSD among a random adult sample from the UK general population with a history of traumatic events (N = 1,051). Results: Six classes were identified; a low-symptom class, a PTSD-class, a CPTSD-class, a class characterized by disturbances in self-organization alone as well as two classes characterized by CPTSD and various levels of psychosis symptom endorsement. Cumulative childhood adversity predicted membership of the PTSD, CPTSD and comorbid classes in a dose-response manner with the strongest effects observed for classes characterised by comorbid symptoms. Conclusion: The present study confirms the co-occurrence of psychosis symptoms and ICD-11 PTSD and CPTSD. Psychosis symptoms did not emerge in isolation from traumatic stress symptoms, underpinning the need for a greater recognition of psychosis symptoms as part of the broader clinical picture among trauma-exposed populations. [ABSTRACT FROM AUTHOR]

To date, open science, particularly open data, in psychology has focused on quantitative research. This article aims to explore ethical and practical issues encountered by UK-based psychologists utilising open qualitative datasets. Semi-structured telephone interviews with eight qualitative psychologists were explored using a framework analysis. From the findings, we offer a context-consent meta-framework as a resource to help in the design of studies sharing their data and/or studies using open data. We recommend secondary studies conduct archaeologies of context and consent to examine if the data available are suitable for their research questions. This research is the first we know of in the study of "doing" (or not doing) open science, which could be repeated to develop a longitudinal picture or complemented with additional approaches, such as observational studies of how context and consent are negotiated in preregistered studies and open data. [ABSTRACT FROM AUTHOR]

This essay explores the intersection of race, religion, and nationality in marriage by concentrating on unions between Britons and 'Arabs' (those from North Africa and the Middle East) in the late nineteenth and early twentieth century. Focusing on this area, most of which was not in the British Empire, allows an analysis of the intersection between the empire and the larger world. Marriage was a nexus in the intertwined prejudices of race, empire, class, and religion. Though the British primarily blamed polygamy for any marital problems, their own gendered law of nationality was equally at fault. Indeed, the centrality of gender was clearest in three circumstances. First, many women refused to be 'white women in peril,' instead exercising agency in their relationships. Second, British men who moved to the Middle East, converted to Islam, and married Muslim women, became legal hybrids who struggled to pass on British nationality to their wives and children. Third, British-born women married to Middle Eastern Christians faced similar problems, despite marrying other monogamists. In the 1930s, the British government formed a committee to address these issues, but the committee failed to find solutions, in part because the members, like the British state, supported racial/national coverture for women and thus refused to consider granting women equal rights in nationality. As a result, women married to men of different races and nations remained vulnerable to desertion and divorce in the interwar period. Such issues both confirmed the importance of an imperial frame of mind, but also the fact that the dilemmas went well beyond the formal empire. [ABSTRACT FROM AUTHOR]

Summary: The outbreak of bluetongue virus (BTV) serotype 8 (BTV‐8) during 2006–2009 in Europe was the most costly epidemic of the virus in recorded history. In 2015, a BTV‐8 strain re‐emerged in France which has continued to circulate since then. To examine anecdotal reports of reduced pathogenicity and transmission efficiency, we investigated the infection kinetics of a 2007 UK BTV‐8 strain alongside the re‐emerging BTV‐8 strain isolated from France in 2017. Two groups of eight BTV‐naïve British mule sheep were inoculated with 5.75 log10TCID50/ml of either BTV‐8 strain. BTV RNA was detected by 2 dpi in both groups with peak viraemia occurring between 5–9 dpi. A significantly greater amount of BTV RNA was detected in sheep infected with the 2007 strain (6.0–8.8 log10 genome copies/ml) than the re‐emerging BTV‐8 strain (2.9–7.9 log10 genome copies/ml). All infected sheep developed BTV‐specific antibodies by 9 dpi. BTV was isolated from 2 dpi to 12 dpi for 2007 BTV‐8‐inoculated sheep and from 5 to 10 dpi for sheep inoculated with the remerging BTV‐8. In Culicoides sonorensis feeding on the sheep over the period 7–12 dpi, vector competence was significantly higher for the 2007 strain than the re‐emerging strain. Both the proportion of animals showing moderate (as opposed to mild or no) clinical disease (6/8 vs. 1/8) and the overall clinical scores (median 5.25 vs. 3) were significantly higher in sheep infected with the 2007 strain, compared to those infected with the re‐emerging strain. However, one sheep infected with the re‐emerging strain was euthanized at 16 dpi having developed severe lameness. This highlights the potential of the re‐emerging BTV‐8 to still cause illness in naïve ruminants with concurrent costs to the livestock industry. [ABSTRACT FROM AUTHOR]