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Complement, a critical defence against pathogens, has been implicated as a driver of pathology in COVID‐19. Complement activation products are detected in plasma and tissues and complement blockade is considered for therapy. To delineate roles of complement in immunopathogenesis, we undertook the largest comprehensive study of complement in COVID‐19 to date, comprehensive profiling of 16 complement biomarkers, including key components, regulators and activation products, in 966 plasma samples from 682 hospitalized COVID‐19 patients collected across the hospitalization period as part of the UK ISARIC4C (International Acute Respiratory and Emerging Infection Consortium) study. Unsupervised clustering of complement biomarkers mapped to disease severity and supervised machine learning identified marker sets in early samples that predicted peak severity. Compared to healthy controls, complement proteins and activation products (Ba, iC3b, terminal complement complex) were significantly altered in COVID‐19 admission samples in all severity groups. Elevated alternative pathway activation markers (Ba and iC3b) and decreased alternative pathway regulator (properdin) in admission samples were associated with more severe disease and risk of death. Levels of most complement biomarkers were reduced in severe disease, consistent with consumption and tissue deposition. Latent class mixed modelling and cumulative incidence analysis identified the trajectory of increase of Ba to be a strong predictor of peak COVID‐19 disease severity and death. The data demonstrate that early‐onset, uncontrolled activation of complement, driven by sustained and progressive amplification through the alternative pathway amplification loop is a ubiquitous feature of COVID‐19, further exacerbated in severe disease. These findings provide novel insights into COVID‐19 immunopathogenesis and inform strategies for therapeutic intervention. [ABSTRACT FROM AUTHOR]

The importance of collaborative practice between those who provide services to children with special educational needs is now regarded as essential and is supported strongly by the UK government. However, joint working is often difficult to implement, despite the goodwill of all involved. This paper describes a pilot study aimed at developing collaboration between a local education authority and a National Health Service (NHS) Trust. It reports on the results of the evaluation and discusses aspects of the project that facilitated collaborative working between the various parties involved. (Contains 3 tables.)

This series focuses on aspects of prescribing for neonates, children and young people, from A–Z. Aspects of pharmacokinetics will be considered, alongside legal considerations, consent and medications in schools [ABSTRACT FROM AUTHOR]

It is recognised that specialist nurses play a unique role in managing patients with vulval conditions, providing ongoing assessment, early intervention for deterioration, and the tailoring of treatments in reaction to symptoms and presentation. Standards documents have been published for vulval services in the UK, which includes nurse intervention and mirrors the NHS Health Education England (2017).' The focus of this clearly defines the rationale and benefits of embedding advanced clinical practice nursing roles within the NHS workforce. In view of this a nurse competency document Scope of Practice (SOP) has been developed to promote robust clinical governance, appropriate clinical supervision with clear pathways of communication supporting safe and effective practice. The document has been compiled by experienced clinicians in this field in collaboration with The British Society for the Study of Vulval disease (BSSVD). This article will give an overview of the document content with recommendations on how to implement in clinical practice. [ABSTRACT FROM AUTHOR]

This is the first in a series of articles explaining the development of a specifically-designed Dermatology Nurse Registrar (NR) pilot programme, carried out over a 3-year training period. The programme has been designed for our department to provide a structured succession plan for the current Nurse Consultant (NC) in post. Succession planning provides a smooth transition and is considered crucial to reduce risk in clinical services by, reducing disruption for patients and the clinical team.1 This is a potential model for dermatology and for other specialities to replicate and to consider a more structured pathway for NC roles that can be tailored to respond to the pressures of delivering high quality care in a challenging NHS. The organisation and structure of the role will be discussed to include the NR job plan, clinical supervision, academia, competency assessment and evidence, perceived risks and the personal experience of Nurse Registrar/Consultant. The launch of the Nurse Registrar programme was presented at the BDNG Annual Conference 2017 in Belfast. [ABSTRACT FROM AUTHOR]

The importance of collaborative practice between those who provide services to children with special educational needs is now regarded as essential and is supported strongly by the UK government. However, joint working is often difficult to implement, despite the goodwill of all involved. This paper describes a pilot study aimed at developing collaboration between a local education authority and a National Health Service (NHS) Trust. It reports on the results of the evaluation and discusses aspects of the project that facilitated collaborative working between the various parties involved. [ABSTRACT FROM AUTHOR]