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Increasing access to university for those currently under-represented is a UK government priority. Understanding the views of under-represented students can help direct widening participation activities. In recent years, a positive trend finds increasing numbers of Black students attending university, but it is not clear why White disadvantaged student numbers have not increased. Thus, we aimed to explore the student viewpoint on barriers and facilitators to university access in disadvantaged adolescents and how this might differ by ethnicity. We used an online semi-structured interview with questions about applying to university. Seventy adolescents (mean 16.9 yr.) were recruited who are currently under-represented at university level, based on various measures of disadvantage. Black, Asian, and ethnic minority students (BAME) reported similar barriers and facilitators to applying to university as White disadvantaged students. However, there were some differences, for example, BAME participants stated 'having no choice' was a reason to apply to university while White participants did not mention this. Also [approximately]60% of BAME students said they would prefer to study close by compared to far away, while only 46% of White participants said this. Our results support previous findings that financial issues are a key barrier to university access and that outreach activities can act as facilitators to increase university access. However, we compare the unique viewpoints on the barriers and facilitators to university access in Black, Asian and White under-represented students. Based on these views we also make recommendations for future widening participation events targeted at different ethnicities.

Energy system optimization is needed for optimal sustainable net-zero electricity (NZE) mix even at regional/local scales because of the energy storage needs for addressing the intermittency of renewable energy supply. This study presents a novel regional/local energy planning model for optimum sustainable NZE mix under spatiotemporal climate/meteorological and electrical load demand constraints. A generic robust non-linear constrained mathematical programming (NLP) algorithm has been developed for energy system optimization; it minimizes the levelized cost and greenhouse gas emissions while maximizing reliability against stored energy discharge analysis (RADA). Reliability, defined as the ratio of excess stored renewable power discharge to unmet load demand, is a measure of the extent of unmet load demand met by the excess stored renewable power. Coupled with the NLP, the RADA and energy storage evaluations are used to determine the seasonal energy storage (SES) conditions and realistic renewable proportions for NZE. The significance of the proposed framework lies in determining the maximum hours of viable electrical energy storage beyond which the reliability enhancement is infinitesimal. The significant observations of this work include 96 h of maximum viable electrical energy storage beyond which the reliability enhancement is infinitesimal. While this observation is robust based on previous reports for the case of the United States, a realistic NZE mix for Southern United Kingdom is obtained as follows. Direct wind and solar sources can meet 63%, 62%, and 55% of the electricity demands in the southwest, Greater London, and southeast regions of the United Kingdom, respectively; further, battery energy storage systems can increase the renewable proportions by 21%, 22%, and 13% in these three regions. The unmet demands can be met by renewable electricity through SES. Compressed air energy storage (CAES) and pumped hydro storage offer viable SES. Following these, natural gas with carbon capture and storage (CCS), bioenergy, and hydrogen SES are the choices based on increasing cost per lifecycle climate impact potential to meet the electricity demands. [ABSTRACT FROM AUTHOR]

Background: Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. Objective: To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure‐16 (FROM‐16). Methods: A cross‐sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM‐16. Results: 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM‐16. The FROM‐16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM‐16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non‐malignant conditions (mean = 11, SD = 7.4, n = 56, p <.01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM‐16 score>16) on their quality of life. Conclusions: Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM‐16, identify those most affected and should consider how to provide appropriate holistic support within routine practice. [ABSTRACT FROM AUTHOR]

Objective: Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. Methods: Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. Results: The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). Conclusions: The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available. [ABSTRACT FROM AUTHOR]

Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children's cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services. [ABSTRACT FROM AUTHOR]

Background Recent work in the UK estimated the prevalence of current cannabinoid-based vaping to be higher than in the USA, a factor previously associated with e-cigarette or vaping-associated lung injury (EVALI). Research in the USA has demonstrated that attendances to emergency departments relating to e-cigarettes began to rise before the EVALI outbreak, suggesting that vapers also experience milder forms of vaping-related illness. Aim Quantify symptom prevalence and healthcare utilization amongst current UK vapers. Design Voluntary online survey of individuals aged 16 and over within the UK. Methods Anonymized data were collected on demographics, vaping/smoking status and vaping substances used. Current vapers were asked about the presence of 10 prevalent symptoms from previous US EVALI case series, healthcare attendances and diagnoses given. Risk-ratios were calculated to compare the likelihood of symptoms and attendances between substances. Results A total of 2477 complete responses were analysed. In all, 397 respondents were current vapers. Symptom prevalence within the previous 12 months ranged from 3.8% to 30.5% (bloody sputum, cough). Healthcare attendances per symptomatic respondent ranged from 0.1 to 1.4 (bloody sputum, shortness of breath). Current vapers of cannabinoid-based products (alone/in combination) had the most attendances per symptomatic respondent for 9/10 symptoms and were more likely to report symptoms aside from 'cough' (nicotine-free e-liquids [risk ratio = 1.7]). Clinicians reportedly never diagnosed vaping-related illness. Conclusions UK vapers experience symptoms previously reported in EVALI cases for which they also seek healthcare. Users of cannabinoid-based products were more likely to report symptoms and accounted for a higher healthcare burden. UK vapers may also experience vaping-related illness that does not meet EVALI case criteria. [ABSTRACT FROM AUTHOR]

There is a significant shortage of transplantable organs in the UK particularly from Black, Asian and Minority Ethnic (BAME) groups, of which Muslims make a large proportion. The British Islamic Medical Association (BIMA) held a nationwide series of community gatherings with the aim of describing the beliefs and attitudes to organ donation amongst British Muslims and evaluate the efficacy of a national public health programme on views and uncertainties regarding religious permissibility and willingness to register. Eight public forums were held across the UK between June 2019 and March 2020 by the British Islamic Medical Association (BIMA). A panel of experts consisting of health professionals and Imams discussed with audiences the procedures, experiences and Islamic ethico-legal rulings on organ donation. Attendees completed a self-administered questionnaire which captured demographic data along with opinions before and after the session regarding religious permissibility and willingness to register given permissibility. A total of 554 respondents across seven UK cities were included with a M:F ratio 1:1.1. Only 45 (8%) respondents were registered as organ donors. Amongst those not registered multiple justifications were detailed, foremost of which was religious uncertainty (73%). Pre-intervention results indicated 50% of respondents were unsure of the permissibility of organ donation in Islam. Of those initially unsure or against permissibility or willingness to register, 72% changed their opinion towards deeming it permissible and 60% towards a willingness to register indicating a significant change in opinion (p < 0.001). The effectiveness of our interventions suggests further education incorporating faith leaders alongside local healthcare professionals to address religious and cultural concerns can reduce uncertainty whilst improving organ donation rates among the Muslim community. [ABSTRACT FROM AUTHOR]

Explores new doctors' perceptions of their educational development during the first year of postgraduate training. Uses semi-structured open interviews with pre-registration house officers and investigates their views on the importance of their experience to the General Medical Council's competencies. (Author/KHR)

Background Vaping of cannabinoid-based products and informal acquisition of vaping products were associated with the outbreak of E-cigarette or vaping associated lung injury (EVALI) in the USA. Current prevalence of cannabinoid-based vaping within the UK is not known and literature regarding the acquisition of vaping products is limited. Aim To estimate the prevalence of nicotine-based, nicotine-free and cannabinoid-based product vaping within the UK and to determine where vaping products are acquired. Design and methods A voluntary online survey of individuals aged 16 and over within the UK was conducted using a convenience sample. Data were collected on respondent demographics, smoking/vaping history and acquisition of e-liquids/products. Results A total of 2478 responses were included. Median age 45 years (interquartile range 35–57). Prevalence of current vaping of nicotine-based e-liquids, nicotine-free e-liquids and cannabinoid-based products was 14.4%, 11.2% and 5.49%, respectively. Current nicotine-based and nicotine-free vaping was most prevalent in 25–34 years olds (22.4% and 19.2% of respondents). Current cannabinoid-based vaping was most prevalent in 16–24 years olds. The most common 'ever' used cannabinoid-based products were cannabidiol oil/cannabigerol oil and cannabis leaves (4.8%). Specialist vaping stores were the most common source of 'ever' acquisition for all products. 36.8% and 40.5% of respondents who had ever vaped nicotine-based and nicotine-free e-liquids reported prior acquisition from informal sources. Conclusion This survey reported a higher prevalence of current cannabinoid-based vaping within the UK (5.5%) than previously reported in the USA (2.0%). In addition to the informal acquisition of vaping products as demonstrated within the survey, these results highlight potential underestimation of the risk of EVALI within the UK. [ABSTRACT FROM AUTHOR]

Profiles the refugee Bravanese community in the United Kingdom and offers recommendations for improving their education. Brava is a coastal city in Somali primarily inhabited by conservative Sufi Muslims. Describes Bravanese traditional schooling and argues for the replication of this among the refugees. (MJP)

Previous studies have reported patients with VEXAS being transplanted in the absence of a prior diagnosis, including one of the patients we report here (P4). Keywords: allogeneic haematopoietic stem cell transplantation; chronic myelomonocytic leukaemia; myelodysplastic syndrome; VEXAS syndrome EN allogeneic haematopoietic stem cell transplantation chronic myelomonocytic leukaemia myelodysplastic syndrome VEXAS syndrome 777 781 5 11/24/22 20221201 NES 221201 Vacuoles, E1-ligase, X-linked, Auto-inflammatory, Somatic (VEXAS) syndrome, is an acquired, progressive systemic auto-inflammatory disorder with overlapping rheumatological and haematological features.1,2 It is caused by myeloid-restricted somatic mutations in ubiquitin-like modifier-activating enzyme 1 ( I UBA1 i ), the gene that encodes E1 ubiquitin ligase. Very few patients had any inflammatory symptoms or disease manifestations classically associated with VEXAS (Table 2).2,5 The MDS features were also different. [Extracted from the article]

The corrosion mechanisms and kinetics of a Mg-rich alkali aluminoborosilicate glass simulating UK high-level waste (CaZn28) were investigated upon dissolution in synthetic cement solutions. Dissolution varied as a function the different pH and alkali/alkaline earth content of each cement solution. High resolution microscopy and spectroscopy techniques ascertained the nature of the interface between the glass and the cement solutions. TEM-EDS revealed alkali- and alkaline earth-rich silica gels, into which K, Ca and Mg were incorporated. TEM-SAED, combined with synchrotron micro-focus XRD, identified the ubiquitous precipitation of the Mg-aluminate layered double hydroxide phase, meixnerite (Mg6Al2(OH)18·4H2O), in addition to goethite (FeOOH) and crystalline silica. The C-S-H phase, tobermorite (Ca5Si6O16(OH)2·4H2O), was identified in the most Ca-rich solution only. These data give insight to the role of alkali/alkaline earth-rich solutions in the dissolution or radioactive waste glasses, of importance to the final disposition in a geological disposal facility. [ABSTRACT FROM AUTHOR]

Background: Covaxin/BBV152 is one of the most widely used vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and one of the few vaccines used extensively in low- and middle-income countries (LMIC).Methods: We investigated the effect of Covaxin on the SARS-CoV-2 specific IgG and IgA and neutralizing antibody (NAb) levels at baseline (M0) and at Months 1 (M1), 2 (M2), 3 (M3), 4 (M4), 6 (M6) and 12 (M12) following vaccination in healthcare workers. In addition, we also examined the NAb levels against variant lineages of B.1.617.2 (Delta, India), B.1.617.2.1 (Delta Plus, India), B.1.351 (Beta, SA), B.1.1.7 (Alpha, UK) and B.1.1.529 (Omicron).Results: Covaxin induces enhanced SARS-CoV-2 binding antibodies of IgG and IgA responses against both spike (S) and nucleocapsid (N) antigens at M1, M2, M3, M4, M6 and M12 in comparison with M0. Our data also reveal that NAb levels against the ancestral strain (Wuhan, wild type) are elevated and sustained at M1, M2, M3, M4, M6 and M12 in comparison with M0 and against variant lineages of B.1.617.2 (Delta, India), B.1.617.2.1 (Delta Plus, India), B.1.351 (Beta, SA) and B.1.1.7 (Alpha, UK) are elevated at M3, M6 and M12 in comparison with M0. However, NAb levels against B.1.1.529 (Omicron) was consistently below the limit of detection except at M12.Conclusion: Thus, Covaxin induces an enhanced humoral immune response, with persistence till at least 12 months post-vaccination against most SARS-CoV-2 variants. [ABSTRACT FROM AUTHOR]

We present high-angular resolution observations of OH maser emission towards the high-mass star-forming region IRAS 06056+2131. The observations were carried out using the UK radio interferometer array, Multi-Element Radio Linked Interferometer Network (MERLIN) in the OH main lines at 1665 and 1667 MHz, in addition to the OH satellite line at 1720 MHz. The results of this study reveal the small upper limit to the size of emission in the 1665-MHz line with an estimated total intensity of ∼4 Jy. We did not detect any emission from the 1667 and 1720-MHz lines. The full polarization mode of MERLIN enables us to investigate the magnetic field in the OH maser region. In this transition, a Zeeman pair is identified from which a magnetic strength of ∼−1.5 mG is inferred. Our results show that IRAS 06056+2131 is highly polarized, with ∼ 96 |${{\ \rm per\ cent}}$| circular polarization and ∼6 |${{\ \rm per\ cent}}$| linear polarization. The linear polarization angle is ∼29°, implying a magnetic field which could be aligned with the outflow direction detected towards this region, but the actual magnetic field direction has an uncertainty of up to 110° due to the possible effects of Faraday rotation. The star-forming evolutionary status of the embedded protostellar object is discussed. [ABSTRACT FROM AUTHOR]

Background: The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes.Methods: This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database.Results: Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12).Conclusions: Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has tremendously caused significant health impacts leading to high load of ICU critical patients. Multiple Intensive Care Unit (ICU) admission framework and triaging score have been adapted worldwide for admission of COVID-19 patients. The aim of this article is to review the COVID-19 ICU admission policy in five (5) countries, identify challenges and provide recommendations. Materials and Methods: Literature review was carried out through searching available literature from online databases such as EBSCO, PubMed, Research Gate, Google Scholar and Google search engine. The selected information used in this review is taken from any journal, article, report, thesis, national report, news update regarding the topic. Result: The ICU admission policy in 5 countries, namely South Africa, USA, UK, Hong Kong and Malaysia were reviewed. Different countries apply different guidelines to triage, prioritize and admit severe COVID-19 patients to ICU such as Color-coded Priority Scale in South Africa, Critical Care Triage Tool in USA, COVID-19 Critical Care Guideline in UK, COVID- 19 Critical Care Triage Tool in Hong Kong and ICU Admission Prioritization Criteria in Malaysia. The ICU admission decision-making is supported with multiple ICU scorings such as Sequential Organ Failure Assessment (SOFA), Clinical Frailty score and National Early Warning score 2 (NEWS2). Conclusion: The COVID-19 ICU admission policies in these countries are well established and have been practised appropriately despite challenges faced by the ICU practitioners. All five selected national guidelines in this paper correspond to the WHO framework on the ICU admission policy. Ethical issues and legal supports on the ICU practitioners in ICU admission decision-making requires great attention form government and relevant policy stakeholders. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide an objective means of identifying patterns in academic publication among ENT trainees during their higher surgical training. Method: A cross-sectional survey was distributed to ENT higher surgical trainees. Results: A total of 153 ENT specialty trainees participated, giving a response rate of 46.5 per cent. Across all years of training, the mean number of first author publications was three and the mean number of non-first author publications was two. For trainees at specialty trainee year 8 level, these figures were nine and five, respectively. Participants with doctoral degrees and those in academic programmes published more papers but the mean difference was only significant for the doctoral subgroup (p < 0.0001). Those with additional undergraduate degrees and those in less than full-time training had an overall lower number of publications. Conclusion: Participants in the current survey achieved a higher average number of academic publications than is presently required to successfully complete higher surgical training in ENT. It is hoped that these results act as a guide for trainees planning the research component of their training to ensure that they remain competitive at consultant interview. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. Methods: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. Results: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. Conclusions: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns. [ABSTRACT FROM AUTHOR]

Background: High early postnatal weight gain has been associated with childhood adiposity; however, the mechanism remains unknown. DNA methylation is a hypothesised mechanism linking early life exposures and subsequent disease. However, epigenetic changes associated with high early weight gain have not previously been investigated. Our aim was to investigate the associations between early weight gain, peripheral blood DNA methylation, and subsequent overweight/obese. Data from the UK Avon Longitudinal study of Parents and Children (ALSPAC) cohort were used to estimate associations between early postnatal weight gain and epigenome-wide DNA CpG site methylation (Illumina 450 K Methylation Beadchip) in blood in childhood (n = 125) and late adolescence (n = 96). High weight gain in the first year (a change in weight z‐scores > 0.67), both unconditional (rapid weight gain) and conditional on birthweight (rapid thrive), was related to individual CpG site methylation and across regions using the meffil pipeline, with and without adjustment for cell type proportions, and with 5% false discovery rate correction. Variation in methylation at high weight gain-associated CpG sites was then examined with regard to body composition measures in childhood and adolescence. Replication of the differentially methylated CpG sites was sought using whole-blood DNA samples from 104 children from the UK Southampton Women's Survey. Results: Rapid infant weight gain was associated with small (+ 1% change) increases in childhood methylation (age 7) for two distinct CpG sites (cg01379158 (NT5M) and cg11531579 (CHFR)). Childhood methylation at one of these CpGs (cg11531579) was also higher in those who experienced rapid weight gain and were subsequently overweight/obese in adolescence (age 17). Rapid weight gain was not associated with differential DNA methylation in adolescence. Childhood methylation at the cg11531579 site was also suggestively associated with rapid weight gain in the replication cohort. Conclusions: This study identified associations between rapid weight gain in infancy and small increases in childhood methylation at two CpG sites, one of which was replicated and was also associated with subsequent overweight/obese. It will be important to determine whether loci are markers of early rapid weight gain across different, larger populations. The mechanistic relevance of these differentially methylated sites requires further investigation. [ABSTRACT FROM AUTHOR]

Purpose: Intermittent energy restriction (IER) is a popular weight loss (WL) strategy; however, its efficacy in clinical practice remains unknown. The present study compared the effects of IER compared to continuous energy restriction (CER) on WL and cardiometabolic risk factors in primary care. Methods: A (self-selected) cohort study was conducted at the Rotherham Institute for Obesity (RIO), a primary care-based weight management service. 197(24% male) obese patients volunteered to participate and selected their diet group. IER participants (n = 99) consumed ~ 2600 kJ for two days/week. CER participants (n = 98) restricted their diet by ~ 2100 kJ/day below estimated requirements. Both interventions were delivered alongside RIO standard care. Changes in anthropometry and cardiometabolic disease risk markers (fasting biochemistry and blood pressure) were assessed after a 6-month intervention period and then participants were followed up again 6 months later (month 12). Results: 27 IER patients (27%) and 39 CER patients (40%) completed the 6-month weight loss phase. Among completers, mean (SEM) WL was greater in the IER group at 6 months (5.4 ± 1.1% versus 2.8 ± 0.6%; p = 0.01), as were reductions in fat mass (p < 0.001) and improvements in systolic blood pressure (p < 0.001). Fasting insulin (p = 0.873) and diastolic blood pressure (p = 0.701) were reduced similarly in both groups. However, in the IER group, changes in anthropometry and blood pressure in the IER group had reverted to baseline by 12-month follow-up, whilst the CER group maintained weight loss but showed an increase in blood pressure. Conclusions: Among completers, IER resulted in superior short-term changes in anthropometry and some cardiometabolic risk factors. However, rates of attrition and weight regain were higher compared with standard care, providing important insights in the implementations of IER within a "real-life" NHS setting. Trial registration number: ISRCTN31465600. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of monozygotic splitting with embryo biopsy during in vitro fertilisation (IVF).Design: A cohort study.Setting: Anonymised assisted reproductive technology national data from the Human Fertilisation and Embryology Authority, UK.Population: Women undergoing single-embryo transfer (SET) following either pre-implantation genetic testing (PGT) involving embryo biopsy or IVF without PGT.Methods: Data on women undergoing SET either following PGT and non-PGT IVF treatment in 2000-2016 were analysed to compare the risk of zygotic splitting and monozygotic twining. Logistic regression analysis was performed adjusting for potential confounders.Main Outcomes: Monozygotic spitting, monozygotic twin birth.Results: Data comprising a total of 207 697 SET cycles (4544 following PGT and 203 153 following non-PGT IVF) were analysed. The live birth rate per embryo transfer was 31.9% (95% confidence interval [CI] 30.5-33.2%) following PGT and 26.9% (95% CI 26.7-27.1%) following non-PGT IVF. The incidence of zygotic splitting following PGT was 2.4% (95% CI 1.7-3.3%) versus 1.5% (95% CI 1.4-1.6%) following non-PGT IVF. There was a significantly higher risk of zygotic splitting with PGT versus non-PGT IVF cycles (odds ratio [OR] 1.64, 95% CI 1.19-2.27). The higher risk of zygotic splitting with PGT cycles remained significant after adjusting for potential confounders (adjusted OR 1.51, 95% CI 1.06-2.15).Conclusions: The present study demonstrated an increased risk of monozygotic splitting with embryo biopsy. Given the current sparse literature, it is important to accumulate further evidence to validate the findings.Tweetable Abstract: A likely increased risk of monozygotic splitting following embryo biopsy. [ABSTRACT FROM AUTHOR]

Background and purpose: Factors influencing the outcome after the critical care unit (CCU) for patients with status epilepticus (SE) are poorly understood. Survival for these patients was examined to establish (i) whether the risk of mortality has changed over time and (ii) whether admission to different unit types affects mortality risk over and above other risk factors. Methods: The Intensive Care National Audit and Research Centre database and the Case Mix Programme database (January 2001 to December 2016) were analysed. Units were defined as neuro‐CCU (NCCU), general CCU with 24‐h neurological support (GCCU‐N) or general CCU with limited neurological support (GCCU‐L). Results: There were 35 595 CCU cases of SE with a 3‐fold increase over time (4739 in 2001–2004 to 14 166 in 2013–2016). More recent admissions were older and were more often unsedated on admission. Mortality declined for all units although this was more marked for NCCUs (8.1% in 2001–2004 to 4.4% in 2013–2016 compared to 5.1% and 4.1% for GCCU‐L). Acute hospital mortality was two to three times higher than CCU mortality although this has also declined with time. GCCU‐L appeared to have lower mortality than NCCUs (odds ratio 0.84, 95% confidence interval 0.72, 0.98) but after post hoc adjustment for case mix there were no differences. Older age and markers of seriousness of morbidity were all associated with increased mortality risk. Conclusions: The number of patients admitted to a CCU for SE is rising but critical care and acute hospital mortality is decreasing. Patients treated in an NCCU have higher mortality but this is explicable by more severe underlying disease. [ABSTRACT FROM AUTHOR]

When the same weather or climate simulation is run on different high-performance computing (HPC) platforms, model outputs may not be identical for a given initial condition. While the role of HPC platforms in delivering better climate projections is to some extent discussed in the literature, attention is mainly focused on scalability and performance rather than on the impact of machine-dependent processes on the numerical solution. Here we investigate the behaviour of the Preindustrial (PI) simulation prepared by the UK Met Office for the forthcoming CMIP6 (Coupled Model Intercomparison Project Phase 6) under different computing environments. Discrepancies between the means of key climate variables were analysed at different timescales, from decadal to centennial. We found that for the two simulations to be statistically indistinguishable, a 200-year averaging period must be used for the analysis of the results. Thus, constant-forcing climate simulations using the HadGEM3-GC3.1 model are reproducible on different HPC platforms provided that a sufficiently long duration of simulation is used. In regions where El Niño–Southern Oscillation (ENSO) teleconnection patterns were detected, we found large sea surface temperature and sea ice concentration differences on centennial timescales. This indicates that a 100-year constant-forcing climate simulation may not be long enough to adequately capture the internal variability of the HadGEM3-GC3.1 model, despite this being the minimum simulation length recommended by CMIP6 protocols for many MIP (Model Intercomparison Project) experiments. On the basis of our findings, we recommend a minimum simulation length of 200 years whenever possible. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73-year-old gentleman with chronic myelomonocytic leukaemia with bone marrow fibrosis, who was taking interferon and deferoxamine for iron chelation. It discusses that computed tomography scan of the head revealed right-sided pansinusitis, pre-septal cellulitis and paranasal soft tissue swelling.

When the same weather or climate simulation is run on different High Performance Computing (HPC) platforms, model outputs may not be identical for a given initial condition. While the role of HPC platforms in delivering better climate projections is often discussed in literature, attention is mainly focused on scalability and performance rather than on the impact of machine-dependent processes on the numerical solution. At the same time, machine dependence is an overlooked source of uncertainty when it comes to discussing the model spread observed within the Coupled Model Intercomparison Projects (CMIP). Here we investigate the impact of machine dependence on model results and quantify, for a selected case study, the magnitude of the uncertainty. We consider the Preindustrial (PI) simulation prepared by the UK Met Office for the forthcoming CMIP6. We compare key climate variables between PI control simulations run on the UK Met Office supercomputer and the ARCHER HPC platform. Discrepancies strongly depend on the timescale. Decadal means show substantial differences of up to 0.2 °C for global mean air temperature, 1 W/m² for TOA outgoing longwave flux and 1.2 million km² for Southern Hemisphere sea ice area. However, on multi-centennial timescales the differences are not significant and the long-term statistics of the two runs are similar. Differences between the two simulations can be linked to variations in the strongest modes of climate variability. In the Southern Hemisphere, this results in large SST anomalies where ENSO teleconnection patterns are expected that can reach 0.6 °C (and SNR > 1) even on centennial timescales. [ABSTRACT FROM AUTHOR]

Background: Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost‐effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers. Methods: This was a within‐trial cost‐utility analysis with a 1‐year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality‐adjusted life‐year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health‐related quality of life, and per protocol. Results: After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost‐effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost‐effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost‐effective. Conclusion: Early treatment of superficial reflux is highly likely to be cost‐effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com). This study found that, in addition to compression therapy, early endovenous ablation of superficial reflux is highly likely to be cost‐effective at UK decision‐making thresholds. This reinforces the benefits of early intervention and should have a global impact on the management of patients with venous ulceration. Early intervention should be routine [ABSTRACT FROM AUTHOR]

This paper defines market orientation following a critique of existing literature. It then operationalises this definition via a model containing three behavioural elements (customer orientation, employee orientation, and organisational co-ordination) linked to a long term survival requirement The model is tested in the context of the development of market orientation in the further education sector (in which professional--rather than commercial--values have tended to dominate). This sector is characterised by dynamic change in both its social/demographic and economic circumstances as well as the impact of government policy initiatives--especially the Education Reform Act of 1988 and Local Management of Colleges. The empirical focus of the paper is on three large FE Colleges in the English Midlands. It provides evidence to support the operationalisation of the definition of market orientation in the context of the management of change. [ABSTRACT FROM AUTHOR]

Describes a study to test whether individualized teacher training materials which had been used successfully in both Britain and the United States could be used with similar success in a developing country and whether such a transfer would be advantageous. (Author/LLS)

Child Nutrition Programs in schools are considered one of the best approaches towards improving diet and health. Yet it is considered a newly developed approach to be applied in Saudi Arabia. According to the ministry of health, undernutrition and obesity both are increasing in Saudi Arabia, due to various factors, which include both diet and environmental factors associated with schools and home environments. We have chosen a descriptive study to describe Child Nutrition Programs run by governmental sectors in United States and United Kingdom, in addition to global nutrition consulting companies in different countires, which included India and Singapore. The objectives of this review is to demonstrate successful Child Nutrition Programs approaches, strategies, tools, marketing plans and resources targeting pupils, parents, teachers and schools staff. Thus, this review supports implementing Child Nutrition Programs in Saudi Arabia, by choosing the most suitable strategies to improve child health and nutrition. [ABSTRACT FROM AUTHOR]

Abstract: Clark's claims about the scale of English agricultural output from the 1200s to the 1860s flout historical and geographical reality. His income‐based estimates start with the daily real wages of adult males and assume that days worked per year were constant. Those advanced in British economic growth make no such assumption and instead are built up from the output side. They correlate better with population trends and are consistent with an economy slowly growing and becoming richer. Clark's denial that such growth occurred, his assertion that substantially more land must have been under arable cultivation, his belief that conditions of full employment invariably prevailed in the countryside at harvest time, his concern that the wage bill would have exceeded the value of output in British economic growth, his refusal to consider the possibility that the working year was of variable length, and his assertion that output per acre must have been equalized across arable and pasture are all shown to be figments of his ‘Malthus delusion’. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (e-cigarettes) are increasing in popularity with 19% of UK smokers reporting to have used them. The ability to regulate the evaporation temperature in newer electronic nicotine delivery systems (ENDS) facilitates the potential for use of these devices to 'vape' cannabis, novel psychoactive substances (NPS) and other recreational drugs. Vaping cannabis does have the potential to reduce tobacco use and combustible cannabis/tobacco-related disease, but with over one-third of UK adults reporting life-time use of recreational drugs and increasing e-cigarette uptake in adolescent groups the misuse of these devices poses a serious potential public health risk. Further work is therefore urgently required to inform the appropriate treatment and primary prevention strategies for this emerging issue. [ABSTRACT FROM AUTHOR]

Catharine Macaulay was one of the most significant republican writers of her generation. Although there has been a revival of interest in Macaulay among feminists and intellectual historians, neo-republican writers have yet to examine the theoretical content of her work in any depth. Since she anticipates and addresses a number of themes that still preoccupy republicans, this neglect represents a serious loss to the discipline. I examine Macaulay’s conception of freedom, showing how she uses the often misunderstood notion of virtue to reconcile the individual and collective elements inherent in the republican model. In her own analysis of the deep-rooted social obstacles that stand in the way of women becoming free, Macaulay identifies a serious problem that confronts all republicans, namely how to secure freedom in the face of entrenched structural imbalances that systematically disadvantage certain classes of person. In the end, I conclude that Macaulay herself cannot overcome the issues she raises. This in no way diminishes the importance of her work since her diagnosis is as relevant today as in her own time. [ABSTRACT FROM AUTHOR]

This study investigates ways to passively suppress wind-induced instabilities such as flutter and torsional divergence. The control system design study is based on a sectional flexible bridge model interacting with a constant velocity airstream. Two strategies are considered, separately and in combination. The first makes use of trailing and leading flaps adjacent to the bridge deck, the motion of which is triggered by the deck's movement through a combination of springs, dampers, and inerters at the hinged connection. Emphasis is placed on the effect of the flap hinge location and an optimization procedure is used for determining the compensator parameters that result in favorable aeroelastic properties. The second approach reexamines the efficacy and limitations of using tuned mass dampers (TMDs) placed inside the bridge deck for controlling self-excited motion. The paper then combines the two approaches and introduces a kinematic constraint between the masses of the TMD and the flaps. This combined mechanical system, the flap mass damper (FMD), combines favorable aerodynamic properties of the flaps with a driving force provided by the vibrating mass. Consequently it has the advantage of not requiring complex and often impractical linkages in order to transmit the deck motion to the flaps. Special attention is given to ensuring that the passive control system attains optimum robustness properties and maximizes tolerance to uncertainties. Uncertainties are quantified in a series of simulations showing how the alteration of the bridge's natural frequencies affect the stability of the controlled system. The Humber Bridge in the United Kingdom is chosen as an example for the numerical simulations. [ABSTRACT FROM AUTHOR]

BackgroundConcerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.MethodThis was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.Results3 58 383 registered patients aged 6–18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.ConclusionAntidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required. [ABSTRACT FROM PUBLISHER]

Objectives:Very little up-to-date information is available on the microbiology of complicated acute bacterial rhinosinusitis. Reliable microbiology testing is necessary to inform current empirical antimicrobial treatments. This study was conducted in response to recent US guidelines on antimicrobial treatments for acute bacterial rhinosinusitis. It aimed to describe the pathological micro-organisms involved in complicated acute bacterial rhinosinusitis in the UK and their antimicrobial susceptibility.Methods:This study collected retrospective data on cases of complicated acute bacterial rhinosinusitis with sinogenic orbital and/or intracranial infections from 2007 to 2012. Bacteria identified in paranasal sinus pus were compared with those identified in orbital and/or intracranial infections.Results:Streptococcus anginosus group bacteria were isolated from 61.3 per cent of paranasal sinus pus samples, 83.3 per cent of orbital infections and 77.8 per cent of intracranial infections. All S anginosus isolates were sensitive to penicillin; no penicillin-resistant organisms were isolated.Conclusion:S anginosus was the predominant organism isolated from complicated acute bacterial rhinosinusitis samples at our UK centre. S anginosus is sensitive to penicillin, suggesting that penicillin can be used as an appropriate first-line empirical antibiotic for uncomplicated acute bacterial rhinosinusitis. [ABSTRACT FROM PUBLISHER]

The mean upper pressure reported was 8.5 cm H SB 2 sb O (range: 6-11 cm H SB 2 sb O), with a mean baseline pressure of 5cm H SB 2 sb O (range: 3-6cm H SB 2 sb O). When starting BiPAP, 31 units utilised pressures in keeping with conventional BiPAP pressure levels. Indeed, up to 25 per cent of those units utilising BiPAP report delivering pressure levels higher (i.e., upper pressure greater than 12 cm H SB 2 sb O) than the conventionally recommended BiPAP pressures (Table 1). [Extracted from the article]

Background:Periorbital infections represent a spectrum of sepsis that carries potentially significant morbidity and mortality. Early recognition, systematic assessment and aggressive treatment of the condition are essential.Methods:A retrospective five-year case note review on the management of periorbital infections was performed at a tertiary centre. A literature review on the management of periorbital infections was also undertaken. A multidisciplinary guideline on the management of periorbital infections was developed based on the findings of the case and literature reviews.Results:The results of the retrospective case series correlate well with those of recent reports.Conclusion:The new multidisciplinary guideline has been finalised and approved for practice and future auditing. [ABSTRACT FROM PUBLISHER]

BackgroundLittle is known about the factors influencing the stability of obsessive–compulsive behaviour (OCB) from childhood to adolescence. The current study aimed to investigate: (1) the stability of paediatric OCB over a 12-year period; (2) the extent to which genetic and environmental factors influence stability; and (3) the extent to which these influences are stable or dynamic across development.MethodThe sample included 14 743 twins from a population-based study. Parental ratings of severity of OCB were collected at ages 4, 7, 9 and 16 years.ResultsOCB was found to be moderately stable over time. The genetic influence on OCB at each age was moderate, with significant effects also of non-shared environment. Genetic factors exerted a substantial influence on OCB persistence, explaining 59–80% of the stability over time. The results indicated genetic continuity, whereby genetic influences at each age continue to affect the expression of OCB at subsequent ages. However, we also found evidence for genetic attenuation in that genetic influences at one age decline in their influence over time, and genetic innovation whereby new genes ‘come on line’ at each age. Non-shared environment influenced stability of OCB to a lesser extent and effects were largely unique to each age and displayed negligible influences on OCB at later time points.ConclusionsOCB appears to be moderately stable across development, and stability is largely driven by genetic factors. However, the genetic effects are not entirely constant, but rather the genetic influence on OCB appears to be a developmentally dynamic process. [ABSTRACT FROM AUTHOR]

Background Configural processing in face recognition is a sensitivity to the spacing between facial features. It has been argued both that its presence represents a high level of expertise in face recognition, and also that it is a developmentally vulnerable process. Method We report a cross-syndrome investigation of the development of configural face recognition in school-aged children with autism, Down syndrome and Williams syndrome compared with a typically developing comparison group. Cross-sectional trajectory analyses were used to compare configural and featural face recognition utilising the ' Jane faces' task. Trajectories were constructed linking featural and configural performance either to chronological age or to different measures of mental age (receptive vocabulary, visuospatial construction), as well as the Benton face recognition task. Results An emergent inversion effect across age for detecting configural but not featural changes in faces was established as the marker of typical development. Children from clinical groups displayed atypical profiles that differed across all groups. Conclusion We discuss the implications for the nature of face processing within the respective developmental disorders, and how the cross-sectional syndrome comparison informs the constraints that shape the typical development of face recognition. [ABSTRACT FROM AUTHOR]

A Cochrane systematic review has shown midwifery-led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care, with a comparable level of safety. This study explored the local impact of the review, alongside other midwifery-led care evidence and guidelines. Electronic surveys were undertaken exploring women’s and health professionals’ awareness of models of maternity care evidence, including midwifery-led care and homebirth, and how they use evidence to guide their choices and practice. A low awareness of much of the available evidence was shown among the women and the professionals. There is a need for better dissemination of information to professionals as they are women’s preferred source of information about the options available for place of birth and midwifery-led care. [ABSTRACT FROM AUTHOR]

Background. Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. Currently, 20% of mothers in the UK are obese and the prevalence of obesity is increasing. In the UK, there is a lack of evidence or guidelines quantifying an ideal gestational weight gain or strategies to encourage women to remain within these limits. Aim. To provide an overview of systematic evidence which have synthesised the results from trials on the efficacy of gestational weight management interventions, and to discuss key components of effective diet or physical activity interventions in improving pregnancy and birth outcomes. Method. English language systematic reviews published after the NICE guidance on weight management before, during and after pregnancy (2010) were searched for using Medline. Findings. A total of 12 systematic reviews were identified. Most reported interventions had an effect on reducing weight gain, however, included studies were often of poor quality. Conclusion. Dietary interventions seem to be more effective in reducing gestational weight gain with some improvement in clinical outcomes (for example, reducing the risk of gestational diabetes, gestational hypertension and shoulder dystocia). Physical activity also has a role to play, however, in light of low compliance and concerns over limited understanding of its full impact on fetal growth and birthweight, more robust investigations are required to address the balance between its benefits, acceptability and impact on birthweight. Implications. Further research is required to identify optimum gestational weight gain and the particular components of interventions that have been shown to be effective and safe in reducing this during pregnancy. Midwives, with their key role in health promotion, should be offered support and training in keeping up to date with the growing body of evidence on gestational weight management and behaviour change techniques to promote a healthy lifestyle for women and their families. [ABSTRACT FROM AUTHOR]

Nitrous oxide emissions ( N2O) from agricultural land are spatially and temporally variable. Most emission measurements are made with small (≪ 1 m2 area) static chambers. We used N2O chamber data collected from multiple field experiments across different geo-climatic zones in the UK and from a range of nitrogen treatments to quantify uncertainties associated with flux measurements. Data were analysed to assess the spatial variability of fluxes, the degree of linearity of headspace N2O accumulation and the robustness of using ambient air N2O concentrations as a surrogate for sampling immediately after closure ( T0). Data showed differences of up to more than 50-fold between the maximum and minimum N2O flux from five chambers within one plot on a single sampling occasion, and that reliability of flux measurements increased with greater numbers of chambers. In more than 90% of the 1970 cases where linearity of headspace N2O accumulation was measured (with four or more sampling points), linear accumulation was observed; however, where non-linear accumulation was seen this could result in a 26% under-estimate of the flux. Statistical analysis demonstrated that the use of ambient air as a surrogate for T0 headspace samples did not result in any consistent bias in calculated fluxes. Spatial variability has the potential to result in erroneous flux estimates if not taken into account, and generally introduces a far larger uncertainty into the calculated flux (commonly orders of magnitude more) than any uncertainties introduced through reduced headspace sampling or assumption of linearity of headspace accumulation. Hence, when deploying finite resources, maximizing chamber numbers should be given priority over maximizing the number of headspace samplings per enclosure period. [ABSTRACT FROM AUTHOR]

There are estimated to be approximately 1500 people in the United Kingdom with C1 inhibitor ( C1INH) deficiency. At BartsHealth National Health Service ( NHS) Trust we manage 133 patients with this condition and we believe that this represents one of the largest cohorts in the United Kingdom. C1INH deficiency may be hereditary or acquired. It is characterized by unpredictable episodic swellings, which may affect any part of the body, but are potentially fatal if they involve the larynx and cause significant morbidity if they involve the viscera. The last few years have seen a revolution in the treatment options that are available for C1 inhibitor deficiency. However, this occurs at a time when there are increased spending restraints in the NHS and the commissioning structure is being overhauled. Integrated care pathways ( ICP) are a tool for disseminating best practice, for facilitating clinical audit, enabling multi-disciplinary working and for reducing health-care costs. Here we present an ICP for managing C1 inhibitor deficiency. [ABSTRACT FROM AUTHOR]

Background:Despite marked improvements in childhood leukaemia survival, 20% still die within 5 years of diagnosis. The aim of this study was to evaluate the relationship between socioeconomic status, as assessed by paternal occupation at birth, and survival from childhood leukaemia in children, using data from the Northern Region Young Persons Malignant Disease Registry.Methods:All 1007 cases of leukaemia in children aged 0-14 years, diagnosed between 1968 and 2010 and registered with the Registry were studied. Paternal occupational social class at the time of the child's birth was obtained and analysed in relation to survival using Cox-proportional regression.Results:Compared with the most advantaged group (I/II), those in the middle group (IIIN/M) had a 68% increased risk of death, while those in the least advantaged group (IV/V) had 86% higher risk for acute lymphoblastic leukaemia. While the survival advantage of children in class I/II was apparent from the time of diagnosis, survival for children in groups IIIN/M and IV/V were comparable until 3-4 years after diagnosis, when they began to minimally diverge.Conclusion:The existence of such socioeconomic disparities cannot be attributed to accessibility to health care in the United Kingdom. Further research into the likely factors underlying these disparities is required. [ABSTRACT FROM AUTHOR]

The author reflects on the studies which analysed the effect of awareness with recall (AWR) on surgical patients in Great Britain. He informs that AWR is an important adverse event for patients requiring the attention of healthcare practitioners and policy makers. According to the findings of the 5th National Audit Project (NAP5), Royal College of Anaesthetists in Great Britain that presents issues related to patients and anaesthetists.