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There are few longitudinal studies of adolescent students' choice to persist in post-compulsory education. Hence, the present study introduces a longitudinal model that describes the interplay between sociological and psychological explanations of adolescents' choice to persist in post-compulsory education in the UK. Data on parental education, early childhood self-regulation (age 5), sustained school engagement (ages 7, 11, 14) and persistence in education after the end of compulsory schooling (age 17) were utilised. The sample comprised 8333 (51.1% females, 89.5% white) children from the Millennium Cohort Study. Statistical analyses included state-trait modelling, longitudinal mediation and multigroup moderation. A trait-state-occasion model was run to disentangle the trait from state variance in school engagement. Afterwards, two hypotheses were formulated, namely the 'instilment' and the 'differential'. The 'instilment' hypothesis involved a longitudinal predictive model, whereby parental education predicted early childhood self-regulation which, in turn, predicted sustained school engagement which predicted students' choice to persist. The 'differential' hypothesis examined whether higher vs. lower parental education changed the nature of the predictive relations between self-regulation, sustained school engagement and persistence. The results were in favour of an 'instilment' hypothesis, whereby higher parental education was translated to higher levels of early self-regulation which predicted higher sustained engagement, which, in turn, predicted greater probability of persisting in post-compulsory education. The findings suggest a pathway from early childhood experiences to educational outcomes via the development of a trait of engaging with school.

While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

This research investigated how the bug tracker database of the Virtual Learning Environment (VLE) Moodle is developed as an application of crowd work. The bug tracker is used by software developers, who write and maintain Moodle's code, but also by a wider public world of ordinary Moodle users who can report bugs. Despite many studies of the phenomenon of open source bug fixing and software building, much remains to be answered. Specifically, we sought to analyse the implications of this massively distributed collaborative development process for education and educational technology. The research examined the ways educators interface and contribute to the development of the VLE Moodle at the granular level of bug fixing as an example of a global crowdsourced activity. In this study, twenty community participants were interviewed, from fringe members, to key actors, including lead developers from the Open University, Moodle HQ and Moodle founder Martin Dougiamas. We uncovered rich stories of practices of community members. We found that projects are complex interplays of many actors assuming different roles and identities, and that brokers, or "kindly souls", play a key role in activities such as filing reports on behalf of others, or inducting new members.

Against the backdrop of the COVID‐19 pandemic, workplace wellbeing is a key priority for employers. Severe market and health conditions continue to bring inevitable problems that could be reduced with the application of psychological interventions to prevent mental and physical health issues, making this study a highly pertinent and valuable contribution to the field. This paper reports the effects of a rational emotive behaviour therapy (REBT) programme on the irrational beliefs and emotional reactivity of 56 office‐based sales professionals located in the northwest region of the UK. A pre‐test, post‐test experimental design was utilised, and a mixed model ANOVA (repeated measures) was adopted to assess changes in mean differences concerning irrational beliefs and emotional reactivity at pre and post‐test stages for the intervention group, in comparison to a control group. Results indicate that those in the REBT group reported significant reductions in irrational beliefs and emotional reactivity, whilst those in the control group reported no such changes. It is recommended that future research studies consider utilizing a mixed methods design and focus on a strategic collaboration of organisational and individual level interventions for improving the psychological wellbeing and performance of sales personnel. [ABSTRACT FROM AUTHOR]

Few data exist on the prevalence of autism in low-income countries. We translated, adapted and tested the acceptability of a Nepali-language version of a screening tool for autism (Autism Quotient-10). Using this tool, we estimated autism prevalence in 4098 rural Nepali children aged 9-13 years. Fourteen children scored > 6 out of 10, indicative of elevated autistic symptomatology, of which 13 also screened positive for disability. If the AQ-10 screening tool is as sensitive and specific in the Nepali population as it is in the UK, this would yield an estimated true prevalence of 3 in 1000 (95% confidence interval 2-5 in 1000). Future research is required to validate this tool through in-depth assessments of high-scoring children.

This study aimed to evaluate the between-day reliability and usefulness of a fitness testing battery in a group of youth sport athletes. Fifty-nine youth sport athletes (age = 17.3 ± 0.7 years) undertook a fitness testing battery including the isometric mid-thigh pull, counter-movement jump, 5-40 m sprint splits, and the 5-0-5 change of direction test on two occasions separated by 7 days. Usefulness was assessed by comparing the reliability (typical error) to the smallest worthwhile change. The typical error was 5.5% for isometric mid-thigh pull and 3.8% for counter-movement jump. The typical error values were 2.7, 2.5, 2.2, 2.2, and 1.8% for the 5, 10, 20, 30, and 40 m sprint splits, and 4.1% (left) and 5.4% (right) for the 5-0-5 tests. The smallest worthwhile change ranged from 1.1 to 6.1%. All tests were identified as having "good" or "acceptable" reliability. The isometric mid-thigh pull and counter-movement jump had "good" usefulness, all other tests had "marginal" usefulness.

The influence of the law of the United Kingdom in the design of Irish social legislation is notorious. While the imprints of its British antecedents are stamped on the general design of the (Irish) Unfair Dismissals Act 1977, the Irish Act introduced at least two innovations: (1) the imposition on employers of a comparatively higher ‘substantial grounds’ standard for justifying direct dismissal (rather than the weaker British ‘reasonable’ grounds standard); and (2) the insertion of a more liberal ‘reasonable to resign’ standard for justifying constructive dismissal (in place of what appeared, in the mid-1970s, to be the more restrictive British common law ‘entitled’ to resign standard). In various ways, these innovations have not been fully realized. Employees have been denied the benefit of the ‘substantial grounds’ standard by the translation -inappropriately, it is argued- into Irish law of the British range of reasonable responses and reasonable employer tests. At the same time, the reasonableness test for constructive dismissal has become over-calcified. This has been caused by the insistence by the employment tribunals that the employee must, as a condition to claiming constructive dismissal, first exhaust the employer’s grievance processes. While failure to resort to internal processes can be a factor which may affect the ‘reasonableness’ of the decision to resign without notice, there will be cases in which it can be quite ‘reasonable’ to terminate the relationship without resorting to the employer’s grievance process. In the same way that full effect is not being given to the ‘substantial grounds’ standard which regulates direct dismissal, it is possible that full effect is not always being given to the ‘reasonableness’ standard which regulates constructive dismissal. [ABSTRACT FROM AUTHOR]

This scoping review explores the professional literature in allied healthcare to determine which self-assessments of mentor skills are the most valid and reliable for use in occupational therapy doctoral capstone programs. The aims of this scoping review include mapping evidence related to mentor assessments in healthcare, exploring implications for occupational therapy doctoral mentor training programs, and identifying common characteristics of mentor self-assessments for occupational therapy programs to consider when developing capstone mentoring resources. Researchers applied and reported via PRISMA Extension for Scoping Reviews (PRISMA-ScR). A librarian and authors formulated keywords and database selections to search PubMed/MEDLINE/PMC, and Embase were searched from across healthcare professions for training outcomes, mentor self-assessment, mentor attributes, and use of researcher-developed assessments. The search was limited to English publications from the last 20 years. Data were extracted for quantitative information regarding study characteristics and qualitative information about mentoring skills. A total of 852 results were delivered across all databases. Nineteen papers met the final eligibility criteria and were included in the data extraction. Populations were included from several healthcare professions, including 11 nursing, four healthcare researchers, one pharmacy, one midwifery, one medicine, and one medical dietetics. Countries included the United States (n = 7), Finland (n = 5), United Kingdom (n = 4), Japan (n = 1), South Africa (n = 1) and Canada (n = 1). The authors identified four valid self-assessment tools, demonstrating III and IV levels of evidence, that may be implemented by occupational therapy programs as they develop resources for mentor programs. Occupational therapy programs can use the mentor attributes found in this scoping review to create their own mentor assessment measures or may choose to use a validated tool. The authors recommend additional research in mentor education and mentor skill acquisition. [ABSTRACT FROM AUTHOR]

The central aim of this paper is to undertake a critical review of arguments which propose that chess should be taught in schools and other educational settings. In particular, I offer an answer to the question: "Should chess be taught in early childhood?" Many claims have been made about the educational benefits of chess instruction. In evaluating these, I argue that critics of such claims have neglected an important possibility for evaluating the teaching of chess: undertaking research studies that employ an action research (AR) methodology. This paper focuses on the following themes: (1) chess: the gymnasium of the mind; (2) teaching and learning chess: the current context; (3) teaching young children to play chess: some common claims; (4) research studies and "the ideal experiment"; (5) teaching chess: the role of AR and (6) conclusion: should chess be taught in early childhood?

The arts are often seen as peripheral to the "real business" of school and schooling. While this has been the case for some time now, the increasing pressures of high-stakes testing and ever-more draconian public funding schemes (particularly in the wake of 9/11) have created something of a "perfect storm" for those working in the arts. Arts proponents today live and operate within a culture of scarcity, having to justify their increasingly marginalized vocations while competing for continually shrinking resources. The result is an often deep-bodied sense of vulnerability, one which saturates the social field (both micro and macro) of arts education in ways not often publicly acknowledged. In this article, I explore this notion of "vulnerability" as a framework for understanding qualitative data which emerged from a three-year arts and education project I conducted in a large, northeast city in the USA beginning in 2003. In so doing, I look to open up a broader discussion about the oft-ignored intersection(s) between the material and aesthetic in arts and education--a discussion which is sober about the future of such work in times of economic scarcity and conservative retrenchment. (Contains 1 note.)

The proliferation of anti-vaccination arguments online can threaten immunisation programmes, including those targeting COVID-19. To effectively refute misinformed views about vaccination, communicators need to go beyond providing correct information and debunking of misconceptions, and must consider the underlying motivations of people who hold contrarian views. Drawing on a taxonomy of anti-vaccination arguments that identified 11 "attitude roots"—i.e., psychological attributes—that motivate an individual's vaccine-hesitant attitude, we assessed whether these attitude roots were identifiable in argument endorsements and responses to psychological construct measures corresponding to the presumed attitude roots. In two UK samples (total n = 1250), we found that participants exhibited monological belief patterns in their highly correlated endorsements of anti-vaccination arguments drawn from different attitude roots, and that psychological constructs representing the attitude roots significantly predicted argument endorsement strength and vaccine hesitancy. We identified four different latent anti-vaccination profiles amongst our participants' responses. We conclude that endorsement of anti-vaccination arguments meaningfully dovetails with attitude roots clustering around anti-scientific beliefs and partisan ideologies, but that the balance between those attitudes differs considerably between people. Communicators must be aware of those individual differences. [ABSTRACT FROM AUTHOR]

Data from peer reviews of 258 teaching sessions involving 129 nursing teachers and interviews with 14 teachers identified several themes. Initially perceived as a threat, peer review became a positive experience for both reviewer and reviewed. Preparation of reviewers and a process for changing nominated reviewers were recommended. (SK)

Action research was used for a follow-up study of the implementation of a philosophy of health in nursing curricula. Health was interpreted both as health education and health promotion. Issues arose in terms of the gap between rhetoric and reality in action research and the expectations and needs of key partners. (SK)

Objective The incidence and prevalence of JIA was last estimated in the UK in 1994. Since then the disease has been reclassified, the specialty of paediatric rheumatology has evolved and there has been a significant shift in disease management with new advanced therapies. This study aimed to provide up-to-date national estimates of this disease. Methods Children and young people (CYP) with JIA were identified in the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, which source data from the two most commonly used primary care electronic health record systems in the UK. These databases were combined and the cohort was identified (2000–18) using predefined code lists. Validation was performed through linkage to the England Hospital Episode Statistics. Annual incidence and prevalence rates were calculated and stratified by gender, age group and nation of the UK. Direct standardization to the UK population was performed and 5 year incidence rates were calculated between 2003 and 2018. Results The age-standardized incidence rate was 5.61 per 100 000 population. The age-standardized prevalence rate in 2018 was 43.5 per 100 000. Rates were higher in Scotland compared with England: incidence rate ratio 1.27 (95% CI 1.11, 1.46). The 5 year incidence rates did not change significantly over time. Conclusions This study has provided the first contemporaneous estimates of occurrence of JIA in the UK in 25 years. These data provide important estimates to inform resource allocation and health service development for management of JIA. [ABSTRACT FROM AUTHOR]

Objectives Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. Methods Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies. [ABSTRACT FROM AUTHOR]

Background/aims : Functional visual symptoms are relatively common symptoms seen by ophthalmologists. However, there are no consensus guidelines on ophthalmological management of this condition, and there is a paucity of knowledge about the collective challenges experienced in treating patients with functional visual symptoms. In order to establish an ophthalmological perspective on this condition, we undertook the first national survey of experience, knowledge and management of functional visual symptoms amongst ophthalmologists. Methods: An online survey was disseminated to ophthalmologists in the UK via all Royal College of Ophthalmology college tutors. Results: One hundred nineteen ophthalmologists completed the survey. Functional visual symptoms accounted for 3% of all new referrals. Forty per cent of respondents felt they had a good understanding of functional visual symptoms. Two-thirds reported a need for further training in this area. Respondents estimated two-thirds of patients' symptoms improved, but a third experienced severe or extreme disability. Following diagnosis, a minority of patients were referred to mental health or neurology services. The majority of respondents described difficulty discussing psychological factors, with a lack of time or space in a clinic preventing a holistic approach. Free text comments highlighted a lack of access to dedicated psychological support for patients. Conclusion: Functional visual symptoms are disabling and are seen relatively frequently by ophthalmologists. This preliminary survey suggests that care pathways for patients with functional visual symptoms could be optimised. Fostering links between ophthalmology and existing services with expertise in functional disorders could improve patient care and clinician education and ultimately encourage research in this area. [ABSTRACT FROM AUTHOR]

Objectives: Evidence in mouse models has found that the antidepressant trazodone may be protective against neurodegeneration. We therefore aimed to compare cognitive decline of people with dementia taking trazodone with those taking other antidepressants. Methods: Three identical naturalistic cohort studies using UK clinical registers. We included all people with dementia assessed during 2008–16 who were recorded taking trazodone, citalopram or mirtazapine for at least 6 weeks. Linear mixed models examined age, time and sex‐adjusted Mini‐mental state examination (MMSE) change in people with all‐cause dementia taking trazodone compared with those taking citalopram and mirtazapine. In secondary analyses, we examined those with non‐vascular dementia; mild dementia; and adjusted results for neuropsychiatric symptoms. We combined results from the three study sites using random‐effects meta‐analysis. Results: We included 2,199 people with dementia, including 406 taking trazodone, with mean 2.2 years follow‐up. There was no difference in adjusted cognitive decline in people with all‐cause or non‐vascular dementia taking trazodone, citalopram or mirtazapine in any of the three study sites. When data from the three sites were combined in meta‐analysis, we found greater mean MMSE decline in people with all‐cause dementia taking trazodone compared to those taking citalopram (0·26 points per successive MMSE measurement, 95% CI 0·03–0·49; p = 0·03). Results in sensitivity analyses were consistent with primary analyses. Conclusions: There was no evidence of cognitive benefit from trazodone compared to other antidepressants in people with dementia in three naturalistic cohort studies. Despite preclinical evidence, trazodone should not be advocated for cognition in dementia. Key points: There is no evidence of cognitive benefit of trazodone in dementiaPeople taking trazodone had worse cognitive decline than those taking citalopramResults were similar in analyses restricted to people with mild dementiaResults were consistent after adjustment for severity of neuropsychiatric symptoms [ABSTRACT FROM AUTHOR]

Background: In the UK, annual influenza vaccination is currently recommended for adults aged 16-64 years who are in a clinical at-risk group. Despite recommendations, rates of vaccine uptake in the UK have historically been low and below national and international targets. This study aims to analyse vaccine uptake among adults in clinical at-risk groups from the 2015-2016 influenza season to the present.Methods: A retrospective analysis of influenza vaccine coverage in the UK was conducted using data extracted from publicly available sources. Clinically at-risk individuals (as defined by Public Health England), including pregnant women, aged 16-64 years, were included in this study.Results: Influenza vaccination coverage rates across the UK in adults aged 16-64 years in a clinical at-risk group have been consistently low over the past 5 years, with only 48.0, 42.4, 44.1 and 52.4% of eligible patients in England, Scotland, Wales and Northern Ireland receiving their annual influenza vaccination during the 2018-2019 influenza season. Influenza vaccine coverage was lowest in patients with morbid obesity and highest in patients with diabetes in 2018-2019. Coverage rates were below current national ambitions of ≥75% in all clinical risk groups. In these clinical at-risk groups, influenza vaccine coverage decreased between 2015 and 2019, and there was considerable regional variation.Conclusions: Uptake of the influenza vaccine by adults aged 16-64 years in a clinical at-risk group was substantially below the national ambitions. As a result, many individuals in the UK remain at high risk of developing severe influenza or complications. Given that people who are vulnerable to COVID-19 are also at increased risk of complications from influenza, during the 2020-2021 season, there is a heightened need for healthcare professionals across the UK to address suboptimal vaccine uptake, particularly in at-risk patients. Healthcare professionals and policymakers should consider measures targeted at increasing access to and awareness of the clinical benefits of the influenza vaccine. [ABSTRACT FROM AUTHOR]

Respiratory rate (RR) is routinely used to monitor patients with infectious, cardiac and respiratory diseases and is a component of early warning scores used to predict patient deterioration. However, it is often measured visually with considerable bias and inaccuracy. Objectives. Firstly, to compare distribution and accuracy of electronically measured RR (EMRR) and visually measured RR (VMRR). Secondly, to determine whether, and how far in advance, continuous electronic RR monitoring can predict oncoming hypoxic and pyrexic episodes in infectious respiratory disease. Approach. A retrospective cohort study analysing the difference between EMRR and VMRR was conducted using patient data from a large tertiary hospital. Cox proportional hazards models were used to determine whether continuous, EMRR measurements could predict oncoming hypoxic (SpO2 < 92%) and pyrexic (temperature >38 °C) episodes. Main results. Data were gathered from 34 COVID-19 patients, from which a total of 3445 observations of VMRR (independent of Hawthorne effect), peripheral oxygen saturation and temperature and 729 117 observations of EMRR were collected. VMRR had peaks in distribution at 18 and 20 breaths per minute. 70.9% of patients would have had a change of treatment during their admission based on the UK's National Early Warning System if EMRR was used in place of VMRR. An elevated EMRR was predictive of hypoxic (hazard ratio: 1.8 (1.05–3.07)) and pyrexic (hazard ratio: 9.7 (3.8–25)) episodes over the following 12 h. Significance. Continuous EMRR values are systematically different to VMRR values, and results suggest it is a better indicator of true RR as it has lower kurtosis, higher variance, a lack of peaks at expected values (18 and 20) and it measures a physiological component of breathing directly (abdominal movement). Results suggest EMRR is a strong marker of oncoming hypoxia and is highly predictive of oncoming pyrexic events in the following 12 h. In many diseases, this could provide an early window to escalate care prior to deterioration, potentially preventing morbidity and mortality. [ABSTRACT FROM AUTHOR]

EMERGING EVIDENCE FOR EARLY MEDIEVAL UPLAND COLONISATION IN BRITAIN AND IRELAND When we broaden the perspective out to the whole of Britain and to Ireland, the temporal correlation between upland colonisation and the population growth and temperature increases c 850-1300 becomes less clear. Graph: Fig 4 Illustration of the "pull" and "push" factors in upland colonisation in the 10th to 14th centuries, in the context of wider climate variability: A) local factors within uplands which acted as facilitative "pull" factors for new hill farms; B) regional socio-political and demographic pressures which acted as "push" factors for people to settle in uplands. PHOTO (COLOR): Fig 8 Hypothetical summary of three key long-term trends that influenced decisions to establish year-round farms in uplands and influenced the viability of these farms once established (c ad 500-1900): A) the economic value of uplands; B) population pressure to settle in uplands; and C) arable carrying capacity of uplands. The review comprises three temporal case studies: (1) "classic" early second millennium ad expansion in south-west England, and the role of pre-existing transhumant niches in upland colonisation; (2) the growing evidence for early medieval farming in uplands across Britain and Ireland, and the role of local environmental factors in this expansion; and (3) the resilience of hill farmers during the late-medieval and early modern "Little Ice Age". [Extracted from the article]

Objectives Patients with RA are frequently treated with glucocorticoids (GCs), but evidence is conflicting about whether GCs are associated with hypertension. The aim of this study was to determine whether GCs are associated with incident hypertension in patients with RA. Methods A retrospective cohort of patients with incident RA and without hypertension was identified from UK primary care electronic medical records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use, dose and cumulative dose, with a 3 month attribution window. Hypertension was identified through either: blood pressure measurements >140/90 mmHg, or antihypertensive prescriptions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards regression models were fitted to determine whether there was an association between GC use and incident hypertension. Results There were 17 760 patients in the cohort. A total of 7421 (42%) were prescribed GCs during follow-up. The incident rate of hypertension was 64.1 per 1000 person years (95% CI: 62.5, 65.7). The Cox proportional hazards model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio 1.17; 95% CI: 1.10, 1.24). When categorized by dose, only doses above 7.5 mg were significantly associated with hypertension. Cumulative dose did not indicate a clear pattern. Conclusion Recent GC use was associated with incident hypertension in patients with RA, in particular doses ≥7.5 mg were associated with hypertension. Clinicians need to consider cardiovascular risk when prescribing GCs, and ensure blood pressure is regularly monitored and treated where necessary. [ABSTRACT FROM AUTHOR]

Background staff burnout and turnover lead to care home residents receiving poorer quality care. Burnout is thought to cause turnover, but this has never been investigated. We know little about which care home staffs are burnt out. Aims to explore burnout's relationship with staff turnover and prevalence and predictors of burnout. Method we calculated the relationship between Maslach Burnout Inventory scores and future staff turnover (12-month number of staff leaving/number employed). We explored staff, resident and care home predictors of burnout, measured as emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Results two-thousand sixty-two care staff in 97 care home units participated. Median yearly staff turnover was 22.7%, interquartile range (IQR) 14.0–37.7%. Care staff recorded low median burnout (median EE: 14, IQR: 7–22; DP: 1, IQR: 0–5; PA 42, IQR: 36–45). We found no association between staff burnout and turnover rate. Younger staff age was associated with higher burnout (EE coefficient − 0.09; 95% confidence interval (CI): −0.13, −0.05; DP −0.02; 95% CI: −0.04, −0.01; PA 0.05; 95% CI: 0.02, 0.08). Speaking English as a second language predicted higher EE (1.59; 95% CI: 0.32, 2.85), males had higher DP (0.02; 95% CI: 0.01, 0.04) and staff working only night shifts lower PA (−2.08; 95% CI: −4.05, −1.30). Conclusions we found no association between care homes staff burnout level and staff turnover rates. It is a myth that burnout levels are high. Interventions for burnout could focus on at-risk groups. Future studies could consider turnover at an individual level. [ABSTRACT FROM AUTHOR]

Background and Purpose: Pressures on hospital bed occupancy in the English National Health Service have focused attention on enhanced service delivery models and methods by which physical therapists might contribute to effective cost savings, while retaining a patient-centered approach. Earlier access to physical therapy may lead to better outcomes in frail older inpatients, but this has not been well studied in acute National Health Service hospitals. Our aim was to retrospectively study the associations between early physical therapy input and length of hospital stay (LOS), functional outcomes, and care needs on discharge. Methods: This was a retrospective observational study in a large tertiary university National Health Service hospital in the United Kingdom. We analyzed all admission episodes of people admitted to the department of medicine for the elderly wards for more than 3 months in 2016. Patients were categorized into 2 groups: those examined by a physical therapist within 24 hours of admission and those examined after 24 hours of admission. The outcome variables were as follows: LOS (days), functional measures on discharge (Elderly Mobility Scale and walking speed over 6 m), and the requirement of formal care on discharge. Characterization variables on admission were age, gender, existence of a formal care package, preadmission abode, the Clinical Frailty Scale, Charlson Comorbidity Index, the Emergency Department Modified Early Warning Score, C-reactive protein level on admission, and the 4-item version of the Abbreviated Mental Test. The association between the delay to physical therapy input and LOS before discharge home was evaluated using a Cox proportional hazards regression model. Results and Discussion: There were 1022 hospital episodes during the study period. We excluded 19 who were discharged without being examined by a physical therapist. Of the remaining 1003, 584 (58.2%) were examined within 24 hours of admission (early assessment) and 419 (41.8%) after 24 hours of admission (late assessment). The median (interquartile range) LOS of the early assessment group was 6.7 (3.1-13.7) versus 10.0 (4.2-20.1) days in the late assessment group, P <.001. The early assessment group was less likely to require formal care on discharge: n = 110 (20.3%) versus n = 105 (27.0%), P =.016. No other statistically significant differences were seen between the 2 groups. In the unadjusted Cox proportional hazards model, the hazard ratio for early assessment compared with late assessment was 1.29 (95% confidence interval: 1.12-1.48, P <.001). Early assessment was associated with a 29% higher probability of discharge to usual residence within the first 21 days after admission than the late assessment. Adjustment for possible confounding variables increased the hazard ratio: 1.34 (1.16-1.55), P <.001. Conclusions: Early physical therapy input was associated with a shorter LOS and lower odds of needing care on discharge. This may be due to the beneficial effect of early physical therapy in preventing hospital-related deconditioning in frail older adults. However, causality cannot be inferred and further research is needed to investigate causal mechanisms. [ABSTRACT FROM AUTHOR]

Describes different styles and approaches toward broadcasting which could be used within the Open University Continuing Education Division. Three types of courses using television are discussed: advice courses, how to courses, and why (basis of knowledge) courses. Three references are included. (Author/BK)

It has become increasingly important to qualitatively and quantitatively assess the volatile metabolites in a range of bodily fluids for use in monitoring health. There has been relatively little work on the quantitative analysis of compounds, particularly with respect to the effects of ethnicity or geographic location. A novel method for the quantification of compounds in stool using 13C labelled compounds as internal standards is presented. Using thermal desorption gas chromatography mass spectrometry, stool samples from 38 healthy volunteers were analysed. The 13C labelled compounds, acetone, ethyl butanoate, ethanoic acid, butanoic acid, 3-methylbutanoic acid, and indole, were added as internal standards. This process mimics the solubility characteristics of the compounds and thus the method was able to quantify the compounds within the solid stool. In total, 15 compounds were quantified: Dimethyl sulphide (26–25,626 ng/g), acetone (442–3006 ng/g), ethyl butanoate (39–2468 ng/g), ethyl 2-methylbutanoate (0.3–180 ng/g), dimethyl disulphide (35–1303 ng/g), 1-octen-3-one (12 ng/g), dimethyl trisulphide (10–410 ng/g), 1-octen-3-ol (0.4–58 ng/g), ethanoic acid (672–12,963 ng/g), butanoic acid (2493–11,553 ng/g), 3-methylbutanoic acid (64–8262 ng/g), pentanoic acid (88–21,886 ng/g), indole (290–5477 ng/g), and 3-methyl indole (37–3483 ng/g). Moreover, by altering the pH of the stool to pH 13 in conjunction with the addition of 13C trimethylamine, the method was successful in detecting and quantifying trimethylamine for the first time in stool samples (range 40–5312 ng/g). Statistical analysis revealed that samples from U.K. origin had five significantly different compounds (ethyl butanoate, 1-octen-3-ol, ethanoic acid, butanoic acid, pentanoic acid, and indole) from those of South American origin. However, there were no significant differences between vegetarian and omnivore samples. These findings are supported by pre-existing literature evidence. Moreover, we have tentatively identified 12 compounds previously not reported as having been found in stool. [ABSTRACT FROM AUTHOR]

In the palliative phase of a person's illness, the needs of the patient and informal caregivers are paramount. Caregivers often look to palliative care practitioners for support, guidance and emotional comfort. This article reviews the role of the informal caregiver at the end of life, summarising their concerns and needs. The paper also highlights caregiver difficulties in making the coping transition when the patient's medical condition becomes advanced and they require end-of-life care. The focus of the review is placed on discussions about Advanced Care Planning (ACP). ACP is a complex legal, ethical and practical issue that can enable caregivers to consider future strategies and enable them to provide high quality care at the end of life. The paper looks at some of the ethical and legal issues associated with this sensitive end-of-life issue. [ABSTRACT FROM AUTHOR]

Introduction: Guidelines for the management of rheumatoid arthritis (RA) recommend using influenza and pneumococcal vaccinations to mitigate infection risk. The level of adherence to these guidelines is not well known in the UK. The aims of this study were to describe the uptake of influenza and pneumococcal vaccinations in patients with RA in the UK, to compare the characteristics of those vaccinated to those not vaccinated and to compare vaccination rates across regions of the UK. Methods: A retrospective cohort study of adults diagnosed with incident RA and treated with non-biologic immunosuppressive therapy, using data from a large primary care database. For the influenza vaccination, patients were considered unvaccinated on 1st September each year and upon vaccination their status changed to vaccinated. For pneumococcal vaccination, patients were considered vaccinated after their first vaccination until the end of follow-up. Patients were stratified by age 65 at the start of follow-up, given differences in vaccination guidelines for the general population. Results: Overall (N = 15,724), 80% patients received at least one influenza vaccination, and 50% patients received a pneumococcal vaccination, during follow-up (mean 5.3 years). Of those aged below 65 years (N = 9,969), 73% patients had received at least one influenza vaccination, and 43% patients received at least one pneumococcal vaccination. Of those aged over 65 years (N = 5,755), 91% patients received at least one influenza vaccination, and 61% patients had received at least one pneumococcal vaccination. Those vaccinated were older, had more comorbidity and visited the GP more often. Regional differences in vaccination rates were seen with the highest rates in Northern Ireland, and the lowest rates in London. Conclusions: One in five patients received no influenza vaccinations and one in two patients received no pneumonia vaccine over five years of follow-up. There remains significant scope to improve uptake of vaccinations in patients with RA. [ABSTRACT FROM AUTHOR]

Background: It is important that scales exhibit strong measurement properties including those related to the investigation of issues that impact evidence-based practice. The validity of the Barriers to Research Utilization Scale (BARRIERS Scale) has recently been questioned in a systematic review. This study investigated the dimensional structure and stability of the 28 item BARRIERS Scale when completed by three groups of participants from three different crosscultural environments. Method: Data from the BARRIERS Scale completed by 696 occupational therapists from Australia (n = 137), Taiwan (n = 413), and the United Kingdom (n = 144) were analysed using principal components analysis, followed by Procrustes Transformation. Poorly fitting items were identified by low communalities, cross-loading, and theoretically inconsistent primary loadings, and were systematically removed until good fit was achieved. The cross-cultural stability of the component structure of the BARRIERS Scale was examined. Results: A four component, 19 item version of the BARRIERS Scale emerged that demonstrated an improved dimensional fit and stability across the three participant groups. The resulting four components were consistent with the BARRIERS Scale as originally conceptualised. Conclusion: Findings from the study suggest that the four component, 19 item version of the BARRIERS Scale is a robust and valid measure for identifying barriers to research utilization for occupational therapists in paediatric health care settings across Australia, United Kingdom, and Taiwan. The four component 19 item version of the BARRIERS Scale exhibited good dimensional structure, internal consistency, and stability. [ABSTRACT FROM AUTHOR]

Detention as part of migration control is sometimes portrayed as a 'necessary adjunct' of the state's power to control immigration. This characterization is a masking device, obscuring the grounds of detention (or the lack thereof) from proper scrutiny. It has convincingly been argued that human rights law fails to scrutinize the necessity of immigration detention. Many scholars have pointed out the anomalous approach to assessing the legal justifications for immigration detention, compared with other forms of deprivation of liberty, which are more powerfully constrained by human rights law. Yet, cogent as this critique is, it sometimes fails to interrogate the related questions concerning the legal grounds of detention. A ground is a particular form of legal reason, which both explains and justifies the official action in question. By examining the question of grounds, this article aims to elucidate the manner in which immigration law itself produces reasons to detain, and by doing so creates detainable subjects, migrants. Basic liberty-protective principles and practices developed in other areas of law are notably absent. This state of affairs is not inevitable, and legal alternatives are within reach. [ABSTRACT FROM AUTHOR]

Contemporary societies are characterized by complex interdependence, with industrial activity increasingly having the potential to cause effects beyond local and national borders. Courts have previously illustrated that liability for injurious action must lie with the individual who created the risk of damage under the common law rule of Rylands v. Fletcher. Having fallen out of favour in the twentieth century, this article proposes a re-articulation of the rule to cover situations in modern society in which invasive methods are used in the extraction of volatile fuels from the earth, specifically in the case of 'fracking'. The article examines recent rulings from the United States and the United Kingdom, as well as precedent from the United Kingdom and Ireland to establish the manner in which the rule of Rylands v. Fletcher might be successfully re-articulated in the context of contemporary common law jurisdictions - specifically focusing on Ireland - as a means for redressing environmental damage. [ABSTRACT FROM AUTHOR]

Orders issued by justices operating the poor law in seventeenth and eighteenth century England – orders for removing paupers, orders for the maintenance of bastard children, orders adjudicating poor rate appeals – generated vast quantities of litigation. Most of that litigation was by way of appeal to Quarter Sessions; but a small number of cases went further, to the King's Bench, by way of certiorari. This account examines this litigation phenomenon from several vantage points: from the perspective of the King's Bench (which innovated procedures to regulate certiorari, and which expanded its means of reviewing legal error through the development of the special case); from the perspective of Parliament (which was required to respond to demands by justices that the process be abolished); and from the perspective of contemporary commentators (who were critical of the money wasted by parishes litigating in the King's Bench). [ABSTRACT FROM PUBLISHER]

In Edwards v Chesterfield Royal Hospital NHS Foundation Trust [2011] UKSC 58 [2012] 2 W. L. R. 55 the Supreme Court addressed the following question: is an employee, who can establish that (a) if a contractual disciplinary process had been correctly administered he would have been exonerated, and (b) thereafter employed until retirement, able to sue for loss of the earnings that he would have acquired until retirement? Three members of the Supreme Court held that such a remedy was not reconcilable with the enactment, originally in the Industrial Relations Act 1971, of a statutory unfair dismissals protection regime. It was Parliament's intention that an employee should not be able to outmanoeuvre the statute's compensation limitation rules by deploying a superior common law remedy. This note considers that reading of Parliament's intention. [ABSTRACT FROM AUTHOR]

Objective: To rigorously test the relation between perceived risk (ie, belief about the likelihood of harm) and quitting smoking. Methods: Data from a longitudinal study with a nonrestrictive sample of smokers (N = 4307) from the United States, Canada, the United Kingdom, and Australia were examined to predict quitting behaviors at 8-12 months. Results: Perceived risk predicted plans to quit, quit attempts, and, to some extent, sustained quitting. The relation was stronger for relatively simple (eg, plans to quit) than for complex behaviors (eg, sustained quitting). Conclusion: Perceived risk plays a significant role in predicting quitting smoking, more so for relatively simple behaviors. [ABSTRACT FROM AUTHOR]

The objective of this research was to study the UK government's strategic policy development in the information and communications technology (ICT) industry, in particular the role of higher education institutions (HEIs). Information gathered from nine universities in one region demonstrates their impact in driving local economy. The collaborations between universities and small and medium enterprises (SMEs) reveal a dynamic approach towards encouraging innovation activities. Also deliberated are issues relating to the role of HEIs in economic development and the challenges that both SMEs and universities face, with the biggest challenge being a positive change in attitude. In a climate where many information systems(IS) students remain close to home, there may also be a potential correlation between courses delivered in local proximity that have an impact on competitive advantage. [ABSTRACT FROM AUTHOR]

Abstract: Eurasian badgers (Meles meles) are a reservoir host of Mycobacterium bovis and are implicated in the transmission of tuberculosis to cattle in Ireland and Great Britain. The development of a vaccine for use in badgers is considered a key element of any long-term sustainable campaign to eradicate the disease from livestock in both countries. The aim of this study was to investigate the protective response of badgers vaccinated orally with Bacille Calmette–Guérin (BCG) encapsulated in a lipid formulation, followed by experimental challenge with M. bovis. A group of badgers was vaccinated by inoculating the BCG–lipid mixture containing approximately 108 colony forming units (cfu) of BCG into the oesophagus. The control group was sham inoculated with the lipid formulation only. Thirteen weeks after vaccination all the badgers were challenged with approximately 104 cfu of M. bovis delivered by endobronchial inoculation. Blood samples were taken throughout the study and the cell mediated immune (CMI) responses in peripheral blood were monitored by the IFN-γ ELISA and ELISPOT assay. At 17 weeks after infection all the badgers were examined post-mortem to assess the pathological and bacteriological responses to challenge. All badgers in both groups were found to be infected. However, a significant protective effect of BCG vaccination was measured as a decrease in the number and severity of gross lesions, lower bacterial load in the lungs, and fewer sites of infection. The analysis of immune responses showed that vaccination with BCG did not generate any detectable CMI immunological responses, however the levels of the responses increased in both groups following M. bovis infection. The results of the study showed that vaccination with oral BCG in the lipid formulation generated a protective effect in the badgers. [ABSTRACT FROM AUTHOR]

Summary: Mycobacterium bovis is endemic in badger (Meles meles) populations of Ireland and the United Kingdom and infected badgers are a potential source of infection for cattle. In domestic livestock tuberculosis causes economic losses from lost production and the costs associated with eradication programmes, and in addition there is a risk of zoonotic infection. Whereas culling is currently used to control tuberculous badger populations in Ireland, vaccination, if it were available, would be preferred. A study was undertaken to examine the protective responses of badgers vaccinated either by the subcutaneous or mucosal (intranasal and conjunctival) routes with bacille Calmette-Guérin (BCG), when challenged with M. bovis by the endobronchial route. Three groups of badgers were used. The first group (n =4) was vaccinated with ∼5×105 colony forming units (cfu) of BCG by subcutaneous injection. In the second group (n =5) badgers were vaccinated via the mucosal route by instilling 1.0×105 cfu into each conjunctival sac and spraying 1.0×105 cfu into each nostril (final vaccine dose of 4×105 cfu). The control (n =5) badgers served as a non-vaccinated group. Twelve weeks post-vaccination all badgers in the three groups were challenged with ∼104 cfu of M. bovis by endobronchial inoculation. At 12weeks post-infection all badgers were examined post-mortem to assess the pathological and bacteriological responses to challenge. Gross and histological lesions of tuberculosis were seen in all challenged badgers and M. bovis was recovered from all challenged badgers. However, across six of the eight parameters used to measure disease severity, the infection in the vaccinated badgers was significantly less severe than in the control group. The BCG vaccine induced a significant protective effect in the badgers and the protective immunity was generated by subcutaneous and mucosal vaccination. [Copyright &y& Elsevier]

This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. There have been over 5000 articles published globally describing syringe drivers in the medical and nursing literature within the last decade. Many provide guidance on their use, although much of the data are repetitious, disease or age-group specific, and focused on pragmatic issues to do with clinical application. Several trusts and hospices across the UK are carrying out trials of the recently launched Mckinley T34 syringe driver. Therefore, it seems timely to consider their wider use internationally. Globally, practitioners in palliative care are very familiar with their use, although the literature lacks specific guidance and, at times, the information is ambiguous. Having briefly reviewed their benefits, the article considers the limitations of using syringe drivers and comments on some of the lesser known/reported practical and patient-focused drawbacks associated with their use. We conclude by considering why, when so much education and training exists to help practitioners use these devices effectively, so many human errors occur. [ABSTRACT FROM AUTHOR]

Explores the practice of development support needs of specialist nurses working in cancer and palliative care in order to assist in the improvement of cancer and palliative care services in Great Britain. Manner of involvement by specialists in practice development; Factors affecting practice development activity.

This paper argues that understanding of the performance and price structure of urban housing markets in the UK would be enhanced by limited investment in comprehensive systems for collecting data on housing transactions. These data would allow the construction of reliable and accurate indices at different levels of spatial aggregation. The empirical part of the paper uses data from the Western Australian Valuer General's Office to illustrate the data requirements and practical considerations in the construction of indices. The dataset provides comprehensive information on property attributes and the sales history of individual transactions and allows a comparison of the accuracy of a number of variants on the hedonic and repeat-sales index methods. The evidence suggests repeat-sales indices can be constructed on less detailed data with little loss of accuracy. The paper concludes by suggesting that repeat-sales methods, although largely ignored in the UK to date, lend themselves well to the development of a system of local price indices using the information recorded by the Land Registry. [ABSTRACT FROM AUTHOR]

Unfractionated heparin is widely used for prophylaxis against venous thromboembolism after Caesarean section. We performed a survey of thromboprophylactic methods after elective Caesarean section in 50 maternity units in the United Kingdom. We found that a variety of regimens were used. Thirteen (26%) used subcutaneous unfractionated heparin at standard (non-pregnant) doses. We then studied anti-Xa activity in women following elective Caesarean section under regional anaesthesia. Initially, eight women were given 5000 U unfractionated heparin subcutaneously after surgery and anti-Xa activity was measured 1, 2, 3, 4, 5, 6, 8 and 10 h after administration. There was no detectable anti-Xa activity in any of the samples so the dose was increased to 7500 U in a further five women and a single anti-Xa assay performed at 3 h when peak activity should occur. Again, no activity was detected so the dose was increased to 10 000 U heparin in a final group of 10 women and anti-Xa activity measured at 0.5, 1, 1.5, 2, 3, 4, 5 and 6 h. Although there was some activity after 10 000 U heparin, the level was below that accepted for prophylaxis. If anti-Xa activity is an appropriate monitor of prophylactic unfractionated heparin, doses up to 10 000 U are inadequate. Since there is evidence that enoxaparin is effective at producing adequate prophylactic anti-Xa activity following Caesarean section, we suggest abandoning the use of unfractionated heparin in favour of enoxaparin for this purpose. [ABSTRACT FROM AUTHOR]

The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self‐advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers. [ABSTRACT FROM AUTHOR]

The PAS-ADD Checklist is a screening instrument specifically designed to help staff recognize mental health problems in the people with intellectual disability for whom they care, and to make informed referral decisions. The instrument consists of a life-events checklist and 29 symptom items scored on a four-point scale. Scores are combined to provide three threshold scores. The crossing of any of these thresholds indicates the need for a fuller assessment. The items are worded in everyday language, making the Checklist suitable for use by individuals who do not have a background in psychopathology. The present paper presents the results of a number of studies evaluating the reliability and validity of the Checklist. Factor analysis of Checklists completed on a community sample of 201 individuals yielded eight factors, of which seven were readily interpretable in diagnostic terms. Internal consistency of the scales was generally acceptable. Inter-rarer reliability in respect to individual items gave a fairly low average Kappa of 0.42. However, agreement on case identification, the main purpose of the Checklist, was quite good, with 83% of the decision being in agreement. Validity in relation to clinical opinion was also satisfactory, case detection rising appropriately with the clinically judged severity of disorder. The PAS-ADD Checklist is published and distributed by the Hester Adrian Research Centre, Manchester, England, from where further information and order forms are available on request. [ABSTRACT FROM AUTHOR]

The article presents a study on the relationship between sleep patterns, and reactive and endogenous depressions conducted to all patients admitted to the Munroe Wing mental hospital by Master's of Management Science (MMS) in Great Britain. Patients were interviewed unless they were found completely unable to cooperate, or unless the psychiatrist found the need for sedatives during their first night of hospitalization. Sleep patterns and reports on sleep of a group of reactive and a group of endogenous depressions were investigated. Result shows that observations of sleep has indicated no difference in their patterns. Such patterns also has appeared to vary considerably under different conditions.