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Purpose: We surveyed the treatment of acute spinal cord injuries in the UK and compared current practices with 10 years ago. Methods: A questionnaire survey was conducted amongst neurosurgeons, neuroanaesthetists, and neurointensivists that manage patients with acute spinal cord injuries. The survey gave two scenarios (complete and incomplete cervical spinal cord injuries). We obtained opinions on the speed of transfer, timing and aim of surgery, choice of anaesthetic, intraoperative monitoring, targets for physiological parameters, and drug treatments. Results: We received responses from 78.6% of UK units that manage acute spinal cord injuries (33 neurosurgeons, 56 neuroanaesthetists/neurointensivists). Most neurosurgeons operate within 12 h for incomplete (82%) and complete (64%) injuries. There is a significant shift from 10 years ago, when only 61% (incomplete) and 30% (complete) of neurosurgeons operated within 12 h. The preferred anaesthetic technique in 2022 is total intravenous anaesthesia (TIVA), used by 69% of neuroanaesthetists. Significantly more intraoperative monitoring is now used at least sometimes, including bispectral index (91%), non-invasive cardiac output (62%), and neurophysiology (73–77%). Methylprednisolone is no longer used by surgeons. Achieving at least 80 mmHg mean arterial blood pressure is recommended by 70% neurosurgeons, 62% neuroanaesthetists, and 75% neurointensivists. Conclusions: Between 2012 and 2022, there was a paradigm shift in managing acute spinal cord injuries in the UK with earlier surgery and more intraoperative monitoring. Variability in practice persists due to lack of high-quality evidence and consensus guidelines. [ABSTRACT FROM AUTHOR]

Background: Enthesitis is a key feature of spondyloarthropathy (SpA). In recent years, JAK inhibitors have emerged as efficacious drugs in the landscape of advanced therapies for patients with SpA. Method: The aim of this scoping literature review was to search the published literature for studies on JAK inhibitors and their effects on enthesitis in patients with SpA and evaluate the data and summarise the findings. The clinical trials reviewed used the Leeds Enthesitis Index, Spondyloarthritis Research Consortium of Canada Enthesitis Index, and Maastrich Ankylosing Spondylitis Enthesitis Score as outcome measures. Results: Tofacitinib, upadacitinib, and filgotinib had numerically greater reductions in the enthesitis scores when compared with placebo. Conclusion: While the JAK inhibitors are therapeutic options for enthesitis in SpA, head‐to‐head studies are needed to compare the JAK inhibitors against the biological drugs (targeting TNF, IL‐17, and IL‐12/23) as well as studies showing the effects of JAK inhibitors on enthesitis imaging. [ABSTRACT FROM AUTHOR]

The economic landscape of the United Kingdom has been significantly shaped by the intertwined issues of Brexit, COVID-19, and their interconnected impacts. Despite the country's robust and diverse economy, the disruptions caused by Brexit and the COVID-19 pandemic have created uncertainty and upheaval for both businesses and individuals. Recognizing the magnitude of these challenges, academic literature has directed its attention toward conducting immediate research in this crucial area. This study sets out to investigate key economic factors that have influenced various sectors of the UK economy and have broader economic implications within the context of Brexit and COVID-19. The factors under scrutiny include the unemployment rate, GDP index, earnings, and trade. To accomplish this, a range of data analysis tools and techniques were employed, including the Box-Jenkins method, neural network modeling, Google Trend analysis, and Twitter-sentiment analysis. The analysis encompassed different periods: pre-Brexit (2011-2016), Brexit (2016-2020), the COVID-19 period, and post-Brexit (2020-2021). The findings of the analysis offer intriguing insights spanning the past decade. For instance, the unemployment rate displayed a downward trend until 2020 but experienced a spike in 2021, persisting for a six-month period. Meanwhile, total earnings per week exhibited a gradual increase over time, and the GDP index demonstrated an upward trajectory until 2020 but declined during the COVID-19 period. Notably, trade experienced the most significant decline following both Brexit and the COVID-19 pandemic. Furthermore, the impact of these events exhibited variations across the UK's four regions and twelve industries. Wales and Northern Ireland emerged as the regions most affected by Brexit and COVID-19, with industries such as accommodation, construction, and wholesale trade particularly impacted in terms of earnings and employment levels. Conversely, industries such as finance, science, and health demonstrated an increased contribution to the UK's total GDP in the post-Brexit period, indicating some positive outcomes. It is worth highlighting that the impact of these economic factors was more pronounced on men than on women. Among all the variables analyzed, trade suffered the most severe consequences in the UK. By early 2021, the macroeconomic situation in the country was characterized by a simple dynamic: economic demand rebounded at a faster pace than supply, leading to shortages, bottlenecks, and inflation. The findings of this research carry significant value for the UK government and businesses, empowering them to adapt and innovate based on forecasts to navigate the challenges posed by Brexit and COVID-19. By doing so, they can promote long-term economic growth and effectively address the disruptions caused by these interrelated issues. [ABSTRACT FROM AUTHOR]

Distributed lags play important roles in explaining the short-run dynamic and long-run cumulative effects of features on a response variable. Unlike the usual lag length selection, important lags with significant weights are selected in a distributed lag model (DLM). Inspired by the importance of distributed lags, this research focuses on the construction of distributed lag inspired machine learning (DLIML) for predicting vaccine-induced changes in COVID-19 hospitalization and intensive care unit (ICU) admission rates. Importance of a lagged feature in DLM is examined by hypothesis testing and a subset of important features are selected by evaluating an information criterion. Akin to the DLM, we demonstrate the selection of distributed lags in machine learning by evaluating importance scores and objective functions. Finally, we apply the DLIML with supervised learning for forecasting daily changes in COVID-19 hospitalization and ICU admission rates in United Kingdom (UK) and United States of America (USA). A sharp decline in hospitalization and ICU admission rates are observed when around 40% people are vaccinated. For one percent more vaccination, daily changes in hospitalization and ICU admission rates are expected to reduce by 4.05 and 0.74 per million after 14 days in UK, and 5.98 and 1.04 per million after 20 days in USA, respectively. Long-run cumulative effects in the DLM demonstrate that the daily changes in hospitalization and ICU admission rates are expected to jitter around the zero line in a long-run. Application of the DLIML selects fewer lagged features but provides qualitatively better forecasting outcome for data-driven healthcare service planning. [ABSTRACT FROM AUTHOR]

Background and purpose -- The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs. Patients and methods -- The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/ reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and highvolume (≥ 30 UKRs/year). Results -- 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87--93), 93% (CI 91--95), and 96% (CI 94--97). 8-year reoperation survivals were 76% (CI 71--80), 81% (CI 78--85), and 84% (CI 82--86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95--97) and 81% (CI 80--83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3--2.9), 2.0 (CI 1.6--2.7), and 1.0 (CI 0.8--1.3) and for reoperation were 1.2 (CI 1.0--1.4), 0.9 (CI 0.8--1.0), and 0.6 (CI 0.5--0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR. Interpretation -- Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for midvolume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs. [ABSTRACT FROM AUTHOR]

Objective: Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods: Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results: Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions: We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes. [ABSTRACT FROM AUTHOR]

Summary: Background: The first UK guidelines for the management of hidradenitis suppurativa (HS) were published by the British Association of Dermatologists (BAD) in 2018. The guidelines contained a set of audit criteria. Aim: To evaluate current HS management against the audit standards in the BAD guidelines. Methods: BAD members were invited to complete audit questionnaires between January and May 2020 for five consecutive patients with HS per department. Results: In total, 88 centres participated, providing data for 406 patients. Disease staging using the Hurley system and disease severity using a validated tool during follow‐ups was documented in 75% and 56% of cases, respectively, while quality of life and pain were documented in 49% and 50% of cases, respectively. Screening for cardiovascular disease risk factors was as follows: smoking 75%, body mass index 27% and others such as lipids and diabetes 57%. Screening for depression and anxiety was performed in 40% and 25% of cases, respectively. Support for smokers or obese patients was documented in 35% and 23% of cases. In total, 182 patients were on adalimumab, of whom 68% had documentation of baseline disease severity, and 76% were reported as having inadequate response or contraindications to systemic treatments; 44% of patients continued on adalimumab despite having < 25% improvement in lesion count. Conclusion: UK dermatologists performed well against several audit standards, including documenting disease staging at baseline and smoking status. However, improvements are needed, particularly with regard to screening and management of comorbidities that could reduce the long‐term complications associated with HS. A re‐audit is required to evaluate changes in practice in the future. [ABSTRACT FROM AUTHOR]

The twenty first century has witnessed a heightened interest in Muslim settlers in western democracies. In Britain, following the suicide bombings of 9/11 and particularly in the aftermath of the 7th July 2005 bombings in London, much of this focus has been on the threat of terror attacks emanating from radicalised Muslims. It is clearly the case that the same focus also applies to other west European countries which have witnessed similar attacks. The question arises as to the kind of milieu in which domestic jihadist perpetrators have been raised and live. In most cases—though not all—an upbringing in segregated Muslim neighbourhoods is a recurring theme. These can be deemed 'closed communities', yet they are situated in open societies underpinned by a secular, liberal democratic polity. This paper provides reasons and evidence for the epithet of closed communities with respect to Muslims in Britain and explores how these—in many significant respects—differ from mainstream, liberal, secular society. The tensions that inevitably arise are considered together with their implications. The inspiration for this paper stems from Karl Popper's The Open Society and its Enemies. [ABSTRACT FROM AUTHOR]

Aims: To describe the use and validation of a survey tool to elicit the opinion of hospital pharmacists and medicines safety officers in the UK regarding the perceived effectiveness of strategies to improve insulin prescribing safety in hospitals. Methods: One respondent from each participating organization completed the survey on behalf of the main acute hospital in their trust (n = 92). A five‐point Likert scale was used to determine opinion on how effective 22 different interventions were at promoting insulin safety at the respondent's trust. The tool, the Perception of Effectiveness of Prescribing Safety Interventions for Insulin (PEPSII) questionnaire, underwent content validity testing. The reliability was estimated using Cronbach's alpha (α). Results: The PEPSII questionnaire demonstrated good reliability (α = 0.867). Outreach team review and mandatory insulin education were the highest‐scoring interventions; the insulin passport was amongst the lowest scoring interventions. Most interventions were considered more effective by trusts using them compared to those who didn't, except for self‐administration policies, electronic prescribing and the insulin passport. Conclusions: The perceived effectiveness of a variety of insulin prescribing safety strategies in UK hospitals was described by leveraging a purposely developed survey tool. The results describe current levels of support for recommended interventions, and may facilitate the direction of both local and national insulin prescribing safety improvement efforts. What's new?: Insulin prescription errors still commonly occur in the hospital setting.Many strategies have been developed to overcome possible hindrances to guaranteeing the safety and quality of insulin prescriptions, but no common tool has been developed to identify the best fit for both strategy and local organizational requirements.Outreach team review, mandatory insulin education and local guidelines on managing hypoglycaemia were the highest‐scoring interventions.The uptakes of both the insulin passport and insulin order forms were low, and these interventions were not perceived to be effective. [ABSTRACT FROM AUTHOR]

Background and purpose — Registries report high revision rates after unicompartmental knee replacement (UKR) due, in part, to aseptic loosing. In an attempt to improve Oxford UKR femoral component fixation a new design was introduced with a Twin rather than a Single peg. We used the National Joint Registry (NJR) to compare the 5-year outcomes of the Single and Twin Peg cemented Oxford UKRs. Patients and methods — We performed a retrospective observational study using NJR data on propensity score matched Single and Twin Peg UKRs (matched for patient, implant and surgical factors). Data on 2,834 Single Peg and 2,834 Twin Peg were analyzed. Cumulative implant survival was calculated using the Kaplan–Meier method and comparisons between groups performed using Cox regression models. Results — In the matched cohort, the mean follow up for both Single and Twin Peg UKRs was 3.3 (SD 2) and 3.4 years (SD 2) respectively. The 5-year cumulative implant survival rates for Single Peg and Twin Peg were 94.8% (95% CI 93.6–95.8) and 96.2% (CI 95.1–97.1) respectively. Implant revision rates were statistically significantly lower in the Twin Peg (hazard ratio [HR)] = 0.74; p = 0.04). The revision rate for femoral component aseptic loosening decreased significantly (p = 0.03) from 0.4% (n = 11) with the Single Peg to 0.1% (n = 3) with the Twin Peg. The revision rate for pain decreased significantly (p = 0.01) from 0.8% (n = 23) with the Single Peg to 0.3% (n = 9) with the Twin Peg. No other reasons for revision had significant differences in revision rates. Interpretation — The revision rate for the cemented Twin Peg Oxford UKR was 26% less than the Single Peg Oxford UKR. This was mainly because the revision rates for femoral loosening and pain more than halved. This suggests that the Twin Peg component should be used in preference to the Single Peg design. [ABSTRACT FROM AUTHOR]

Aim: To describe insulin prescribing practice in National Health Service hospitals in the UK and the current use of interventions and strategies to reduce insulin prescribing errors. Methods: We sent a cross‐sectional questionnaire to chief pharmacists in all National Health Service hospital trusts in the UK in January 2019. Questions concerned the use and functionality of electronic and paper systems used to prescribe subcutaneous insulin, along with features and interventions designed to reduce insulin prescribing errors. Results: Ninety‐five hospital trusts responded (54%). Electronic prescribing of insulin was reported in 40% of hospitals, most of which were teaching hospitals in England. We found a wide variation in the functionality of both electronic prescribing and paper‐based systems to enable the safe prescribing of insulin for inpatients. The availability of specialist diabetes pharmacists to support the safe prescribing of insulin was low (29%), but was positively associated with the use of a greater number of insulin prescribing error reduction strategies (P=0.002). The use of specific interventions to improve insulin prescribing quality (e.g. self‐administration policies) varied greatly between respondent hospitals. Conclusions: There is potential to optimize the functionality of both electronic and paper‐based prescribing systems to improve the safe prescribing of insulin in hospitals in the UK. The wide variation in the use of insulin error reduction strategies may be improved by the availability of specialist diabetes pharmacists who can support the implementation of insulin‐prescribing interventions. What's new?: Strategies to improve insulin prescribing quality are needed to reduce insulin errors in hospital.There is a wide variation in the use of recommended strategies to help improve insulin‐prescribing quality, including mandatory education of healthcare staff, self‐administration and self‐management policies, and prescriber support at the point of care transfer.The use of electronic prescribing systems is slowly increasing, but there are significant differences in the functionality of systems to optimize insulin prescribing safety.The presence of a specialist diabetes pharmacist is associated with the increased use of insulin prescribing safety strategies in hospital. [ABSTRACT FROM AUTHOR]

Recently developed and widely used cemented paste backfill (CPB) method; the mining industry has many benefits in terms of the application of the sectoral, operational, environmental and legal legislation on the disposal of mine tailings. That's why; in some mining in our country, cemented paste backfill (CPB) method has been preferred in recent years. One of the biggest cost items of this method is binder expenses. In this study; The use of materials such as zeolite (Z), blast furnace slag (BFS), fly ash (FA), silica fume (SF) instead of Portland cement (PC) used in CPB was examined as pozzolanic additive. The uniaxial compressive strength and flexural strength of the R, Z, BFS, FA and SF doped mixtures were determined after 28 and 90 days. Using uniaxial compressive, flexural strength and puzzolanic activity index values were determined. Firstly, reference samples formed with tailings, cement (11% by weight) and water were performed Uniaxial compressive strength (UCS) tests and then, UCS tests of 25 % BFS, 20 % Z, 10 % FA, 5 % SF substituted CPB samples were performed after 28 and 90 days curing time. According to the results obtained; The highest compressive and flexural strengths at 28 and 90 days were obtained in UK samples. The highest value of pozzolanic activity index was obtained in UK samples at 28 and 90 days. The UCS value of the reference sample was exceeded by UK, SD and Z at the end of 28 days; in 90 days, it exceeds only SD. [ABSTRACT FROM AUTHOR]

Background and purpose — Unicompartmental knee replacement (UKR) offers advantages over total replacement but has higher revision rates, particularly for aseptic loosening. The cementless Oxford UKR was introduced to address this. We undertook a registry-based matched comparison of cementless and cemented UKRs. Patients and methods — From 40,552 Oxford UKRs identified by the National Joint Registry for England, Wales, Northern Ireland and Isle of Man (NJR) we propensity score matched, based on patient, surgical, and implant factors, 7,407 cemented and 7,407 cementless UKRs (total = 14,814). Results — The 10-year cumulative implant survival rates for cementless and cemented UKRs was 93% (95% CI 90–96) and 90% (CI 88–92) respectively, with this difference being significant (HR 0.76; p = 0.002). The risk of revision for aseptic loosening was less than half (p < 0.001) in the cementless (0.42%) compared with the cemented group (1.00%), and the risk of revision also decreased for unexplained pain (to 0.46% from 0.74%; p = 0.03) and lysis (to 0.04% from 0.15%; p = 0.03). However, the risk of revision for periprosthetic fracture increased significantly (p = 0.01) in the cementless (0.26%) compared with the cemented group (0.09%). 10-year patient survival rates were similar (HR 1.2; p = 0.1). Interpretation — The cementless UKR has improved 10-year implant survival compared with the cemented UKR, independent of patient, implant, and surgical factors. This improved survival in the cementless group was primarily the result of lower revision rate for aseptic loosening, unexplained pain, and lysis, suggesting the fixation of the cementless was superior. However, there was a small increased risk of revision for periprosthetic fracture with the cementless implant. [ABSTRACT FROM AUTHOR]

Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes.Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases.Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention.Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure. [ABSTRACT FROM AUTHOR]

Introduction: this survey has been conducted following the introduction of nurse-led intravitreal injections clinics at the Great Western Hospital. A team of 5 nurses regularly carry out an average of 90 injections per week. Methods: a series of 169 consecutive injection patients have been offered the study questionnaire between 28 January 2016 and 28 February 2016; patients with no previous experience with a nurse injector were excluded. Results: 76.9% strongly agree that the nurse is more friendly and sensitive to their needs. Only 12.4% strongly agree that a doctor will be more suitable to deliver the injections. Seventy-five percent stated that they were very happy with the care, while 0.4% thought a nurse would be unsafe; 69.2% feel more comfortable asking questions when with a nurse injector. Anxiety and nervousness were found to be the main two symptoms experienced by patients around the time of injections (27.8% and 34.9%, respectively). Discussion: the questionnaire was designed based on the feedback from the local friends and family test. A clear majority of patients gave highly positive feedback about nurse injectors. Considering patients’ individual needs at the time of injections, such as allergies or points that needs clarification, helps in overcoming some of the psychological complications of treatment. [ABSTRACT FROM AUTHOR]

Aims To determine the performance of a fasting glucose sample compared with a full oral glucose tolerance test for the detection of glucose abnormalities in a diverse ethnic population after gestational diabetes. Methods Oral glucose tolerance test results for women attending post-natal testing over a 10-year (2003-2013) period at St Mary's Hospital, Manchester, UK were reviewed. Demographic data were also extracted from the hospital maternity database. Results The average attendance for a post-natal oral glucose tolerance test was approximately 45% over the study period. The prevalence of diabetes was 4.8% (30/629), with a higher rate in women of Asian ethnicity compared with other groups (6.6% vs. 3.5%). The sensitivity for a fasting plasma glucose of ≥ 6.1 mmol/l was 90% (95% CI 74.4-96.5%) for the detection of diabetes and 61% (49.1-71.5%) for the detection of diabetes and/or impaired glucose tolerance, with specificities of 91% (88.8-93.3%) and 93% (91.0-95.2%), respectively. The positive and negative likelihood ratios for diabetes and impaired glucose tolerance were 10.4 (7.8-13.8), 0.11 (0.03-0.32) and 9.2 (6.4-13.3), 0.42 (0.31-0.56), respectively. A fasting plasma glucose threshold of 5.6 mmol/l improved the sensitivity for impaired glucose tolerance (from 61% to 77%), but made no difference to the sensitivity for diabetes. Conclusions The current study has demonstrated that detection of diabetes after gestational diabetes, in an ethnically diverse population using a fasting plasma glucose only, was approximately 90%. Compliance with post-natal screening might improve if women attended for a fasting plasma glucose only; this strategy would identify approximately 90% of cases of diabetes and 40% of cases of impaired glucose tolerance. [ABSTRACT FROM AUTHOR]

Highlights: [•] Phylogenomic relationships of 30 global and diverse Mycobacterium abscessus strains. [•] Phylogenomics of M. abscessus supports a three subspecies classification. [•] Phylogenomic comparisons reveal similarities among Brazilian and UK outbreak strains. [ABSTRACT FROM AUTHOR]

Over the past few years, the Building Research Establishment environmental assessment method (Breeam) has increasingly been used for building projects in the UK. This presents design teams with numerous challenges, not the least of which is the need to manage and accommodate the Breeam requirements in their design. This paper examines the impact of the Breeam assessment process on the design of building projects in the UK using eight case studies. The main effects were found to be in the areas of building features, materials and water services. This impact varied from project to project depending on the building type, location, targeted/required Breeam rating, date of assessment and the assessor's role, as well as the team's knowledge of the assessment process. There were significant design changes in the cases aiming to achieve the highest Breeam rating. The results suggest in some cases that Breeam may limit design teams in their design by drawing their attention to achieving Breeam credits rather than the building in its entirety. For instance, Breeam tends to dictate design solutions rather than focusing on the intention - as an example, a designer may focus more on major leak detection than saving water. The paper also discusses potential incorporation of Breeam requirements into building regulations. [ABSTRACT FROM AUTHOR]

Non-communicable diseases have been somewhat neglected as a public health issue in the past, but there is now growing international consensus that they present a significant obstacle to economic development for both high- and low-income countries. Cardiovascular disease accounts for more than half of all non-communicable disease deaths, and presents a promising target for curbing the non-communicable disease epidemic. This article explains the pressing need for non-communicable disease prevention, focusing on strategies that can be employed to decrease cardiovascular disease risk at an individual and population level, and outlines the UK's approaches to cardiovascular disease prevention in particular. Given the mounting burden of non-communicable diseases, responsible health governance and a balanced economic policy could consider the use of low cardiovascular disease rates as a measure of positive and sustainable economic development. [ABSTRACT FROM AUTHOR]

Background: This article investigated the prevalence of peanut allergy in three cohorts of children born in the same geographical location, Isle of Wight, UK and seeks to determine whether the prevalence of peanut allergy has changed between 1994 and 2004. Methods: Three cohorts of children (age 3–4 years) born on the Isle of Wight, were assessed for peanut allergy and the outcomes compared: Cohort A: Born in 1989; reviewed at 4 years of age ( n = 2181). Cohort B: Born between 1994 and 1996; reviewed between 3 and 4 years of age ( n = 1273). Cohort C: Born between 2001 and 2002; reviewed at 3 years of age ( n = 891). Results: Peanut sensitization increased significantly from 1.3% in Cohort A to 3.3% ( P = 0.003) in Cohort B before falling back to 2.0% in Cohort C ( P = 0.145). Similarly, clinical peanut allergy increased significantly from 0.5% in Cohort A to 1.4% ( P = 0.023) in Cohort B, with a subsequent fall to 1.2% in Cohort C ( P = 0.850). Conclusions: Our data from three cohorts of 3- to 4-year-old children born in the same geographical area shows that peanut allergy prevalence has changed over time. Peanut sensitization and reported allergy in children born in 1994–1996 increased from 1989 but seems to have stabilized or slightly decreased since the late 1990s, although not significant. [ABSTRACT FROM AUTHOR]

Research exploring the impact of fasting in Ramadan on eating behaviors has focused on Muslim-majority countries and has neglected to examine impacts beyond the month when "normal" eating patterns resume. This study aimed to explore the experiences of United Kingdom-residing young adult Muslim women who were fasting in Ramadan to understand its impact on their body image and eating behaviors both during and 1-month following Ramadan. In-depth, semi-structured interviews were conducted with 14 Muslim women aged between 18 and 35 (Mage = 27.3) at two distinct time-points: during the last week of Ramadan and 1-2 months later. The interviews explored questions related to motivations for fasting, experience of fasting in Ramadan, and eating behaviors and thoughts related to body image and appearance. Thematic Analysis revealed three themes: (1) family and community expectations to fast (2) exertion of control of on eating behaviors and (3) preoccupation with weight and appearance. The results suggest that family and community play a strong role in motivating women to fast during Ramadan, alongside the need to feel a sense of belonging to their community. This can conflict with the pressure and desire to assimilate with Western culture and associated appearance ideals, thus putting women at greater risk of disordered eating and body image concerns. These findings suggest important implications for increased support in the Muslim community, and the need for further research to explore this topic across longer time-points and in different cultural groups. [ABSTRACT FROM AUTHOR]

Discusses the role played by Great Britain (GB) in the counter-revolution in Turkey on March 31, 1909 against the Young Turks. Attitude of GB toward differences of opinion within various Young Turks groups and between them and the government; Policy of GB after the suppression of the counter-revolution; Implications of the Young Turks' revolution for the Anglo-Turkish relations.

• Transformers are often over-sized and can outlast offshore windfarms by 10s of years. • A novel methodology based on dynamic rating based transformer design is proposed. • NPV & LCOE are optimized for windfarm design with losses & contingency considerations. • Transformer rating can be reduced by 35 percent for offshore windfarms. Application of Dynamic Thermal Rating (DTR) for optimal utilization of transmission system components has been addressed in several studies. For Offshore Wind Power Plants (OWPPs), as a consequence of intermittent wind generation combined with favorable ambient conditions and strict design regulations, power transformers tend to be over-dimensioned. Experience suggests that transformer lifetime exceeds OWPP life by tens of years, therefore DTR-based design of transformers can facilitate the optimization of OWPP export system. The recent breakthroughs in Thermo-Electric Equivalent (TEE) and aging models of transformers suggest that temporal development of Top Oil (TOT) and Hot Spot (HST) temperatures can be calculated efficiently, which when combined with monitoring of moisture and oxygen development can accurately assess the transformer health in real-time using Degree of Polymerization (DP). However, the economic optimization of offshore windfarms substations using DTR and lifetime utilization-based transformer design during the OWPP planning phase has not been addressed in the literature due to the risks involved in balancing system reliability with windfarm profitability. In this paper, a novel strategy is proposed to utilize transformer DTR for cost optimization of offshore windfarm export system during the OWPP design phase. Net Present Value (NPV) is used to assess capital cost impacts on transformer and Offshore Substation (OSS) design in year 0, and yearly revenue change over OWPP lifetime due to increased losses and possible energy curtailment as a result of smaller transformers. The unique methodology accounts for varying wind turbine availability due to maintenance and concurs with OWPP design requirements for OSS transformer contingency by generating statistical scenarios based on distribution functions and Markov Chain (MC) models respectively. Moreover, the MC models are adapted for two fundamentally different design concepts for OWPP export system: n-1 contingent and non-contingent. The implementation of probabilistic Markov models to resolve stressful periods with increased transformer loading is distinctive to this paper and offers a unique perspective for DTR-based transformer size optimization. Long-term site assessment data for OWPP including historical wind generation is used for transformer thermal assessment (TOT and HST) based on its load and ambient conditions. Furthermore, the reliability of design for varying construction and commissioning conditions is ensured by tracking DP-based transformer lifetime utilization over the operation period for three scenarios of oxygen and moisture development: conservative, high moisture and high oxygen. The case study of a 1200 MW offshore windfarm with two 220 kV parallel export circuits and four 33/220 kV transformers in one OSS located 50 km off the east coast of UK has been used in this paper. 100 scenarios of wind turbine availability and transformer contingency are simulated and the optimal design is determined for the worst-case scenario. Results indicate that optimal transformer rating can result in high thermal stress and minor energy curtailment during extreme contingency conditions for both the design concepts. However, the reduction in transformer size to align with OWPP operation life can reliably improve the windfarm business case significantly, particularly for the n-1 contingent design concept with conservative transformer moisture and oxygen conditions. [ABSTRACT FROM AUTHOR]

The relationship between board characteristics and micro-level organizational factors is an area that has been significantly under-researched, and there is a lack of understanding of how these two elements interact with each other. Hence, we aim to explore how board characteristics could potentially have an impact on individual-level job satisfaction. The dataset used for this study encompasses a total of 4020 observations gathered from 804 companies listed in the FTSE 350 and S&P 500 indices, and it covers the period spanning from 2016 to 2021. The results of the adopted multiple regression analysis showed significant positive relationships between board gender diversity, diversity of specific skills, board independence, board meeting attendance, board size, and average board tenure and employees' job satisfaction of the companies under analysis. However, cultural diversity was not found to have a significant impact on employees' satisfaction. We draw out the theoretical implications of these findings and provide practical recommendations regarding companies' boards composition and structure that help them to enhance the level of their employees' job satisfaction. [ABSTRACT FROM AUTHOR]

High competition between universities has been increasing over the years, and stimulates higher education institutions to attain higher positions in the ranking list. Ranking is an important performance indicator of university status evaluation, and therefore plays an essential role in students' university selection. The ranking of universities has been carried out using different techniques. Main goal of decision processes in real-life problems is to deal with the symmetry or asymmetry of different types of information. We consider that multi-criteria decision making (MCDM) is well applicable to symmetric information modelling. Analytic hierarchy process (AHP) is a well-known technique of MCDM discipline, and is based on pairwise comparisons of criteria/alternatives for alternatives' evaluation. Unfortunately, the classical AHP method is unable to deal with imprecise, vague, and subjective information used for the decision making process in complex problems. So, introducing a more advanced tool for decision making under such circumstances is inevitable. In this paper, fuzzy analytic hierarchy process (FAHP) is applied for the comparison and ranking of performances of five UK universities, according to four criteria. The criteria used for the evaluation of universities' performances are teaching, research, citations, and international outlook. It is proven that applying FAHP approach makes the system consistent, and by the calculation of coefficient of variation for all alternatives, it becomes possible to rank them in prioritized order. [ABSTRACT FROM AUTHOR]

The article discusses the development of urological laparoscopy in Great Britain. The author cites that some consider laparoscopic urology to be market-driven rather than evidence-based. It has stressed the general attitude of urologists will play a major role in establishing laparoscopy, because it will influence referral.

It is often assumed that traditional forms of media such as books enhance well-being, whereas new media do not. However, we lack evidence for such claims and media research is mainly focused on how much time people spend with a medium, but not whether someone used a medium or not. We explored the effect of media use during one week on well-being at the end of the week, differentiating time spent with a medium and use versus nonuse, over a wide range of different media types: music, TV, films, video games, (e-)books, (digital) magazines, and audiobooks. Results from a six-week longitudinal study representative of the UK population 16 years and older (N = 2159) showed that effects were generally small; between-person relations but rarely within-person effects; mostly for use versus nonuse and not time spent with a medium; and on affective well-being, not life satisfaction. [ABSTRACT FROM AUTHOR]