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This study uses intergenerational dialogue as an approach to researching Education for Environmental Sustainability (EfES) with UK youth (aged 16-18 years), teachers and teacher educators. Through analysis of qualitative data from 210 participants shared through 18 h of participatory online workshops, we identify the framings introduced into discussions on EfES. We find a range of conceptual framings, with youth tending to centre on levels of accountability and critique of economic prioritisation. The case study demonstrates how intergenerational perspectives can be brought into conversation during the research process and identifies an appetite for intergenerational dialogue in EfES. We argue that intergenerational dialogue opens up our collective selves (adult and youth) to the thinking of others so that we can transform obstructions and enact education for environmental sustainability. Future work should consider the place for dialogue between key actors across generations in education decision-making processes.

What would it mean to put environmental sustainability at the heart of education? This article describes a process of inclusive, participatory manifesto-making to identify young people's (aged 16-18 years) and teachers' priorities for education for environmental sustainability across the UK. Drawing on analysis of qualitative data from over 200 teachers and young people who participated in futures and visualisation workshops, we identify key educational priorities at the levels of classroom, school, community and policy, based on consensus between teacher and youth perspectives. Whilst consensus-seeking comes with a risk of favouring 'soft' actions which reinforce unsustainable practices and systems, the process of identifying more desirable futures and immediate barriers that must be negotiated to reach them has the potential to create spaces for more critical pedagogies and practices. There is a need for policy makers and school leaders to recognise the interests of teachers and young people to enable greater participation in decision making at different scales, and to ensure that those with the greatest capacity bear their burden of responsibility for education for environmental sustainability.

Background: Music is weaved within our cultures; it is ever-present within daily-life and can considerably influence our mood, well-being and relationships. This study explores parental perceptions of the role of music in the home-lives of children and young people with profound and multiple learning disabilities in the UK. It considers parental views of how listening to and making music can shape the mood and behaviours of their child and their relationship. Methods: Using a mixed-method explanatory sequential design and cross-sectional survey methodology, the study collected data from parents and carers of children and young people with profound and multiple learning disabilities. Data were collected from an online questionnaire (n = 48) followed by online one-to-one interviews (n = 10). Findings: Parents reported that children and young people with profound and multiple learning disabilities more frequently listen to music than make music within the home. They also stated that music is used for enjoyment, to support mood-regulation and to add structure to the lives of young people with profound and multiple learning disabilities. Parents finally reported that listening to music together helps families feel more connected and strengthened their relationships. Conclusion: This paper outlines the positive role music may have in the home lives of people with profound and multiple learning disabilities and their families.

We all 'play' music! Play experiences for children with profound and multiple learning disabilities (PMLD) are often compromised, lost in complex care routines, increasingly stretched timetables and a lack of suitable play interventions. This study investigates combining music with play, using a set of guidelines and principles developed by the researcher and staff participants: Musical Play. It evaluates the impact of Musical Play on the play experiences of both the learners and staff. This study included five primary-aged children and four teaching staff, during a five-week implementation period in a UK special school. The study collected multiple data sources to evaluate the impact of the intervention. Results reveal that Musical Play elicited engaged, playful and creative responses, encouraging peer-awareness and interactions. The intervention allowed staff a sense of freedom from target-driven work, providing a unique opportunity to immerse themselves fully in the play experience.

Out-of-school making and engineering programmes that are frequently positioned as playful have increased dramatically in recent years -- but how appropriate is the framing of play for engagement in these informal STEM (science, technology, engineering and mathematics) spaces? Drawing on data from two research sites located in the UK, including observations of making and engineering activities with children aged 5-13 years, and interviews with nine key informants, we identify that play has three key affordances namely: (1) play can provide structure, (2) play is considered to be synonymous with open-ended science inquiry, and (3) play can enable gender inclusive STEM spaces through promoting free-choice. We also note that overly simplistic framings of play may limit recognition by both adults and children of the educational value of these spaces and deny a fuller understanding of the opportunities that such spaces afford in providing children with more opportunities to engage with STEM, particularly engineering. We suggest that play has an important pedagogical role in informal STEM activities, including making, when it is grounded in free-choice exploration and imagination. We argue for continued discussion and reflection upon both the value of play as a pedagogical vehicle and its affordances for enhancing youth engagement in STEM spaces.

Background: The development of a set of questions is a central element of examination development, with the validity of an examination resting to a large extent on the quality of the questions that it comprises. This paper reports on the methods and findings of a project that explores how educational examination question writers engage in the practice of question setting. Although the practice of examination question writing is ubiquitous, limited research has been carried out on how writers actually draft individual examination questions when writing complete examination papers. Purpose: The main aim of this study was to understand more deeply the process of examination question writing. Sample: The study involved 12 experienced educational examination question writers. Design and methods: The first data collection phase involved observing writers whilst they wrote the first draft of a question paper (using a 'think aloud' process). Following the observation, the writers took part in an hour-long interview. This led to the construction of a model of question writing. Phase 2 of the data collection process involved validating the proposed question writing model with six additional question writers by means of telephone interviews. Analysis and findings: A model was developed that outlined the key stages of writing that all of the writers moved through in the completion of their question writing task. The question writing model situates the process of writing individual questions in relation to the broader cognitive tasks required in writing a complete paper. It also situates the writing process within the social dimensions of question writing. Conclusions: Iteration in the writing process appears to have an important function. These iterations represent a form of decision-making that is common to the examination question writing culture and appears to be logical and rule bound. Whilst the recognition of iterative behaviour reveals a highly personalised element of question writing, it also reveals a common expectation that the ideas across a subject area are highly inter-related, and that an examination paper should reflect this.

We explore the professional identities of UK-based secondary science teachers who actively participated in science research for at least six months. The study uses thematic analysis to analyse semi-structured interviews with 17 participants across England and Scotland, from a variety of educational/socio-economic contexts. We found that through participation in research projects, teachers develop a multi-faceted sense of professional identity that includes the roles of teacher, scientist/researcher, mentor and coach. Teachers who are research-active develop complex professional networks that have a positive impact upon their sense of professional worth and self-belief. Through participation in research, teachers identified as both science teachers and scientists and this has been encapsulated in this research as a transition in professional identity to 'teacher scientist'. The key enabling factor in identification as a 'teacher scientist' is a teacher's positive interaction with scientists/researchers. Teachers are motivated to participate in research projects in response to the enthusiasm of their students and a desire for students to contribute to research that could provide solutions to real-world challenges. This understanding of the capacity of science teachers to become 'teacher scientists', and recognising teachers' altruistic motivations, could contribute to teacher retention and recruitment strategies that are less focused on financial incentives.

Dairy production in the UK has undergone substantial restructuring over the last few decades. Farming intensification has led to a reduction in the total numbers of farms and animals, while the average herd size per holding has increased. These ever-changing circumstances have important implications for the health and welfare of dairy cows, as well as the overall business performance of farms. For decision-making in dairy farming, it is essential to understand the underlying causes of the inefficiencies and their relative impact. The investigation of yield gaps regarding dairy cattle has been focused on specific causes. However, in addition to the risk of overestimating the impact of a specific ailment, this approach does not allow understanding of the relative contribution to the total, nor does it allow understanding of how well-described that gap is in terms of underlying causes. Using the English and Welsh dairy sectors as an example, this work estimates the Loss Gap–composed of yield losses and health expenditure ‐ using a benchmarking approach and scenario analysis. The Loss Gap was estimated by comparing the current performance of dairy herds as a baseline with that of scenarios where assumptions were made about the milk production of cows, production costs, market prices, mortality, and expenditure related to health events. A deterministic model was developed, consisting of an enterprise budget, in which the cow was the unit, with milking herd and young stock treated separately. When constraining milk production, the model estimated an annual Loss Gap of £148 to £227 million for the whole sector. The reduction in costs of veterinary services and medicines, alongside herd replacement costs, were important contributors to the estimate with some variation between the scenarios. Milk price had a substantial impact in the estimate, with revenue from milk yield representing more than 30% of the Loss Gap, when milk price was benchmarked against that of the top performing farms. This framework provides the boundaries for understanding the relative burden from specific causes in English and Welsh dairy cattle, ensuring that the sum of the estimated losses due to particular problem does not exceed the losses from all-causes, health or non-health related. [ABSTRACT FROM AUTHOR]

Background: The past decade has seen an exponential growth of minimally invasive surgical procedures. Procedures such as hip arthroscopy have rapidly grown and become the standard of care for patients with Femoroacetabular Impingement Syndrome (FAIS). Although, the results of such procedures are encouraging, a large proportion of patients do not achieve optimal outcomes due to chronicity and deconditioning as a result of delay in diagnosis and increased waiting times amongst other factors. In a recent systematic review and meta-analysis of randomised control trials, moderate certainty evidence supported prehabilitation over standard care in optimising several domains including muscle strength, pain and health related quality of life in patients undergoing orthopaedic surgical interventions. However, the role of prehabilitation in patients with FAI syndrome undergoing hip arthroscopy has received little attention. Aim: To evaluate the feasibility, suitability, acceptability and safety of a prehabilitation programme for FAI to inform a future definitive randomised control trial to assess effectiveness. Methods: A systematically developed prehabilitation intervention based on a literature review and international consensus will be utilised in this study. A mixed methodology encompassing a two-arm randomised parallel study alongside an embedded qualitative component will be used to answer the study objectives. Patients will be recruited from a tertiary referral NHS centre for young adult hip pathology in the UK. Patient reported outcomes such as iHOT-12, Brief Pain Inventory Scale (Short form), Hospital Anxiety and Depression Scale and Patient Global Impression of Change score will be obtained alongside objective measurements such as Muscle Strength and Star Excursion Balance Test at various time points. Outcome measures will be obtained at baseline (prior to prehabilitation intervention), after prehabilitation before surgery, and at 6 weeks+/- 4 weeks and 6 months +/- 4 weeks (planned primary endpoint for definitive RCT) postoperatively when participants attend the research site for clinical care and remotely at 12 months +/- 4 weeks postoperatively. Mean change and 95% CI, and effect size of outcome measures will be used to determine the sample size for a future RCT. For the qualitative component, in depth face-to-face semi-structured interviews with physiotherapists and focus groups with participants will be conducted to assess the feasibility, suitability, and acceptability of the prehabilitation intervention using a predetermined success criteria. All qualitative data will be recorded, transcribed verbatim and thematically analysed. Discussion: This study will be first of its kind to evaluate a systematically developed prehabilitation intervention for patients with FAIS undergoing hip arthroscopy. This study will provide important preliminary data to inform feasibility of a definitive RCT in the future to evaluate effectiveness of a prehabilitation intervention. Trial registration: ISRCTN 15371248, 09/03/2023. Trial protocol: Version 2.3, 26th June 2023. [ABSTRACT FROM AUTHOR]

Background: Limited knowledge exists on current use of patient reported outcome measures (PROMs) and performance measures for adolescents with idiopathic scoliosis (AIS), as well as health care professionals' (HCPs) perceived barriers and facilitators towards their use. This study's objectives were: 1) to explore current practice of HCPs when assessing outcomes for AIS 2) to understand perceived barriers and facilitators of HCPs to use PROMs 3) to understand perceived barriers and facilitators of HCPs to use performance measures. Methods: A qualitative study recruited a purposive sample of HCPs from a tertiary hospital in the United Kingdom. Mean years of experience managing individuals with AIS was 11.8 years; and included surgeons, physiotherapists and nurses, educated at Bachelor, Masters and Doctoral level. Consent to participate and demographic information were collected in advance of the interviews. In-depth, virtual semi-structured interviews were informed by a topic guide based on current evidence. Interviews of approximately 45 minutes were audio and video recorded and transcribed verbatim alongside written field notes. Data were coded and analysed using inductive thematic analysis, involving researchers with topic and methodological expertise and input from a patient representative. Results: Two themes emerged regarding current practice of using PROMs routine practice and personal evaluations. Four themes emerged as barriers to using PROMs for individuals with AIS: priority and support (e.g., HCPs focus on providing care), practical challenges (e.g., inadequate PROMs), patient-related challenges (e.g., patient preferences) and knowledge, education, and perceived value. Two themes emerged as facilitators: quality existing measure (e.g., sufficient psychometric properties), and priority and support (e.g., research department/culture). Themes for barriers to use performance measures were practicality (e.g., need physical space) and perceived value and knowledge (e.g., PROMs are more important), while the one theme for facilitators was practical consideration (e.g., acceptability). Conclusions: Although HCPs perceived the value of using outcome measures, current practice indicates limited use for individuals with AIS. The findings revealed different barriers and facilitators to implement PROMs in practice. Adopting performance measure are limited due to lack of knowledge and perceived value alongside the practicality, while considering practical factors can improve the use of these measures in practice. [ABSTRACT FROM AUTHOR]

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Business schools have the responsibility of preparing students for work in multicultural organisations and global markets. This paper examines a situated learning experience for undergraduates through a virtual collaboration between a UK university and a Brazilian university. This facilitated remote communication using social media and smart devices, allowing students from both institutions to enhance their cross-cultural management competencies. A qualitative approach was used for the research, drawing on the reflections of the tutors from both institutions and feedback received from students in the UK and Brazil. This paper provides empirical observations regarding the use of this innovative pedagogic approach, generating discussion of the implications for teaching, thus contributing to the literature on international collaborations in cross-cultural management education.

Background: While studies of ex-orphanage care show adverse effects on development, the longer-term impact on mid-life psychosocial functioning and physical health has not been established. Methods: Orphanage records provided baseline data on a sample of 100 Hong Kong Chinese girls who were subsequently adopted into the UK. A mid-life follow-up using standardised questionnaires and face-to-face interviews assessed current circumstances, life satisfaction and mental and physical health outcomes. Comparisons were made with age-matched UK-born adopted and nonadopted women. Results: Half the group spent between 1 and 2 years in orphanages, average age at adoptive placement was 23 months and 72% participated in the follow-up. Despite this poor early start, mid-life outcomes were commensurate with the comparison groups in terms of mental and physical health measures. Serious psychiatric and social difficulties were largely absent. Although the timing and extent of exposure to orphanage care did not influence outcome, participants' reports of poorer quality adoptive family experience and a negative view of their adoption were significantly associated with poorer mental health outcomes (difference in means = 0.76, 95% CI 1.33-0.19, p = 0.01; difference in means = 1.2, 95% CI 0.68-1.73, p = 0.01, respectively). Conclusions: Moderately depriving orphanage care did not predict enduring adverse consequences in mid-life but subsequent poor adoption experience was associated with outcome.

Objective: Despite widespread monotherapy use of lamotrigine or levetiracetam during pregnancy, prospectively collected, blinded child development data are still limited. The NaME (Neurodevelopment of Babies Born to Mothers With Epilepsy) Study prospectively recruited a new cohort of women with epilepsy and their offspring for longitudinal follow‐up. Methods: Pregnant women of <21 weeks gestation (n = 401) were recruited from 21 hospitals in the UK. Data collection occurred during pregnancy (recruitment, trimester 3) and at 12 and 24 months of age. The primary outcome was blinded assessment of infant cognitive, language, and motor development on the Bayley Scales of Infant and Toddler Development (3rd edition) at 24 months of age with supplementary parent reporting on the Vinelands Adaptive Behavior Scales (2nd edition). Results: There were 394 live births, with 277 children (70%) completing the Bayley assessment at 24 months. There was no evidence of an association of prenatal exposure to monotherapy lamotrigine (−.74, SE = 2.9, 95% confidence interval [CI] = −6.5 to 5.0, p =.80) or levetiracetam (−1.57, SE = 3.1, 95% CI = −4.6 to 7.7, p =.62) with poorer infant cognition, following adjustment for other maternal and child factors in comparison to nonexposed children. Similar results were observed for language and motor scores. There was no evidence of an association between increasing doses of either lamotrigine or levetiracetam. Nor was there evidence that higher dose folic acid supplementation (≥5 mg/day) or convulsive seizure exposure was associated with child development scores. Continued infant exposure to antiseizure medications through breast milk was not associated with poorer outcomes, but the number of women breastfeeding beyond 3 months was low. Significance: These data are reassuring for infant development following in utero exposure to monotherapy lamotrigine or levetiracetam, but child development is dynamic, and future follow‐up is required to rule out later emerging effects. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors. [ABSTRACT FROM AUTHOR]

We explored teachers' views and students' experiences of going beyond the syllabus in Advanced (A) level Mathematics. Questionnaires were sent to teachers and students in a sample of 200 schools and colleges. Teachers were asked about the necessity, importance and benefits of additional teaching. Students were asked about the extra activities they undertook. Forty-seven teacher questionnaires and 299 student questionnaires were completed. Over half of the students claimed to undertake at least some extra activities. Although a few teachers thought teaching beyond the syllabus was unimportant and unnecessary, over 70% felt it should be undertaken if time allowed. Teaching efficacy was measured by comparing each teacher's students' Mathematics results with those students' results in other A level subjects. Significantly more teachers with relatively high Mathematics results than with relatively low results believed teaching beyond the syllabus strengthens and expands students' existing knowledge and adds interest to the course. (Contains 1 figure.)

This research examines the effects of the Horsham Greenpower Goblin Challenge (HGGC), a hands-on science, engineering and technology (SET) project, on the attitudes of Year 5, primary-school children towards SET. The data collection centred on pre- and post-HGGC questionnaires using Likert scales and picture/word images of scientists and engineers. It was found that the HGGC did not significantly alter children's attitudes to SET and did not dispel previous negative images and attitudes. It was concluded that a greater understanding and acknowledgement of children's existing attitudes was required when designing initiatives aimed at dispelling negative and promoting positive images of SET. (Contains 4 tables and 1 figure.)

Objective: To discover the outcomes for children placed late for adoption (between 5 and 11 years old) from public care and to establish which factors predict poorer outcome. Method: Data were collected prospectively (1993-2003) from a representative sample of domestic U.K. adoptive placements (N = 108) at the start of placement, at 1 year, and 6 years later. Most of the children entered care because of abuse and neglect. Outcome was assessed by the disruption rate, by a twofold classification of the character of continuing placements, and by an assessment of psychological well-being. Results: At the adolescent follow-up, 23% of placements had disrupted, 49% were continuing positively, and 28% were continuing but with substantial ongoing difficulties. Four factors contributed independently to a higher risk of disruption: older age at placement (odds ratio = 1.07), having been singled out from siblings and rejected (5.87), time in care (1.04), and a high level of behavioral problems (1.25). Two factors predicted differences in continuing placements. Conclusions: Late adoption can be successful in that half the children made good progress, but the extent of disruptions and difficulties in continuing placements gives rise to concern. Knowledge of predictors will help in devising planning pre- and postplacement support services. (Contains 5 tables.)

Although there has been increasing attention to the importance of fathers and their relationships with their children, few studies have examined young parenthood and its consequences for fathers' life chances. In recent years, this has begun to change, and research is examining, to a far greater extent, the experiences of young fathers. Using data from a cohort of British men born in 1970, this paper uses a propensity score-matching technique to compare the well-being of 344 men who reported becoming fathers before the age of 22 with men from similar backgrounds who did not. The findings suggest that selection into young fatherhood is substantial but, for some outcomes, significant differences remain.

Leishmaniosis is an uncommon, non‐endemic disease of dogs in the United Kingdom, associated with a range of clinical signs. An 11‐month‐old, neutered, female crossbreed recently imported from Macedonia was presented for evaluation of progressive weight loss, lameness and acute vision loss. Joint effusions, bilateral exophthalmos, deficits in menace response and pupillary light reflex were detected. The dog was serologically diagnosed with leishmaniosis. Computed tomography imaging was consistent with osteomyelitis of the sphenoid bones, with associated meningeal enhancement. The dog demonstrated an excellent clinical response to treatment with meglumine antimoniate, allopurinol and amoxicillin‐clavulanic acid, regaining vision within 30 days. This case is the first to report leishmaniosis‐related osteomyelitis of the sphenoid bones resulting in blindness and describes the imaging findings and response to treatment. [ABSTRACT FROM AUTHOR]

Walking School Bus (WSB) has been recognised as an innovative solution to promote walking to school, bringing a wide spectrum of benefits, including: health benefits from the physical exercise, social skills and traffic reduction. To facilitate the success of WSB, one vital element is its route planning, which directly affects the catchment for the service and the realisation of all the potential benefits. Previously, time has been the only factor that has been considered in WSB routing problems. Other important factors including air quality, safety and comfort will also be considered in this paper. Air quality along a WSB route is important to help realise the health benefits of walking. Traffic safety has been the biggest barrier to walking to school and must be addressed in planning a WSB route. Ensuring children have an enjoyable and comfortable experience is vital for the sustainability and success of WSB. A walking network is introduced to enable modelling pedestrian movements in detail, including walking movements on different sides of the road and crossing movements. This approach enables detailed route‐based analysis to assess the localised effect of air quality on pollutant dose. We define walkability as a measure of children's needs in safety and comfort, which can also be assessed in detail on each route. We propose a multi‐objective optimisation model to generate efficient WSB routes with three objectives representing the potential benefits of WSB: (1) to minimise time; (2) to minimise pollutant dose; and (3) to maximise walkability. We apply our model to a selected school in Bradford in the UK, generating three WSB lines following efficient routes. These lines go through a predetermined sequence of 'WSB Stops', with the final stop as the school. All children within the catchment area will be able to join a WSB within 1–2 min walk from their home to the nearest stop. Our multi‐objective WSB route planning model is highly transferable to any selected school in any WSB targeted area. Planners will be able to select a combination of WSB lines to offer, based on the requirement of coverage area and resource availability. [ABSTRACT FROM AUTHOR]

Commentaries on lived experiences of COVID-19-induced 'lockdown' have simultaneously directed public imaginations backwards to draw inspiration and fortitude from historical periods of national and global challenge, and forwards into futures characterised by greater environmental sensitivity and community resilience. In this article, we argue that individuals' and households' practical coping strategies from different phases of lockdown within the UK offer clues as to how adaptive embodiments of close connection – to nature and community – both inform contemporary practices of everyday resilience and signpost towards enablers of a more socially compassionate and environmentally sustainable future. Our novel approach to conceptualising post-COVID recovery draws on 'back-casting' – an approach which envisages pathways towards alternative, 'better' futures – to work back from the notion of sustainable lifestyles, through participants' narratives of coping in/with lockdown, to the forms of adaptation that provided solace and encouragement. We highlight how these embodied and emotional adaptations constitute a form of nascent 'neo-nostalgia' capable of reaching beyond the enabling of coping mechanisms in the present to inform long-lasting capacity for individual and community resilience in the face of future socio-environmental crises. [ABSTRACT FROM AUTHOR]

Purpose: To understand the patient journey to Lumbar Spinal Fusion Surgery (LSFS) and patients' experiences of surgery. Methods: Qualitative study using interpretive phenomenological analysis. Adult participants following LSFS were recruited from 4 UK clinical sites using purposive sampling to ensure representation of key features (e.g. age). Semi-structured interviews informed by a piloted topic guide developed from the literature were audio-recorded and transcribed verbatim. Framework analysis for individual interviews and then across participants (deductive and inductive) identified emerging themes. Trustworthiness of data analyses was enhanced using multiple strategies (e.g. attention to negative cases). Results: Four emerging themes from n = 31 patients' narratives were identified: decision for surgery, coping strategies, barriers to recovery and recovery after surgery. Decision for surgery and recovery after surgery themes are distinguished by the point of surgery. However, barriers to recovery and coping strategies are key to the whole patient journey encompassing long journeys to surgery and their initial journey after surgery. The themes of coping strategies and barriers to recovery were inter-related and perceived by participants as parallel concepts. The 4 multifactorial themes interacted with each other and shaped the process of an individual patient's recovery. Factors such as sporadic interventions prior to surgery, time-consuming wait for diagnosis and surgery and lack of information regarding recovery strongly influenced perceptions of outcome. Conclusion: Patient driven data enables insights to inform research regarding surgery/rehabilitation through depth of understanding of the patient journey. Awareness of factors important to patients is important; ensuring that patient-driven data informs research and patient care. [ABSTRACT FROM AUTHOR]

Objectives: Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients. Methods: We evaluated a large, single‐centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated. Results and Conclusions: A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05–3.32]) and CFS (HR 1.43 [95%CI 1.29–1.59]; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision‐making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning. [ABSTRACT FROM AUTHOR]

Aim: The COLO‐COHORT study aims to produce a multi‐factorial risk prediction model for colorectal neoplasia that can be used to target colonoscopy to those at greatest risk of colorectal neoplasia, ensuring that people are not investigated unnecessarily and maximizing the use of limited endoscopy resources. The study will also explore the link between neoplasia and the human gut microbiome. Additionally, the study aims to generate a cohort of colonoscopy patients who are 'research ready' through the development of a consent‐for‐contact (C4C) platform, to facilitate a range of colorectal cancer prevention studies to be conducted at scale and speed. Methods and analysis: This is a multi‐centre observational study involving sites across the UK. Recruitment is over a 6‐year period (2019–2025). Patients recruited to the study are those attending for colonoscopy. Patients are recruited into two groups, namely observational group A (10 000 patients) and C4C group B (10 000 patients), known as COLO‐SPEED (Colorectal Cancer Screening Prevention Endoscopy and Early Diagnosis; https://colospeed.uk). Patients complete a health questionnaire, provide anthropometric measurements and submit biosamples (blood and stool—depending on the part of the study they are recruited into). Patients' colonoscopy and histology findings are also recorded. Models of factors associated with the presence of neoplasia at colonoscopy will be developed using logistic or multinomial regression. For internal validation, model discrimination and calibration will be assessed and bootstrapping and cross‐validation approaches used. To enable long‐term follow‐up for outcomes related to colorectal cancer and polyps, patients are asked to consent to follow‐up through data linkage with national databases. Dissemination: In keeping with good research practice, following analysis by the study team the study investigators will make the anonymized dataset available to other researchers. The C4C platform will also be accessible to other researchers. The study findings will be submitted for publication in peer‐reviewed journals and lay summaries will be disseminated to participants and the wider public. [ABSTRACT FROM AUTHOR]

Background: Non-medical prescribing (NMP) was introduced into the United Kingdom to enhance patient care and improve access to medicines. Early research indicated that not all non-medical prescribers utilised their qualification. A systematic review described 15 factors influencing NMP implementation. Findings from a recent linked Delphi study with independent physiotherapist and pharmacist prescribers achieved consensus for 1 barrier and 28 facilitators. However, item ranking differed for pharmacist and physiotherapist groups, suggesting facilitators and barriers to NMP differ depending on profession. The aim of this study was to further explore the lived experiences of NMP by pharmacists and physiotherapists.Method: Study design and analytical approach were guided by Interpretative Phenomenology Analysis principles. Focus groups (November and December 2020) used the 'Zoom®' virtual platform with pharmacist and physiotherapist prescribers. Each focus group followed a topic guide, developed a priori based on the Delphi study results, and was audio recorded digitally. Transcripts underwent thematic analysis and data were visualised using a concept map and sunburst graph, and a table of illustrative quotes produced. Research trustworthiness was enhanced through critical discussion of the topic guide and study findings by the research group and by author reflexivity. The study is reported in line with COREQ guidelines.Results: Participants comprised three physiotherapists and seven pharmacists. Five themes were identified. The most frequently mentioned theme was 'Staff', and the subtheme 'Clinical team', describing the working relationship between participants and team members. The other themes were 'Self', 'Governance', 'Practical aspects' and 'Patient care'. Important inter-dependencies were described between themes and subthemes, for example between 'Governance' and 'Quality and Safety'. Differences were highlighted between the professions, some relating to the way each profession practises (for example decision making), others to the way the prescribing role had been established (for example administration support).Conclusions: The key finding of collaborative working with the clinical team emphasises its impact on successful implementation of NMP. Themes may be inter-dependent, and inter-profession differences were identified. Specifically designed prescribing roles were beneficial for participants. For full NMP benefits to be realised all aspects of such roles must be fully scoped, before recruiting or training non-medical prescribers. [ABSTRACT FROM AUTHOR]

Purpose: The Hintegra total ankle replacement (TAR) has been widely used worldwide for ankle arthroplasty since its introduction in 2000. The implant survivorship, patient reported outcomes, rate of periprosthetic cyst formation and reoperation rates are variably reported. The purpose of this study is to determine the functional outcomes and survivorship of the Hintegra TAR, in consecutive cases by multiple surgeons in a single UK institution, with a minimum of five year follow-up. Methods: A retrospective review of prospectively collected data for 70 consecutive Hintegra TAR cases performed between 2010 and 2014. Data collected included patient demographics, complications, reoperations, revisions and patient reported outcome measures (PROMS: AOS, MOX-FQ, pain VAS and EQ-5D 3L). Results: Seventy patients underwent Hintegra TAR (54 male/16 female) with an average age of 69 (range 48–84 years). Mean follow up was 76 months (range 60–104), 10 patients died during the follow-up. Implant survivorship was 81.7% at most recent follow-up. The commonest radiographic finding was periprosthetic cysts (n = 28, 40%): size range (7–40 mm). Nine patients required re-operation: six periprosthetic cyst debridement and grafting at a mean of 61 months (range 27–91), one lateral gutter debridement, one periprosthetic fracture and one debridement for deep infection. PROMS data was available for the majority of patients. Mean final follow-up scores were total AOS 35 (range: 0–97), MOX-FQ 36 (range: 2–93), pain VAS 34.6 (range: 0–100) and EQ-5D 3L Index 0.69 (range: 0.08–1.00). Conclusion: Our experience demonstrates implant survivorship similar to other TAR studies. We have identified a high incidence of periprosthetic cysts and would recommend ongoing surveillance of these patients. [ABSTRACT FROM AUTHOR]

Background: Abattoir data are under-used for surveillance. Nationwide surveillance could benefit from using data on meat inspection findings, but several limitations need to be overcome. At the producer level, interpretation of meat inspection findings is a notable opportunity for surveillance with relevance to animal health and welfare. In this study, we propose that discovery and monitoring of relational patterns between condemnation conditions co-present in broiler batches at meat inspection can provide valuable information for surveillance of farmed animal health and welfare. Results: Great Britain (GB)-based integrator meat inspection records for 14,045 broiler batches slaughtered in nine, four monthly intervals were assessed for the presence of surveillance indicators relevant to broiler health and welfare. K-means and correlation-based hierarchical clustering, and association rules analyses were performed to identify relational patterns in the data. Incidence of condemnation showed seasonal and temporal variation, which was detected by association rules analysis. Syndrome-related and non-specific relational patterns were detected in some months of meat inspection records. A potentially syndromic cluster was identified in May 2016 consisting of infection-related conditions: pericarditis, perihepatitis, peritonitis, and abnormal colour. Non-specific trends were identified in some months as an unusual combination of condemnation reasons in broiler batches. Conclusions: We conclude that the detection of relational patterns in meat inspection records could provide producer-level surveillance indicators with relevance to broiler chicken health and welfare. [ABSTRACT FROM AUTHOR]

Objective: Stereoelectroencephalography (SEEG) is being used more frequently in the pre‐surgical evaluation of children with focal epilepsy. It has been shown to be safe in children, but there are no multicenter studies assessing the rates and factors associated with the identification of a putative seizure‐onset zone (SOZ) and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Methods: Multicenter retrospective cohort study of all children undergoing SEEG at six of seven UK Children's Epilepsy Surgery Service centers from 2014 to 2019. Demographics, noninvasive evaluation, SEEG, and operative factors were analyzed to identify variables associated with the identification of a putative SOZ and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Results: One hundred thirty‐five patients underwent 139 SEEG explorations using a total of 1767 electrodes. A putative SOZ was identified in 117 patients (85.7%); odds of successfully finding an SOZ were 6.4 times greater for non‐motor seizures compared to motor seizures (p = 0.02) and 3.6 times more if four or more seizures were recorded during SEEG (p = 0.03). Of 100 patients undergoing surgical treatment, 47 (47.0%) had an Engel class I outcome at a median follow‐up of 1.3 years; the only factor associated with outcome was indication for SEEG (p = 0.03); an indication of "recurrence following surgery/treatment" had a 5.9 times lower odds of achieving seizure freedom (p = 0.002) compared to the "lesion negative" cohort, whereas other indications ("lesion positive, define extent," "lesion positive, discordant noninvasive investigations" and "multiple lesions") were not statistically significantly different. Significance: This large nationally representative cohort illustrates that SEEG‐guided surgery can still achieve high rates of seizure freedom. Seizure semiology and the number of seizures recorded during SEEG are important factors in the identification of a putative SOZ, and the indication for SEEG is an important factor in postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background/aims: Few studies have investigated the characteristics of advanced practice physiotherapy in the UK to evaluate current context and implementation. The aim of this study was to understand how advanced practice physiotherapy is implemented in the UK. Methods: A cross-sectional online descriptive national questionnaire was developed, using a previous survey and literature, comprising 33 closed, Likert-scale and open questions. Data analysis was undertaken using frequencies and thematic analysis. All 646 members of the Advanced Practice Physiotherapy Network were invited to participate. Results: A total of 142 (22% response) reported 13 job titles; 40% had experienced ≥1 title change; most (50.7%) preferred 'advanced practice physiotherapist'. High level job satisfaction was identified but barriers prevent fulfilment of the four advanced practice physiotherapy pillars: clinical practice, leadership and management, education and research. High level clinical skills and facilitating patient pathways were key to role differentiation. Problems included lack of support, inconsistency between responsibility and reward, and no consistent framework for advanced practice physiotherapy roles. Conclusions: Advanced practice physiotherapists are largely satisfied, but significant variation exists in titles and implementation of roles. A consistent advanced practice physiotherapy framework is required. [ABSTRACT FROM AUTHOR]

Background Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. Methods We undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) and residents (if any) with suspected COVID-19 in the period 6 April to 6 May 2020. Concurrent descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and sanitizer) were in the data. PPE access was categorized as (most to least) green, amber or red. We undertook two-stage modelling, first for suspected COVID-19 cases amongst residents and second relating any increases in case counts after introduction to staffing or PPE levels. Results Counts of non-care workers had strongest relationships (P  < 0.05) to introduction of suspected SARS-CoV-2 to the homes. Higher staff levels and more severe PPE shortages were linked to higher case counts (P  < 0.05) during the monitoring period. Conclusion Managing aspects of staff interaction with residents and some working practices might reduce ingression to and spread of COVID-19-like illness within care homes. [ABSTRACT FROM AUTHOR]

Background: Annually in the UK, 40,000-90,000 people are involved in a traumatic incident. Severity of injury and how well people recover from their injuries varies, with physiotherapy playing a key role in the rehabilitation process. Recovery is evaluated using multiple outcome measures for perceived levels of pain severity and quality of life. It is unclear however, what constitutes a successful recovery from injury throughout the course of recovery from the patient perspective, and whether this aligns with physiotherapists' perspectives.Methods: A qualitative study using two approaches: Interpretive Phenomenological Analysis (IPA) using semi-structured interviews and thematic analysis following the Kreuger framework for focus groups. A purposive sample of 20 patients who have experienced musculoskeletal trauma within the past 4 weeks and 12 physiotherapists who manage this patient population will be recruited from a single trauma centre in the UK. Semi-structured interviews with patients at 4 weeks, 6 and 12 months following injury, and 2 focus groups with physiotherapists will be undertaken at one time point. Views and perceptions on the definition of recovery and what constitutes a successful recovery will be explored using both methods, with a focus on the lived experience and patient journey following musculoskeletal trauma, and how this changes through the process of recovery. Data from both the semi-structured interviews and focus groups will be analysed separately and then integrated and synthesised into key themes ensuring similarities and differences are identified. Strategies to ensure trustworthiness e.g., reflexivity will be employed.Discussion: Recovery following musculoskeletal trauma is complex and understanding of the concept of successful recovery and how this changes over time following an injury is largely unknown. It is imperative to understand the patient perspective and whether these perceptions align with current views of physiotherapists. A greater understanding of recovery following musculoskeletal trauma has potential to change clinical care, optimise patient centred care and improve efficiency and clinical decision making during rehabilitation. This in turn can contribute to improved clinical effectiveness, patient outcome and patient satisfaction with potential service and economic cost savings. This study has ethical approval (IRAS 287781/REC 20/PR/0712). [ABSTRACT FROM AUTHOR]

Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall's Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: "Being able to prescribe to patients is more effective and really useful working [in my area]". Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal. [ABSTRACT FROM AUTHOR]

* The UK's 2050 net zero target will require deep decarbonisation of all areas of the economy which provides tremendous opportunities for nuclear technology. * The smelting and re-melting of metals accounts for a considerable portion of the world 's primary energy consumption and is responsible for almost 30% of industrial CO2 emissions. Nuclear power and hydrogen could play a key role in reducing this. * Here the history of nuclear metal production in the UK is presented using case studies including the "atomic" smelters of the 1960s and the efforts of the European Nuclear Steelmaking Club. The precedent set by these programmes provides useful lessons that should guide the future application of nuclear technology to metal production. [ABSTRACT FROM AUTHOR]

The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45–64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants' recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients' perspectives. Recognition of a patient's trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Total intravenous anesthesia (TIVA) using a mixture of propofol and remifentanil in the same syringe has become an accepted technique in Pediatric Anesthesia. A survey by a group of respected UK anesthetists demonstrated a low incidence of serious complications, related to the pharmacology and dose of the drugs. However, a current guideline for the safe use of TIVA recommends against this practice. Pharmaceutical concerns include the physical stability of the emulsion when remifentanil is mixed with propofol; changes in drug concentration over time; nonuniform mixing of propofol and remifentanil; the risk of bacterial contamination; and the potential for drug administration errors. Propofol and remifentanil have markedly different pharmacokinetic profiles. When remifentanil is mixed with propofol and delivered as a target‐controlled infusion (TCI) of propofol, remifentanil delivery is not target‐controlled but passively follows the variable infusion rates calculated by the syringe driver to deliver predicted plasma or effect‐site concentrations of propofol. The pharmacokinetic consequences can be illustrated using pharmacokinetic modeling similar to that used in TCI pumps. The clinical consequences reflect the dose‐dependent pharmacodynamics of remifentanil. Increasing the target propofol concentration produces a rapid increase and peak in remifentanil concentration that risks apnea, bradycardia, and hypotension, especially with higher concentrations of remifentanil. The faster decline in remifentanil concentration with falling propofol concentrations risks inadequate narcosis and unwanted responses to surgical stimuli. Remifentanil delivery is inflexible and dosing cannot be adjusted to the clinical need and responses of individual patients. The medicolegal considerations are stark. In UK and EU Law, mixing propofol and remifentanil creates a new, unlicensed drug and the person mixing takes on the responsibilities of manufacturer. If a patient receiving anesthesia in the form of a mixed propofol‐remifentanil infusion suffered a critical incident or actual harm, the clinician's practice may come under scrutiny and criticism, potentially involving a legal challenge and the Medical Regulator. [ABSTRACT FROM AUTHOR]

Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality postheart transplantation, but its long‐term renal consequences are not known. Anonymized data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan–Meier analysis to compare survival and renal function deterioration of the RRT and non‐RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end‐stage renal disease (ESRD). 26.0% of heart recipients received RRT post‐transplant. The RRT group has lower survival rates at all time points, especially in the immediate post‐transplant period. However, conditional on 3 months survival, older age, diabetes and coronary heart disease, but not post‐transplant RRT, were the risk factors for long‐term survival. The predicting factors for ESRD were insulin‐dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post‐transplant, post‐transplant severe AKI and transplantation era. Severe AKI requiring RRT post‐transplant is associated with worse short‐term survival, but has no impact on long‐term mortality. It also accelerates recipients' renal function deterioration in the long term. [ABSTRACT FROM AUTHOR]

Studies of adult outcomes of infant domestic adoptions are considered: the range of psychological and behavioural outcomes recorded, the current state of knowledge summarised and the importance of the chosen comparison groups discussed. The social context of infant adoptions is described. Findings from our follow-ups of British infant adoptions in the post-World War 11 period are then briefly reported and set alongside the previous studies. In these follow-ups, infant adopted children were tracked up to mid-life and compared with others born in similar circumstances and with those raised in two-parent families. We summarise findings on the long-term influence of factors in the prenatal period and in the adoptive home environment. We discuss how rearing in adoptive homes may provide protective effects in relation to internalising problems, but may not be as protective in relation to externalising outcomes. Implications for adoption policy and practice are drawn out. [ABSTRACT FROM AUTHOR]

The first-generation Magnox plants at Calder Hall and Chapelcross did more than generate electricity. These plants were true multi-role facilities which in addition to supporting the UK's nuclear deterrent they produced radioisotopes for medical and industrial uses in addition to steam for reprocessing activities and providing space heating for buildings. These historic examples of co-generation may show the way forward for the next generation of nuclear power stations. [ABSTRACT FROM AUTHOR]

Purpose: To identify temporal changes in antimicrobial resistance of ocular surface bacteria isolated from clinically symptomatic equine eyes in the South West of the UK. Study design: Retrospective. Methods: Clinical and laboratory records of horses treated for suspected bacterial ocular surface disease (ulcerative and non‐ulcerative) at a single facility between January 2011 and December 2019 were reviewed. Cases were included if they underwent ocular surface sampling, aerobic bacterial culture, and antimicrobial susceptibility testing. Cases were split into two time periods based on when sampling occurred: "early" (2012‐2015) and "late" (2016‐2019) to enable identification of temporal trends in resistance to chloramphenicol, gentamicin, fusidic acid, neomycin, cloxacillin, ofloxacin, and polymyxin B. Results: A total of 125 samples from 110 horses were included in analyses. Culture‐positive isolates were identified in 76/110 (60.8%) samples. Principal isolates included Staphylococci spp. (n = 45; 64.3%), Streptococci spp. (n = 14; 20%), and Enterobacter spp. (n = 11; 15.7%). There was a significant increase in resistance to chloramphenicol over time (P =.007) and a decrease in resistance to ofloxacin that approached significance (P =.059). Chloramphenicol (100%) and gentamicin (85.7%) had the highest overall in‐vitro efficacy during the early and late periods, respectively. There was no significant difference in the type of bacteria isolated across the two time periods. Conclusions: These results suggest a potential increase in resistance to chloramphenicol among bacteria isolated from the ocular surface of horses in the South West UK, reinforcing the value of surveillance to guide the empirical use of antimicrobials. [ABSTRACT FROM AUTHOR]

In response to a growing number of patients on the UK urgent heart transplant waiting list, the UK donor heart allocation scheme was revised in October 2016 with the introduction of a new super-urgent category. Patients with temporary mechanical circulatory support (tMCS) became eligible for super-urgent registration. The aim of this study was to compare activity, indications, and outcomes before and after the change. Data on adult (aged ≥16 years) heart transplant registrations and recipients in the 2 years before (Era 1: July 1, 2014–June 30, 2016) and after (Era 2: January 2017–December 2018) the introduction of the new scheme were extracted from the UK Transplant Registry and analyzed using competing risks analysis, Kaplan–Meier analysis, and Cox proportional-hazards regression. There were 525 waiting-list registrations in Era 1 and 594 in Era 2, including 14% super-urgent registrations, with 90% having some form of tMCS. Median waiting time to transplant was 41 days for all urgent registrations in Era 1 compared with 17 days for super-urgent registrations and 71 days for urgent registrations in Era 2. Numbers of non-urgent transplants were not affected. Deaths on the waiting list significantly decreased from 5% to 2% at 6 months between Era 1 and Era 2 (adjusted hazard ratio = 0.29, 95% CI = 0.13–0.62). In addition, total number of patients with tMCS were not different between both eras, suggesting no significant change in this area of clinical decision making. Post-transplant survival at 1 year for super-urgent recipients was not significantly different from post-transplant survival at 1 year for other categories. The Introduction of a super-urgent heart allocation scheme in the UK reduces waiting time to transplant for the sickest patients, with comparable post-transplant survival while reducing deaths on the waiting list. [ABSTRACT FROM AUTHOR]

Summary: Background: Occupational hand dermatitis poses a serious risk for nurses. Objectives: To evaluate the clinical and cost‐effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses Methods: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first‐year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow‐up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171. Results: Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention‐to‐treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow‐up (12–15 months). When adjusted for baseline prevalence of dermatitis and follow‐up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow‐up in the intervention group relative to the controls were 0·72 (0·33–1·55) and 0·62 (0·35–1·10) for student and ICU nurses, respectively. No harms were reported. Conclusions: There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411–412. What is already known about this topics? Nurses are at high risk of developing hand dermatitis.Educational interventions are only partially successful in preventing hand dermatitis in healthcare workers. What does this study add? The nurse participants in our study had a high level of positive beliefs about good hand care; however, this was not translated sufficiently into their behaviours even when they were provided with access to a behavioural change programme and given ready access to hand moisturizers.The behavioural change programme intervention did not have a significant effect on reducing hand dermatitis among at‐risk nurses. Linked Comment: Brans. Br J Dermatol 2020; 183:411–412. Plain language summary available online [ABSTRACT FROM AUTHOR]

Background: Remote delivery of psychological interventions to meet growing demand has been increasing worldwide. Telephone-delivered psychological treatment has been shown to be equally effective and as satisfactory to patients as face-to-face treatment. Despite robust research evidence, however, obstacles remain to the acceptance of telephone-delivered treatment in practice. This study aimed to explore those issues using a phenomenological approach from a patient perspective to identify areas for change in current provision through the use of theoretically based acceptability and behaviour change frameworks. Methods: Twenty-eight semi-structured interviews with patients experiencing symptoms of common mental health problems, waiting, receiving or having recently received telephone-delivered psychological treatment via the UK National Health Service's Improving Access to Psychological Therapies (IAPT) programme. Interviews were recorded, transcribed verbatim, and analysed using the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability (TFA). Results: The majority of data clustered within five key domains of the TDF (knowledge, skills, cognitive and interpersonal, environmental context and resources, beliefs about capabilities, beliefs about consequences) and mapped to all constructs of the TFA (affective attitude, ethicality, intervention coherence, self-efficacy, burden, opportunity costs, and perceived effectiveness). Themes highlighted that early stages of treatment can be affected by lack of patient knowledge and understanding, reservations about treatment efficacy, and practical obstacles such as absent non-verbal communication, which is deemed important in the development of therapeutic alliance. Yet post-treatment, patients can reflect more positively, and report gaining benefit from treatment. However, despite this, many patients say that if they were to return for future treatment, they would choose to see a practitioner face-to-face. Conclusions: Using a combination of theoretically underpinned models has allowed the identification of key targets for change. Addressing knowledge deficits to shift attitudes, highlighting the merits of telephone delivered treatment and addressing skills and practical issues may increase acceptability of, and engagement with, telephone-delivered treatment. [ABSTRACT FROM AUTHOR]

Background: Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT.Methods: Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT).Results: The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to 'sell' treatments to a patient population who are not generally expecting treatment in this form.Conclusions: Perceptions of a need to 'sell' telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes. [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals’ roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic policy review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision. Method: The systematic policy review included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant documents: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Documents published between 2006 and February 2018 were included. Results and discussion: Following exclusions, 45 documents were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006–2010 and the remainder since 2013. Two main themes were identified: chronological aspects and healthcare provision. In the former, a publication gap for policy documents resulted from a change in government and associated major healthcare service reorganisation. In the later, the role of non-medical prescribing was found to have evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, the pharmacy profession continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice. Conclusion: Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this review concerns policy and practice in the UK, the aspect of role adoption has wider potential implications. [ABSTRACT FROM AUTHOR]

Study Design: Laboratory analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods.Objective: The aim of this study was to measure the force produced by explanted MAGEC rods compared with new rods and assess the influence of clinical variables.Summary Of Background Data: MAGEC rods are increasingly used in early-onset scoliosis. Some data are available describing the structure of explanted MAGEC rods, but to date, no study has assessed their function.Methods: Explanted MAGEC rods were received from seven UK and one Danish center. The force produced by explanted rods on activation with the external remote controller was measured using a dedicated jig. Forces were compared with two unused rods as well as the manufacturer's defined standard (42 Ibf). Clinical variables were collected from contributing centers where possible and correlated with the force measurements.Results: Forty-five MAGEC rods from 25 cases were received for analysis. The mean age at insertion was 8.6 years and rods were in vivo for a mean of 2.7 years in predominantly dual rod constructs. Two unused MAGEC rods produced a mean force of 45.3 (0.25) and 50.2 (1.4) Ibf, above the manufacturer's stated standard. Of the 45 explanted rods, 10 (22%) produced force greater or equal to manufacturer's standard, mean 46.7 (2.7) Ibf. Six rods (13%) produced some force but less than the manufacturer's standard, mean 34.8 (3.6) Ibf. Twenty-nine rods (64%) produced no force. The duration the rods were in vivo was significantly negatively correlated with the force produced on testing (r = -0.63, P < 0.005). Of the 12 rods implanted longer than 38 months, none produced any force.Conclusion: This is the first study of the force, and hence likely function, of explanted MAGEC rods. The majority of explanted rods produced no force, while others produced reduced force. These findings raise questions regarding the longevity of the implant and further clinical outcome studies are recommended.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: To study the survival and patient outcome in a population of UK patients supported by an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation.Methods: Data on all adult patients (n=342) who received a HeartMate II or HVAD as a first long-term LVAD between January 2007 and 31 December 2013 were extracted from the UK Ventricular Assist Device (VAD) Database in November 2015. Outcomes analysed include survival on a LVAD, time to urgent listing, heart transplantation and complications including those needing a pump exchange.Results: 112 patients were supported with the Thoratec HeartMate II and 230 were supported with the HeartWare HVAD. Median duration of support was 534 days. During the study period, 81 patients required moving to the UK urgent waiting list for heart transplantation. Of the 342 patients, 85 (24.8%) received a heart transplant, this included 63 on the urgent list. Thirty-day survival was 88.9%, while overall patient survival at 3 years from LVAD implant was 49.6%. 156 patients (46%) died during LVAD support; the most common cause of death on a VAD was a cerebrovascular accident. There was no significant difference between the two devices used in any outcome.Conclusions: In a population of patients with advanced heart failure, who have a very poor prognosis, support with an implantable LVAD allowed a quarter to receive a heart transplant in a 3-year period. Overall survival of the cohort was about 50%. With improvement in technology and in post-LVAD management, it is likely that outcomes will improve further. [ABSTRACT FROM AUTHOR]

The article offers information on contesting narratives of the ongoing mental health crisis in the Great Britain. Topics inlcude the employs familiar metaphorical terminology to illustrate has point that difficulties can depress into a vague, the phrase mental health crisis has become ubiquitous in Great Britain news coverage, and the central tenet of neoliberalism is what David Harvey describes as the belief that ‘human has advanced by liberating individual entrepreneurial freedoms.

This paper seeks to contribute to debates about how people's adult lives unfold after experiencing childhood adversity. It presents analysis from the British Chinese Adoption Study: a mixed methods follow-up study of women, now aged in their 40s and early 50s, who spent their infant lives in Hong Kong orphanages and were then adopted by families in the UK in the 1960s. Sixty-eight women participated via questionnaires and face-to-face interviews. The paper draws on both quantitative analysis (using standardised measures and systematically coded data on adult life events) and qualitative analysis of interview data to identify the context and subjective meaning of the quantitative findings. We found that most of the women lived largely positive, stable, well-supported lives although punctuated by challenging periods. Using regression analysis, two variables were significantly associated with poorer mid-life functioning over and above other potential influences: a) feeling unhappy about being adopted, and b) partnership adversity after age 25. No associations were found between childhood experiences and patterns of adult adversity. Illustrations are given, based on the interviews, of the women's multi-faceted perspectives on the long-term impact of being internationally adopted and on professional support. We conclude that when early orphanage care (of reasonable quality) was followed by a good quality adoption, most women were able to negotiate the majority of later difficulties successfully. The findings suggest two important implications for understanding mid-life outcomes: a) that experiences in both childhood and adulthood should be taken into account and b) individuals' subjective views on being internationally adopted may help explain divergent outcomes within groups with similar early experiences. [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. Methods: The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Results: Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Discussion: Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists. [ABSTRACT FROM AUTHOR]