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In this article, the aim is to explore some of the key themes to emerge in the journal during the past two decades. Each selected theme will be reviewed in the light of issues raised in particular papers. The aim of this approach is, first, to facilitate reflection upon the contribution of the journal as its subject matter has moved from a concern with British public administration to something more international in its scope and, second, to encourage critical attention to the current state and future direction of the discipline of public administration itself. The identification of cross-cutting themes enables the reader to dig a little deeper and draw his/her own conclusions about where the journal has made its distinctive contribution.

Many countries continue to experience pertussis epidemics despite widespread vaccination. Waning protection after booster vaccination has highlighted the need for a better understanding of the immunological factors that promote durable protection. Here we apply systems vaccinology to investigate antibody responses in adolescents in the Netherlands (N = 14; NL) and the United Kingdom (N = 12; UK) receiving a tetanus-diphtheria-acellular pertussis-inactivated poliovirus (Tdap-IPV) vaccine. We report that early antiviral and interferon gene expression signatures in blood correlate to persistence of pertussis-specific antibody responses. Single-cell analyses of the innate response identified monocytes and myeloid dendritic cells (MoDC) as principal responders that upregulate antiviral gene expression and type-I interferon cytokine production. With public data, we show that Tdap vaccination stimulates significantly lower antiviral/type-I interferon responses than Tdap-IPV, suggesting that IPV may promote antiviral gene expression. Subsequent in vitro stimulation experiments demonstrate TLR-dependent, IPV-specific activation of the pro-inflammatory p38 MAP kinase pathway in MoDCs. Together, our data provide insights into the molecular host response to pertussis booster vaccination and demonstrate that IPV enhances innate immune activity associated with persistent, pertussis-specific antibody responses. Epidemics of whooping cough caused by Bordetella pertussis have been seen and are linked to waning immunity globally. Here the authors explore responses to inactivated poliovirus (IPV) in the Tdap-IPV vaccine and show it stimulates early antiviral responses in monocytes and dendritic cells that are associated with long-lived pertussis antibody responses. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the utility of CHROMID® Colistin R for direct detection of colistin-resistant Gram-negative bacteria from positive blood cultures. A total of 390 blood cultures from hospitalised patients containing Gram-negative bacteria were included in this study. These blood cultures were referred to clinical laboratories in the United Kingdom and Türkiye. A further 16 simulated positive blood culture bottles were included that contained a range of colistin-resistant strains as well as susceptible control strains. Fluid from each positive blood culture was diluted 1/200 in saline and 10 µL aliquots cultured onto cystine-lactose-electrolyte-deficient agar and CHROMID® Colistin R. All recovered bacteria were identified, and for Gram-negative bacteria, their minimum inhibitory concentration of colistin was measured using the broth microdilution method. From a total of 443 Gram-negative isolates, 57 colistin-resistant isolates were recovered, of which 53 (93%) grew on CHROMID® Colistin R within 18 h. Of the 377 isolates determined to be colistin-susceptible, only 9 isolates were able to grow, including 6 isolates of Pseudomonas aeruginosa. For positive blood cultures that are shown to contain Gram-negative bacteria, culture on CHROMID® Colistin R is a useful diagnostic tool to detect susceptibility or resistance to colistin within 18 h. [ABSTRACT FROM AUTHOR]

Despite the widespread interest in using and researching simulation in higher education, little discussion has yet to address a key pedagogical concern: difficulty. A "sociomaterial" view of learning, explained in this paper, goes beyond cognitive considerations to highlight dimensions of material, situational, representational and relational difficulty confronted by students in experiential learning activities such as simulation. In this paper we explore these dimensions of difficulty through three contrasting scenarios of simulation education. The scenarios are drawn from studies conducted in three international contexts: Australia, Sweden and the UK, which illustrate diverse approaches to simulation and associated differences in the forms of difficulty being produced. For educators using simulation, the key implications are the importance of noting and understanding (1) the effects on students of interaction among multiple forms of difficulty; (2) the emergent and unpredictable nature of difficulty; and (3) the need to teach students strategies for managing emergent difficulty.

This paper describes a new seamless blended multi‐model ensemble configuration of an existing probabilistic medium‐ to extended‐range weather pattern forecasting tool (called Decider) run operationally at the Met Office. In its initial configuration, the tool calculated and presented probabilistic weather pattern forecast information for five individual ensemble forecasting systems, which varied in terms of their number of ensemble members, horizontal resolution, update frequencies and forecast lead time. This resulted in multiple forecasts for the same validity time which varied in terms of forecast skill depending on the lead time in question. This presented challenges for end‐users (e.g., operational meteorologists) in terms of knowing which forecast output is best to use and at which lead time, as well as knowing what to do in situations where forecasts varied between ensembles. To get around these challenges, a new seamless blended multi‐model ensemble configuration has been implemented operationally, comprising of output from five separate ensembles, and provides a single best forecast from day one out to day 45. Objective verification for a set of eight weather pattern groups covering forecasts initialized over a 6‐year period (2017–2022) shows that the seamless blended multi‐model ensemble forecasts are at least as good as, if not better than the best performing individual model. [ABSTRACT FROM AUTHOR]

What is understood by "public administration" in the contemporary UK higher education setting? Is it still being taught and, if so, why? These questions initially appear to be fairly straightforward but any review of the topic quickly poses some rather more tricky areas of enquiry. This article will focus upon three central questions. First, some persistent issues surrounding public administration as a field of research and enquiry provide a problematic start for any discussion: what is meant academically by public administration and does it retain any scholarly meaning, or any disciplinary base(s) that warrants its location in university departments? Is it distinct from public policy and public management or can it now be wholly subsumed within these more readily understood (and more marketable) categories? Second, there are difficult issues around public administration as a field of practice in a highly turbulent public sector world. Public administration (especially in its received meaning from the continental European tradition) was predicated upon stability, structure and law. Contemporary UK public administration is built upon flux and uncertainty. Third, the pedagogic aspects of teaching this elusive area raise significant additional issues, compounded by the differences between teaching a practitioner audience of public administrators (perhaps allied to work-based learning delivery) alongside, or in place of, an academic social or political science audience. Business schools have grown as the main site for such teaching. Differentiated modes of teaching have proliferated while the focus of what is taught has grown more elusive. Teaching public administration starts to look like quite a rich and contested area of academic activity.

In studies of professional learning, the rise of sociomaterial accounts draw attention to the political importance of nonhuman as well as human actors, the material as well as discursive, as inter-related in knowing and action. Of particular relevance to the issue of inter-professional work in health services, some researchers have argued that multiple worlds--not just multiple worldviews--are produced through socio-material processes. This article focuses on the complex activities involved in combining the multiple worlds of different professions with what some term para-professions. Such arrangements may not be recognised as inter-professional by their practitioners, with problematic consequences for care. The case is emergency mental health care, involving paramedics, police, hospital admissions staff, psychiatric nurses and A&E consultants. A sociomaterial analysis is used to trace how knowledge and practice circulates (or doesn't) within and across different material worlds of practitioners, and the ontological politics produced at their boundaries.

Higher education in the UK has become preoccupied with debates over the authority of knowledge and of criticality. In this article we argue that approaches to knowledge in higher education might benefit from a network sensibility that foregrounds the negotiated processes through which the material becomes entangled with the social to bring forth actions, subjectivities and ideas. We draw from a set of analytic perspectives that have arisen from actor-network theory traditionally associated with the writings of Bruno Latour. These approaches emphasise the contingent in knowledge production, even to claim that objects, knowledge or otherwise, come into being through enactment as effects within particular webs of relations. What becomes visible in such analysis is the precarious fragility of concepts and categories often assumed to be immutable, and the work required to establish their stability. We argue that this actor-network analysis helps to move away from a focus on separate entities and individuals to understand their material relationality. This analysis also foregrounds the controversies that tend to be foreclosed in what Latour calls "matters of fact," and makes visible the different worlds in which knowing is evoked in practice. From this departure point the issue of interest is not which knowledge accounts are superior but how and when particular accounts become more visible or valued, how they circulate, and what work they perform in the process. These approaches afford a criticality that we argue open important entry points for rethinking curriculum, teaching and learning in higher education.

Neoliberalism is a loosely knit bricolage from economics, politics, and various forms of reactionary populism that can be envisioned as a kind of epistemic frame in which largely counterrevolutionary forces engage in the "creative destruction" of institutional frameworks and powers, forging divisions across society that include labor and social relations (Harvey, "A brief history of neoliberalism," 2009). Such "creative destruction" implies that neoliberalism is actually a reactionary "catalog of mind" (Robin, "The reactionary mind: Conservatism from Edmund Burke to Sarah Palin," 2011, p. 17); that when believers engage in reactions to programs and ideas which represent what Bourdieu ("Acts of resistance: Against the tyranny of the market," 1998) called "the left hand of the state" (typically represented by teachers, judges, social workers), one result has been the "involution of the state" (p. 34) and the "destruction of the idea of public service" (Bourdieu, "The abdication of the state." In P. Bourdieu (Ed.), "The weight of the world: Social suffering in contemporary society," 1999, p. 182). We examine neoliberalism using Shaffer's ("Int J Learn Media" 1(2):1-21, 2009) concept of an "epistemic frame" based on the epistemic frame hypothesis that suggests that a community of practice has a culture, and that the collection of values, skills, knowledge, and identity form the "epistemic frame" (p. 4). An epistemic frame has a kind of grammar and structure comprised of people's thoughts and actions, reinforced by the ways that people see themselves, the values to which they hold, and the epistemology that binds together their agenda. The purpose of our analysis is to create a praxis for what has been termed "Regressionsverbot", which is defined as "a ban on backward movement with respect to social gains at the European level" (Bourdieu, "Acts of resistance: Against the tyranny of the market," 1998, p. 41). In the form of cases from the United States, the United Kingdom, and the United Arab Emirates, neoliberal initiatives are examined, unpacked, and interrogated.

Background: Monte Carlo (MC) simulations are used in nuclear medicine imaging as they provide unparalleled insight into processes that are not directly experimentally measurable, such as scatter and attenuation in an acquisition. Whilst MC is often used to provide a 'ground-truth', this is only the case if the simulation is fully validated against experimental data. This work presents a quantitative validation for a MC simulation of a single-photon emission computed tomography (SPECT) system. Methods: An MC simulation model of the Mediso AnyScan SCP SPECT system installed at the UK National Physical Laboratory was developed in the GATE (Geant4 Application for Tomographic Emission) toolkit. Components of the detector head and two collimator configurations were modelled according to technical specifications and physical measurements. Experimental detection efficiency measurements were collected for a range of energies, permitting an energy-dependent intrinsic camera efficiency correction function to be determined and applied to the simulation on an event-by-event basis. Experimental data were collected in a range of geometries with 99 m Tc for comparison to simulation. The procedure was then repeated with 177 Lu to determine how the validation extended to another isotope and set of collimators. Results: The simulation's spatial resolution, sensitivity, energy spectra and the projection images were compared with experimental measurements. The simulation and experimental uncertainties were determined and propagated to all calculations, permitting the quantitative agreement between simulated and experimental SPECT acquisitions to be determined. Statistical agreement was seen in sinograms and projection images of both 99 m Tc and 177 Lu data. Average simulated and experimental sensitivity ratios of ( 0.991 ± 0.011 ) were seen for emission and scatter windows of 99 m Tc, and ( 0.897 ± 0.014 ) and ( 0.839 ± 0.014 ) for the 113 and 208 keV emissions of 177 Lu, respectively. Conclusions: MC simulations will always be an approximation of a physical system and the level of agreement should be assessed. A validation method is presented to quantify the level of agreement between a simulation model and a physical SPECT system. [ABSTRACT FROM AUTHOR]

This article is a report on a study of the use of heuristics, shortcuts, and rules of thumb by middle-line managers in institutions of higher education in the United States and the United Kingdom. Using a nonprobability convenience sample, the coinvestigators interviewed 13 middle-line managers over 5 months from eight institutions. The results indicate that managers employed a range of heuristics in response to a variety of decision-making situations and that choices to determine which heuristic was most appropriate revolved around the respondents' perceptions of personal risk, situational ambiguity, and level of emotionality. An intriguing metaphor that emerged from the study is that of a DNA strand; that is, the three elements of emotionality, ambiguity, and risk were constants in an interactive relationship between administrators and line managers and their connection to the institution. Even at middle-management levels, administrators maintained some independence from their institutions at the level of personal and moral decisions. (Contains 2 figures.)

Introduction: There is a growing understanding of the benefits of patient and public involvement (PPI), and its evaluation, in research. An online version of the CUBE PPI evaluation framework has been developed. We sought to use the CUBE to evaluate the value of early PPI with two small healthcare companies during product development. Methods: Contributors were recruited online and had lived experience of either type 1 diabetes or obesity. Two 1‐h sessions were run with a company developing a smartphone application to manage diabetes (DEE‐EM): one with young people (YP; n = 5) and one with parents (n = 7). Two 1‐h sessions were run with a company developing a weight‐loss product, both with adults (n = 7 in each session). Sessions were facilitated by an independent University researcher and attended by company representatives, who presented their product. One facilitator led the evaluation of the session by giving a demonstration of the CUBE and asking simple questions in the YP session. Results: A high proportion of contributors completed the CUBE (80.5% DEE‐EM; 93% Oxford Medical Products). Responses were positive to all four CUBE dimensions (in italics). Contributors felt there were diverse ways to contribute to the sessions, and that they had a strong voice to add to the discussion. Balance was achieved regarding whose concerns (public or company) led the agenda, and contributors felt that both companies would make changes based on the discussion. The supportive attitude of both companies resulted in most contributors feeling comfortable participating in PPI sessions with the industry, while recognising the profit‐making aspect of their work. Conclusions: PPI with small healthcare companies is both feasible and worthwhile. The CUBE framework facilitated the evaluation of the interaction between experts in different knowledge spaces. We provide recommendations for future projects, including considerations of who should participate and the level of implicit endorsement of the product that participation implies. Patient or Public Contribution: People with lived experience of type 1 diabetes or obesity were invited to contribute to one of four PPI sessions, which they then evaluated. One contributor agreed to contribute to the analysis of the evaluation data and interpretation and preparation of the manuscript. [ABSTRACT FROM AUTHOR]

In 1991, Sheffield was the host city for the XVI Summer Universiade, better known as the World Student Games (WSG). Studies of the 1991 WSG commonly assert that it received little to no television coverage. This article intervenes to demonstrate that the WSG did receive substantial television coverage on Sky Sports and across the ITV network. The article draws on new archival sources to provide perspectives on the negotiations and interactions between the WSG organizers and the broadcasters, focusing on BSkyB. The article serves as an instrumental case study on how newly available television archival collections can be used to reframe perspectives of television history. In particular, the article considers the early history of Sky Sports, its approach to sports acquisition, its relationship with public service broadcasters, and the impact of satellite television on live-sports coverage and a rapidly changing media landscape in the UK in the early 1990s. [ABSTRACT FROM AUTHOR]

Background: Healthcare settings are high-risk environments for fatigue and staff burnout. The Need For Recovery (NFR) scale quantifies inter-shift recovery, which contributes to cumulative fatigue and may precede occupational burnout. Advanced clinical practitioners (ACPs) are an established feature of the emergency medicine workforce in the UK, however, little is known about factors affecting their inter-shift recovery, fatigue or how NFR correlates with formal burnout inventories. Methods: A prospective cross-sectional online survey of UK emergency medicine ACPs from 1 September to 30 September 2020. The primary aim was to determine the NFR of these ACPs. The secondary aims were to determine any statistical associations between NFR and selected variables, and whether NFR could reliably predict burnout using the Copenhagen Burnout Inventory (CBI) as a comparator. Results: There were 529 responses to the survey from 50 sites (response rate: 88%). The median NFR was 63.6 (95% CI 54.5–63.6). Lower NFR scores were found in ACPs who see both adults and children (54.5, 95% CI 45.4-63.6), work shifts of 7–10 hours (54.5, 95% CI 36.3–63.6) and who found it easy to park before work (54.5, 95% CI 45.5–54.5). Linear regression modelling indicated significant associations between shift length, ease of parking, ability to get breaks and feeling overwhelmed. Spearman's rho between NFR and CBI for personal and work-related burnout was 0.741 and 0.766 respectively. Correlation between NFR and patient-related burnout was less at 0.471. Conclusion: This study has shown the second highest NFR score reported in any occupational group. Several factors have been identified that may potentially reduce NFR and could be changed by organisations. NFR could also be used to identify those suffering with occupational burnout. [ABSTRACT FROM AUTHOR]

Key message: Analysis of a wheat multi-founder population identified 14 yellow rust resistance QTL. For three of the four most significant QTL, haplotype analysis indicated resistance alleles were rare in European wheat. Stripe rust, or yellow rust (YR), is a major fungal disease of wheat (Triticum aestivum) caused by Puccinia striiformis Westend f. sp. tritici (Pst). Since 2011, the historically clonal European Pst races have been superseded by the rapid incursion of genetically diverse lineages, reducing the resistance of varieties previously showing durable resistance. Identification of sources of genetic resistance to such races is a high priority for wheat breeding. Here we use a wheat eight-founder multi-parent population genotyped with a 90,000 feature single nucleotide polymorphism array to genetically map YR resistance to such new Pst races. Genetic analysis of five field trials at three UK sites identified 14 quantitative trait loci (QTL) conferring resistance. Of these, four highly significant loci were consistently identified across all test environments, located on chromosomes 1A (QYr.niab-1A.1), 2A (QYr.niab-2A.1), 2B (QYr.niab-2B.1) and 2D (QYr.niab-2D.1), together explaining ~ 50% of the phenotypic variation. Analysis of these four QTL in two-way and three-way combinations showed combinations conferred greater resistance than single QTL, and genetic markers were developed that distinguished resistant and susceptible alleles. Haplotype analysis in a collection of wheat varieties found that the haplotypes associated with YR resistance at three of these four major loci were rare (≤ 7%) in European wheat, highlighting their potential utility for future targeted improvement of disease resistance. Notably, the physical interval for QTL QYr.niab-2B.1 contained five nucleotide-binding leucine-rich repeat candidate genes with integrated BED domains, of which two corresponded to the cloned resistance genes Yr7 and Yr5/YrSp. [ABSTRACT FROM AUTHOR]

Objective: Pancreatic neuroendocrine tumours (panNETs) arise sporadically or as part of a genetic predisposition syndrome. CT/MRI, endoscopic ultrasonography and functional imaging using Octreoscan localise and stage disease. This study aimed to evaluate the complementary role of 68Gallium (68Ga)-DOTA PET/CT in managing patients with panNETs. Design: A retrospective study conducted across three tertiary UK NET referral centres. Methods: Demographic, clinical, biochemical, cross-sectional and functional imaging data were collected from patients who had undergone a 68Ga-DOTA PET/CT scan for a suspected panNET. Results: We collected data for 183 patients (97 male): median (SD) age 63 (14.9) years, 89.1 vs. 9.3% (n=163 vs. 17) alive vs. dead (3 data missing), 141 sporadic vs. 42 familial (MEN1, n=36; 85.7%) panNETs. Non-functional vs. functional tumours comprised 73.2 vs. 21.3% (n=134 vs. 39) (10 missing). Histological confirmation was available in 89% of individuals (n=163) but tumour grading (Ki67 classiifcation) was technically possible only in a smaller cohort (n=143): grade 1, 50.3% (n=72); grade 2, 46.2% (n=66) and grade 3, 3.5% (n=5) (40 histopathological classification either not technically feasible or biopsy not perfomed). 60.1% (n=110) were localised, 14.2% (n=26) locally advanced and 23.5% (n=43) metastatic (4 missing). 224 68Ga-DOTA PET/CT scans were performed in total for: diagnosis/staging 40% (n=88), post-operative assessment/clinical surveillance 53% (n=117) and consideration of peptide receptor radionuclide therapy (PRRT) 8% (n=17) (2 missing). PET/CT results confirmed other imaging findings (53%), identified new disease sites (28.5%) and excluded suspected disease (5%). Overall, 68Ga-DOTA PET/CT imaging findings provided additional information in 119 (54%) patients and influenced management in 85 (39%) cases. Conclusion: 68Ga-DOTA PET/CT imaging more accurately stages and guides treatment in patients with sporadic/familial panNETs with newly diagnosed/recurrent disease. [ABSTRACT FROM AUTHOR]

Purpose: The IDEAL-CRT phase 1/2 multicenter trial of isotoxically dose-escalated concurrent chemoradiation for stage II/III non-small cell lung cancer investigated two 30-fraction schedules of 5 and 6 weeks' duration. We report toxicity, tumor response, progression-free survival (PFS), and overall survival (OS) for both schedules, with long-term follow-up for the 6-week schedule.Methods and Materials: Patients received isotoxically individualized tumor radiation doses of 63 to 71 Gy in 5 weeks or 63 to 73 Gy in 6 weeks, delivered concurrently with 2 cycles of cisplatin and vinorelbine. Eligibility criteria were the same for both schedules.Results: One-hundred twenty patients (6% stage IIB, 68% IIIA, 26% IIIB, 1% IV) were recruited from 9 UK centers, 118 starting treatment. Median prescribed doses were 64.5 and 67.6 Gy for the 36 and 82 patients treated using the 5- and 6-week schedules. Grade ≥3 pneumonitis and early esophagitis rates were 3.4% and 5.9% overall and similar for each schedule individually. Late grade 2 esophageal toxicity occurred in 11.1% and 17.1% of 5- and 6-week patients. Grade ≥4 adverse events occurred in 17 (20.7%) 6-week patients but no 5-week patients. Four adverse events were grade 5, with 2 considered radiation therapy related. After median follow-up of 51.8 and 26.4 months for the 6- and 5-week schedules, median OS was 41.2 and 22.1 months, respectively, and median PFS was 21.1 and 8.0 months. In exploratory analyses, OS was significantly associated with schedule (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.32-0.98; P = .04) and fractional clinical/internal target volume receiving ≥95% of the prescribed dose (HR, 0.88; 95% CI, 0.77-1.00; P = .05). PFS was also significantly associated with schedule (HR, 0.53; 95% CI, 0.33-0.86; P = .01).Conclusions: Toxicity in IDEAL-CRT was acceptable. Survival was promising for 6-week patients and significantly longer than for 5-week patients. Survival might be further lengthened by following the 6-week schedule with an immune agent, motivating further study of such combined optimized treatments. [ABSTRACT FROM AUTHOR]

Primary hepatobiliary cancer incidence in the UK is rising and survival rates are low. Surgery is the main curative option for these cancers, but multimodality therapies are expanding. The aim of our original study was to determine trends in survival, over an 8-year period, of patients treated for primary hepatobiliary cancers at our tertiary referral Centre. Patients treated for the most common types of primary hepatobiliary cancers, namely Hepatocellular carcinoma (HCC), Cholangiocarcinoma and Gallbladder cancer between January 2009 and December 2016 were retrospectively analysed from a prospective database linked to UK Hospital Episode Statistics data. A total of 1536 patients with primary hepatobiliary cancers were assessed and treatment plans formulated at our supra-regional specialist Hepatobiliary MDT. The primary hepatobiliary cancers treated were HCC (n = 836), Cholangiocarcinoma (n = 516), and Gallbladder cancer (n = 184). Survival for all the 3 cancers was significantly better with curative treatment. Overall median survival times were 350, 180, and 150 days respectively for HCC, Cholangiocarcinoma and Gallbladder cancer. Excluding best supportive care patients, the respective survival figures were 900, 600, and 400 days. Survival for HCC patients improved over time and was significantly increased in the final 3 years of the study (p ≤ 0.011 for all). Cholangiocarcinoma and Gallbladder cancer survivals were poor and did not change significantly over time. HCC outcome has improved in association with expanded multimodal therapies. Survivals for cholangiocarcinoma and gallbladder cancer remain poor in parallel with limited expansion of multimodal therapies highlighting an unmet therapeutic need for biliary tract cancers. [ABSTRACT FROM AUTHOR]

Introduction: Imraldi™ is a biosimilar of the anti-tumor necrosis factor (TNF) monoclonal antibody adalimumab and was recently approved in Europe for the treatment of various inflammatory conditions. Imraldi is administered via an autoinjector device that features distinct design attributes compared with other biologic TNF inhibitor autoinjectors, such as the Humira (adalimumab) Pen® and Enbrel® (etanercept) MyClic® Pen were developed by the relevant pharmaceutical companies. The aim of this study was to evaluate patients' and nurses' preferences for the Imraldi versus Humira or Enbrel MyClic autoinjectors in the UK and Germany. Methods: Patients with inflammatory joint or bowel disease and nurses with experience in educating patients with these conditions on self-injection participated in two survey studies, the first comparing the Imraldi and Humira autoinjectors and the second comparing the Imraldi and Enbrel MyClic autoinjectors. Results: Overall, 101 nurses (UK, n = 50; Germany, n = 51) and 151 patients (UK, n = 90; Germany, n = 61) participated in both studies. In the first study, 85% of nurses and 78% of patients preferred the Imraldi autoinjector over the Humira autoinjector (P < 0.001); in the second study, 86% of nurses and 79% of patients preferred the Imraldi autoinjector over the Enbrel MyClic autoinjector (P < 0.001). Top reasons for preferring the Imraldi autoinjector included ease of use, ease of grip, and its button-free initiation mechanism. Most nurses indicated they would recommend the Imraldi autoinjector over the Humira and Enbrel MyClic autoinjectors, and most patients indicated they would choose the Imraldi autoinjector over the Humira and Enbrel MyClic autoinjectors to continue treatment. Conclusion: Nurses and patients in the UK and Germany preferred the Imraldi autoinjector over both the Humira and Enbrel MyClic autoinjectors, which may be a consideration, along with other factors, for treatment decisions in the management of patients with inflammatory joint or bowel disease. Funding: Biogen International GmbH. [ABSTRACT FROM AUTHOR]

Abstract Background This study sought to evaluate the impact of the advancements in clinical care, obtained over the last 20 years, for patients aged 70 and older undergoing liver resection for colorectal liver metastases (CRLM). Methods Consecutive patients age 70 or older who underwent liver resection for CRLM at Aintree University Hospital (Liverpool, UK) between May 2008 and May 2015 were compared to a dataset of consecutive patients, meeting the same criteria, between 1990 and 2007. An enhanced recovery programme after surgery (ERAS) combined with cardiopulmonary exercise testing (CPET) was introduced in January 2008. Results The proportion of patients over 70 years undergoing liver resection for CRLM increased over the study period (6% in 1990, 16.3% in 2000, 26.5% in 2005 and 25.8% in 2007). The patients in the later group were more often treated with neoadjuvant chemotherapy (58 vs 34, p = 0.006) and underwent parenchymal sparing surgery, resulting in fewer major hepatectomies (51 vs 111, p < 0.001) and less perioperative morbidity (49 vs 70, p = 0.043) and mortality (3 vs 9, p = 0.229). Although there was shorter disease free survival (DFS) in the later group (DFS at 1, 3 and 5 years was 52.1%, 31.6%, 29% vs. 71.8%, 49.1%, 44.0%)(p < 0.01), similar overall survival (OS) was achieved (OS at 1, 3 and 5 years was 85.4%, 51.6%, 32.8% vs. 81.7%, 42.1%, 27.3%)(p = 0.21). Conclusions This study demonstrates that, with modern management (ERAS, CPET, neoadjuvant chemotherapy and parenchymal sparing surgery), a greater number of patients with CRLM, over the age of seventy, can undergo liver resection, with improved perioperative outcomes. [ABSTRACT FROM AUTHOR]

Objective: There is limited information on the psychosocial impact of growing up with Silver-Russell syndrome (SRS), characterised by slow growth in utero leading to short stature in adulthood. Such information could aid families in making difficult treatment decisions and guide management strategies for health professionals. We aimed to explore the lived experience of people with SRS across the lifespan.Design/setting/patients: In-depth, semi-structured interviews were conducted between January 2015 and October 2016 with a sample of 15 adults (six women) with genetically confirmed SRS from the UK. Qualitative interviews were transcribed and coded to identify similarities and differences: codes were then grouped to form overarching themes.Results: Four themes were identified from participant accounts: (1) appearance-related concerns extending beyond height; (2) strategies to deal with real and perceived threats; (3) women's experiences of pain, disability and feeling older than their years; and (4) feeling overlooked in romantic relationships. These themes show that other factors, beyond short stature, affect patient well-being and indicate a mismatch between patient need and healthcare provision.Conclusions: Challenges in SRS during childhood and adolescence were central to the psychosocial impact of SRS, and were not limited to height. These challenges, as well as symptoms such as pain and fatigue for women, have not previously been documented. To help individuals with SRS develop strategies to manage psychosocial issues, we recommend clinicians incorporate psychological services as an integral part of multidisciplinary teams managing individuals with SRS during childhood, adolescence and adulthood. [ABSTRACT FROM AUTHOR]

Abstract: Restrictions on speaking events in universities have been created both by recent student‐led efforts at ‘no‐platforming’ and by Part 5 of the Counter‐terrorism and Security Act 2015 which placed aspects of the government's Prevent strategy on a statutory basis. The statutory Prevent duty in universities includes, under the accompanying Guidance, curbing or monitoring events that could have an impact in drawing persons into terrorism. This article places the combined impact of Part 5 and student‐led curbs on campus speech in context by juxtaposing pre‐existing restrictions with the various free speech duties of universities. Focusing on speaking events, it evaluates the resulting state of free speech and academic freedom in universities. It finds potential violations of established free speech norms due to the impact of pre‐emptive strikes against some campus‐linked speech articulating non‐mainstream viewpoints. But it also argues that not all such speech has a strong foundation within such norms. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is a common occurrence in the UK, with 60,000 cases reported annually. To improve outcomes among these patients it is necessary to improve links in the cardiac arrest chain of survival. Cardiopulmonary resuscitation (CPR) is one of the main elements of this chain because it reduces further ischaemic insult in the brain and heart by contributing to blood flow. However, even the best manual CPR provides only 20%-30% of the normal cardiac output. Despite the emphasis on timely CPR at the correct rate and depth, delivery of compressions is suboptimal for many patients and mechanical devices may improve outcomes. This article critically appraises two important papers on the use of mechanical CPR for OHCA. It also suggests potential uses for this treatment option and areas for future research. [ABSTRACT FROM AUTHOR]

Three comparison exercises have been performed in 1996, 1999 and 2015 with 123 I to assess the UK hospitals measurement capabilities using radionuclide calibrators for this particular radionuclide. The exercise performed in 1996 showed that only 62% of the participants could measure the solution to within 10% of the standardised value and only 28% could measure within 5% of the certificated value. The intercomparison exercise performed in 1999 showed no improvement in the measurement capability, with only 66% of the participants measuring to within 10% of the standardised value. The exercise performed in 2015 showed great improvement in the hospitals measurement capability, 94% of participants reported results within 10% of the certificated activity and 85% of the participants reported results within the 5% of the reported activity. The intercomparison exercises are an important way to identify possible measurement problems within the medical community. Additionally, the intercomparison exercises provide hospitals with traceability to national primary standards and improve measurement capability within the Nuclear Medicine community. [ABSTRACT FROM AUTHOR]

This paper is concerned with current moves toward sub-national devolution in England and the prospects for a federal government system within the United Kingdom as a whole. The initial focus of the paper is upon the contested nature and governance of regions in England. Current steps toward devolution to such regions are considered through a critical lens, before moving to a wider discussion of the theory and practice of federalism and of whether England could be part of a federal system of UK government. It is concluded that the devolution agenda may proceed in a more serious and consistent manner than at present but there are severe barriers to federalism, including major constitutional constraints, the lack of a written constitution, significant asymmetry between different nations of the UK, the lack of clarity about the definition of sub-national English regions and the lack of political will. These all render a true UK federal state impossible to envisage. [ABSTRACT FROM AUTHOR]

Samuel Fenwick (Earsdon House 1821-Kensal Green 1902) was a gastroenterologist of the Victorian age. His interest in anorexia nervosa derives from his studies on the diseases of the stomach and digestive organs, published in On the atrophy of the stomach and on the nervous affections of the digestive organs (1880). In this book, from which the present article is taken, he presents theoretical reflections and clinical observations of anorexia nervosa. In Fenwick's view loss of appetite can depend on several diseases of digestive functions, but it is rare that it is the unique symptom. Rather, it often depends on more general anomalous conditions of the nervous system. Fenwick is probably the first scholar asserting that the fasting girls of the Middle Age suffered of mental illness. He presents a history of anorexia and criticizes Gull's (apepsia hysterica) and Lasègue's (hysterical anorexia) definitions of this morbid condition, while agreeing with the other term used by Gull, that is "anorexia nervosa". Fenwick's contribution is particularly interesting because his approach differs significantly from the other British physicians that studied anorexia following Gull's approach. While they mainly focused on medical issues related to anorexia, without contextualizing this syndrome in a broader historical and psychopathological framework, Fenwick discusses anorexia in relations to its history, giving space to theoretical reflections and not only to the description of clinical cases. [ABSTRACT FROM AUTHOR]

This article evaluates two significant methods of protecting private information in the UK – via actions under the tort of misuse of private information, and via press regulation. As the Leveson Report has recently found, parts of the press have systematically abused their power, in terms of acquiring and publishing personal information non-consensually. Thus, as the Report found, it appears that the system of press self-regulation has been shown to be ineffective. The article considers the Leveson proposals for an improved system of press regulation and the current proposal of a Royal Charter. It suggests that, ideally, press regulation could work alongside the tort, tending to encourage press restraint, obviate the need for court action, and providing a remedy for those not willing or able, due to lack of resources, to go to court to seek a remedy for privacy invasion. The history of press self-regulation indicates that those results may not be achieved, but it will be argued that the current response to the Leveson Report in the form of a Royal Charter suggests otherwise. [ABSTRACT FROM AUTHOR]

This article assesses the role of the Big Society within the complex pattern of UK service provision. It is argued that the relevance of the Big Society was transient and it has had little impact on practice. Reasons for this are located within the complexity of relationships between public, private and third sectors. Such complexity is a permanent feature of contemporary service provision in which the moment of the Big Society has now passed. [ABSTRACT FROM PUBLISHER]

The article comments on the article "When parents refuse: Resolving entrenched disagreements between parents and clinicians in situations of uncertainty and complexity" by J. Winters. It highlights a case where parents want to pursue a (particular) treatment for their child that clinicians do not feel is in the child's best interests. it states that the author's proposed tool manages disagreements between clinicians and parents where parents refuse treatment.

Digital technologies in combination with ‘big’ data and predictive analytics are having a significant impact upon professional practices at individual, organisational, national and international levels. The interplay of code, algorithms and big data are increasingly pervasive in the governing, leadership and practices of different professional groups. They are reshaping the relationships between professional grouping and between professionals and their clients/users/students. New forms of accountability and responsibility are emerging as a result of these trends, raising important questions about culpability and decision-making in professional practice. However, to date, despite the introduction of many professional codes on the use of digital data and social media, these issues have received limited examination in research addressing professional education. This article aims to explore some of these trends, how they are manifested in different professions and what might be the educational implications. Our argument is that new digital technologies are reconfiguring professional practice and responsibility, but that the education of professionals has yet to adequately reflect these changes. [ABSTRACT FROM AUTHOR]

Abstract: Comparison exercises involving 90Y and 177Lu were performed during 2009 and 2012, respectively, to assess the measurement capability of hospitals in the UK and Europe. The results from the measurement of a typical liquid solution of 90Y show that only 40% of participants could measure the solution to within 5% of the certificated value and that a significant −6% bias was present due to the use of non-standard geometries for the calibration of equipment. The results from the measurement of a standard liquid solution of 177Lu show that 81% of participants could measure to within 5% of the certificated value and in fact 65% of these results were within 2% of the certificated value, showing administered activities can be far more accurately measured for 177Lu than for 90Y and that 177Lu has a far smaller geometry dependence. These studies were performed to identify specific measurement issues in the user community and to identify areas where future research should be focused. In addition to this the work allows the participants to adjust measurement practice and identify key measurement issues. [Copyright &y& Elsevier]

Objective To examine the ability of a broad-spectrum histone deacetylase (HDAC) inhibitor to protect cartilage in vivo, and to explore the effects of class-selective HDAC inhibitors and small interfering RNA (siRNA)-induced knockdown of HDACs on metalloproteinase expression and cartilage degradation in vitro. Methods A destabilization of the medial meniscus (DMM) model was used to assess the in vivo activity of the HDAC inhibitor trichostatin A (TSA). Human articular chondrocytes (HACs) and SW-1353 chondrosarcoma cells were treated with cytokines and TSA, valproic acid, MS-275, or siRNA, and quantitative reverse transcription-polymerase chain reaction was performed to determine the effect of treatment on metalloproteinase expression. HDAC inhibitor activity was detected by Western blotting. A bovine nasal cartilage (BNC) explant assay was performed to measure cartilage resorption in vitro. Results Systemically administered TSA protected cartilage in the DMM model. TSA, valproic acid, and MS-275 repressed cytokine-induced MMP1 and MMP13 expression in HACs. Knockdown of each class I HDAC diminished interleukin-1-induced MMP13 expression. All of the HDAC inhibitors prevented degradation of BNC, in which TSA and MS-275 repressed cytokine-induced MMP expression. Conclusion Inhibition of class I HDACs (HDAC-1, HDAC-2, HDAC-3) by MS-275 or by specific depletion of HDACs is capable of repressing cytokine-induced metalloproteinase expression in cartilage cells and BNC explants, resulting in inhibition of cartilage resorption. These observations indicate that specific inhibition of class I HDACs is a possible therapeutic strategy in the arthritides. [ABSTRACT FROM AUTHOR]

Background:Neo-tAnGo, a National Cancer Research Network (NCRN) multicentre randomised neoadjuvant chemotherapy trial in early breast cancer, enroled 831 patients in the United Kingdom. We report a central review of post-chemotherapy histopathology reports on the surgical specimens, to assess the presence and degree of response.Methods:A central independent two-reader review (EP and HME) of histopathology reports from post-treatment surgical specimens was performed. The quality and completeness of pathology reporting across all centres was assessed. The reviews included pathological response to chemotherapy (pathological complete response (pCR); minimal residual disease (MRD); and lesser degrees of response), laterality, the number of axillary metastases and axillary nodes, and the type of surgery. A consensus was reached after discussion.Results:In all, 825 surgical reports from 816 patients were available for review. Out of 4125 data items there were 347 discrepant results (8.4% of classifications), which involved 281 patients. These involved grading of breast response (169 but only 9 involving pCR vs MRD); laterality (6); presence of axillary metastasis (35); lymph node counts (108); and type of axillary surgery (29). Excluding cases with pCR, only 45% of reports included any comment regarding response in the breast and 30% in the axillary lymph nodes.Conclusion:We found considerable variability in the completeness of reporting of surgical specimens within this national neoadjuvant breast cancer trial. This highlights the need for consensus guidelines among trial groups on histopathology reporting, and the participation of histopathologists throughout the development and analysis of neoadjuvant trials. [ABSTRACT FROM AUTHOR]

The article presents comments on an article by Alex Marsh about local government and elected mayors in Great Britain and also presents Marsh's response to the commentators. The article notes public administration issues such as civic leadership, opposition political parties, and city referendums. Topics include the New Labour and Liberal Democrats political parties, the coalition government, and various cities such as Bristol and London in England.

This article assesses the nature of partnerships through the research site of local governance in England and Scotland, engaging a range of debates and literature around governance and meta-governance. The research used secondary data of local authority partnership working in England and Scotland as well as primary qualitative data from participant observation and interviews with senior officials of local authorities and partner organisations. There is little to suggest that English and Scottish practices are significantly at variance and the article advances an argument of meta-bureaucracy to describe partnerships' activities: that is to say, partnerships do not represent a growth of autonomous networks and governance arrangements but rather an extension of bureaucratic controls. State actors remain pre-eminent within increasingly formalised systems of 'partnership.' [ABSTRACT FROM AUTHOR]

The public participation agenda is a significant element of public service reform in Europe and beyond. This article examines how citizen participation in local public services was conce ived and enacted under successive New Labor governments in the UK during the period 1997–2010. It is suggested that the emphasis on public participation was central to the ethos of New Labor. This accounts for the persistence of the participation agenda even in the face of scant empirical evidence that specific engagement and empowerment initiatives were successful. Significantly, there was no single New Labor participation narrative. There were instead several distinct strands, drawing variously from the Party's received traditions of State welfarism, corporatist central-local relations, municipal socialism, Blairite managerialism, and, lastly, mutual cooperativism. The article assesses the legacy of New Labor and public participation in the UK before drawing wider conclusions relating to international experience. [ABSTRACT FROM AUTHOR]

The nature and the practice of local political leadership are undergoing rapid change. In the UK, policy initiatives have included the adoption of executive leadership systems in the form of the directly elected mayor or the increasing selection of council leaders for four-year terms rather than through annual nomination. The drive toward elected mayors and other reforms of local management continues under the current coalition government. This article draws from extensive research in the UK, other European countries and the USA, in order to propose and develop a matrix for the analysis of both local and national political leadership. Illustrations are offered of how the matrix might be used in such analysis, alongside a consideration of prospects for further research in this area. [ABSTRACT FROM AUTHOR]

Professionals increasingly must collaborate very closely, such as through inter-professional work arrangements. This involves learning both in and for collaboration. Some educational researchers have turned to complexity science to better understand these learning dynamics. This discussion asks, How useful is complexity science for examining professional learning in collaboration? After introducing complexity principles that appear in accounts of professional practice and education, selected studies are presented that draw from complexity science to examine professional collaboration in fields of management, social and health care, and education. A critical discussion of these studies points out oversights and limitations. Complexity theory is concluded to offer useful insights for two areas: (1) articulating complexities of professional practice and knowledge and (2) providing educational support for professional knowing-in-undecidability. However, it is also argued that complexity analyses of professional collaboration could do much more to exploit the explanatory power of complexity concepts, by returning to rich dynamics of strong emergence in a sociomaterialist analysis, and by avoiding metaphorical uses of complexity. Used rigorously rather than romantically, complexity concepts may prove more useful not only in analysing political dynamics of collaborative professional practice, but also in opening new questions and approaches for future research in professional learning. [ABSTRACT FROM AUTHOR]

In this article the authors examine the potential of the classroom as an agency for change rather than a seat of conformity. They question why some schools are not safe spaces for their communities and look at former and current successes and failures. Addressing The Equality Act and other drivers for change, they argue for a new classroom that eliminates prejudice by celebrating equality and diversity in an inclusive environment. They believe that the struggle for LGBT equality is everyone's struggle for equality. The new classroom will take on that struggle by making LGBT people visible, usual and vital. [ABSTRACT FROM AUTHOR]

The perceived successes of CCTV in terms of prevention and detection of crime and terrorist activity provided further impetus to acquire and develop camera surveillance technology. This article argues that the increased use of such technology has inevitably changed the individual's relationship with the state as individuals are now subject to surveillance when they are in public spaces, travelling on public transport and within some business environments. Alongside these developments, the last decade has seen domestic recognition of the ‘right to respect for private and family life’ (Article 8 of the European Convention on Human Rights) after the coming into force of the Human Rights Act 1988 (HRA) in 2000, which received the Convention into domestic law. As the potential for intrusion into citizens' private life grows, it is possible, this article will argue, that the compatibility of visual surveillance under greatly increased CCTV infrastructure with Article 8 may be brought into question. The Coalition government has sought for the first time to address concerns about the erosion of privacy through excessive surveillance in Part 2, Chapter 4 of the Protection of Freedoms Bill 2011, which is currently in Report stage. [ABSTRACT FROM PUBLISHER]

Concerns have been raised that counter-terrorism laws and policies are increasingly alienating Muslims, especially young people and students, and that counter-terrorism measures may themselves feed and sustain terrorism. This paper relies on extracts from a report on this issue commissioned by the Equality and Human Rights Commission to develop and deepen understanding of the impact of counter-terrorism legislation and policies in general, and on Muslim communities in particular. Building on existing studies, this report contributes to the research and wider public discussion of this matter through an examination of the experiences of counter-terrorism legislation and policies on Muslim communities in four local areas across Britain and interviews with practitioners and officials at a national and local level. The areas focused on relate in particular to various uses of technology to further counter-terror strategies and the reaction to them of those interviewed. [ABSTRACT FROM PUBLISHER]

The paper considers a key counter-terror strategy in the UK post-9/11 – the shift from a criminal justice response to the creation of a parallel preventive system running in tandem with the continuing criminal justice one. The preventive response does not rely on the commission of criminal offences or adherence to ordinary criminal justice safeguards. This preventive strategy relies on targeting terrorist suspects – those who, it is thought, may in future commit terrorist acts – and curtailing their liberty with the aim of preventing terrorist activity before it occurs. Since 2005 the preventive strategy has partly relied on the imposition of control orders on certain terrorist suspects; such orders are about to be replaced by Terrorism Prevention and Investigation Orders (TPIMs) at the end of 2011. Both types of order create a means of controlling or curbing the liberty of such suspects without a criminal trial. The paper evaluates the responses of the courts to control orders, and the reasons for their abandonment in favour of TPIMs. It argues that the human rights' issues raised in court in relation to control orders over the last six years are likely to be re-raised – albeit to a somewhat lesser extent – in relation to TPIMs. In considering this issue, the paper touches on the question of the use of technology in relation to both control orders and TPIMs as measures allowing interferences with liberty. [ABSTRACT FROM PUBLISHER]

The Terrorist Asset-Freezing etc Act 2010 came into force on 17 December 2010. The 2010 Act repealed the previous Temporary Provisions Act. This article does not purport to provide comprehensive coverage of the Act; it outlines four main areas of concern that arose in respect of the Draft Terrorist Asset-Freezing Bill and that now arise in respect of the Terrorist Asset-Freezing etc Act 2010. In summary, these are as follows: problems of parliamentary scrutiny relating to the scope of the Act; problems relating to the reasonable suspicion test; problems relating to judicial process; problems relating to ECHR rights. [ABSTRACT FROM PUBLISHER]

An introduction is presented in which the editor discusses various reports within the issue on topics related to counter-terrorist strategies in Great Britain including terrorist asset-freezing, the creation of a parallel preventive system, and visual surveillance as a key technological tool in the prevention of terrorism.

This paper introduces and describes the promotion, development and procurement of the New Tyne Crossing; the construction of a new vehicle tunnel followed by refurbishment of the existing Tyne Tunnel. A suite of papers is planned to cover the construction phase and specific issues of interest. The strategy was to award a concession for the financing, design, construction and operation of the new tunnel, refurbishment and operation of the existing tunnel and operation of the Tyne pedestrian and cyclist tunnels, for a period of 30 years. The intention of the Tyne and Wear Passenger Transport Authority was to transfer the traffic risk and significant design and construction risk to the concessionaire as part of a public-private partnership (PPP) contract. This was subsequently achieved with the award of the contract to TT2/Bouygues TP in November 2007. The project boasts a number of UK firsts: a PPP for which funding has been secured totally from the revenue generated from the tolls and the first UK vehicle tunnel to have an active fire suppression system. [ABSTRACT FROM AUTHOR]

The article offers the insights of Carl Fenwick on the clinical dental technician (CDT) course offered by the Royal College of Surgeons (RCS) Diploma in Clinical Dental Technology at the National Health Service (NHS) Postgraduate Deanery for Kent, Surrey and Sussex (KSS Deanery) in Great Britain. He states that Deanery team offers career development, technical and clinical practice, and patient interaction with its students. He also emphasizes teamwork and building of students' professionalism.

A regimen of a single high dose iron administration was initially adopted for patients commencing haemodialysis (HD) treatment. Iron stores are established and iron metabolism and erythropoiesis stabilise allowing haematinic parameters to be more confidently assessed for use in anaemia management decisions. High doses of IV iron delay the need for subsequent iron supplementation. A high-dose, low-frequency iron infusion regimen for all HD patients was adopted. The outcomes of administering this dosage regimen are reported as observational retrospective analysis using patient record data in 2009. Patients received three [median; semi-interquartile range (SIQR) 0.5] high-dose iron infusions during the year. The median infusion dose was 1100 mg iron (SIQR 0.0) and the median amount of iron received during the year by each patient was 3200 mg (SIQR 750). The median haemoglobin (Hb) level prior to infusion was 108 g/l and post infusion 114 g/l; ZHb = 2.656, p = 0.008). Ferritin levels increased from a median of 376 μg/l preinfusion to 690 μg/l postinfusion; Zferritin =-4.796, p < 0.001. The median time between infusions was 125 days (approximately four months). The 51 patients (76%) who received three or less infusions within the study period received 2537 mg (mean) of iron. These findings indicate that both Hb and ferritin levels can be adequately managed using a high-dose, low-frequency regimen of IV iron in patients undergoing HD. [ABSTRACT FROM AUTHOR]

Background: Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods: A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results: Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions: These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this study. [ABSTRACT FROM AUTHOR]