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HLA‐DPB1 is the classical HLA class II genes with the least recorded variation on the IPD‐IMGT/HLA Database, suggesting the full extent of its diversity is perhaps yet to be characterized. Here, a full‐gene typing strategy was employed to genotype a UK cohort of 1470 HCT recipients (n = 744) and donors (n = 726). In total, 2940 full‐length HLA‐DPB1 sequences were generated, comprising 193 distinct alleles. Of these, 107 sequences contained novel variation, totaling 49 unique intronic HLA‐DPB1 alleles, and one coding variant (HLA‐DPB1*1188:01). Full‐gene sequencing resulted in zygosity changes for 129 individuals by identifying two distinct intronic variants of the same coding allele. We verified the existence of nine unconfirmed alleles and extended the sequence of two existing alleles on the IPD‐IMGT/HLA Database. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused numerous casualties, overloaded hospitals, reduced the wellbeing of many and had a substantial negative economic impact globally. As the population of the United Kingdom was preparing for recovery, the uncertainty relating to the discovery of the new Omicron variant on November 24 2021 threatened those plans. There was thus an important need for sensemaking, which could be provided, partly, through diffusion of information in the press, which we here examine. Method: We used topic modeling, to extract 50 topics from close to 1,500 UK press articles published during a period of approximately one month from the appearance of Omicron. We performed ANOVAs in order to compare topics between full weeks, starting on week 48 of 2021. Results: The three topics documenting the new variant (Omicron origins, Virus mutations, News of a new variant) as well as mentions of vaccination excluding booster, Scotlands First minister statement (Communications) travel bans and mask wearing (Restrictions) and the impact of market and investing (Domains and events) decreased through time (all ps <.01). Some topics featured lower representation at week two or three with higher values before and after: Government's Scientific Advisory Group for Emergencies recommendations (Communications), Situation in the US, Situation in Europe (Other countries and regions), all ps <.01. Several topics referring to symptoms and cases—e.g., rises of infections, hospitalisations, the pandemic the holidays, mild symptoms and care; restrictions and measures—e.g., financial help, Christmas and Plan B, restrictions and New Year; and domains of consequences and events—e.g., such as politics, NHS and patients, retail sales and airlines, featured increasing representation, (all ps <.01). Other topics featured less regular or non-significant patterns. Conclusion. Changes in sensemaking in the press closely matched the changes in the official discourse relating to Omicron and reflects the trajectory of the infection and its local consequences. [ABSTRACT FROM AUTHOR]

The dissolved organic carbon (DOC) export from land to ocean via rivers is a significant term in the global C cycle, and has been modified in many areas by human activity. DOC exports from large global rivers are fairly well quantified, but those from smaller river systems, including those draining oceanic regions, are generally under-represented in global syntheses. Given that these regions typically have high runoff and high peat cover, they may exert a disproportionate influence on the global land–ocean DOC export. Here we describe a comprehensive new assessment of the annual riverine DOC export to estuaries across the island of Great Britain (GB), which spans the latitude range 50–60° N with strong spatial gradients of topography, soils, rainfall, land use and population density. DOC yields (export per unit area) were positively related to and best predicted by rainfall, peat extent and forest cover, but relatively insensitive to population density or agricultural development. Based on an empirical relationship with land use and rainfall we estimate that the DOC export from the GB land area to the freshwater-seawater interface was 1.15 Tg C year−1 in 2017. The average yield for GB rivers is 5.04 g C m−2 year−1, higher than most of the world's major rivers, including those of the humid tropics and Arctic, supporting the conclusion that under-representation of smaller river systems draining peat-rich areas could lead to under-estimation of the global land–ocean DOC export. The main anthropogenic factor influencing the spatial distribution of GB DOC exports appears to be upland conifer plantation forestry, which is estimated to have raised the overall DOC export by 0.168 Tg C year−1. This is equivalent to 15% of the estimated current rate of net CO2 uptake by British forests. With the UK and many other countries seeking to expand plantation forest cover for climate change mitigation, this 'leak in the ecosystem' should be incorporated in future assessments of the CO2 sequestration potential of forest planting strategies. [ABSTRACT FROM AUTHOR]

Background This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers. Methods Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020. Results 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 µmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19. Conclusions This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs. [ABSTRACT FROM AUTHOR]

Highlights • Ultra-high resolution (UHR) HLA typing by NGS results in improved survival. • CMV matching can further improve outcomes when used with UHR HLA typing. • DPB1 T cell epitope matching provides a viable alternative to a 12/12 UHR HLA match. Abstract HLA matching at an allelic-level resolution for volunteer unrelated donor (VUD) hematopoietic cell transplantation (HCT) results in improved survival and fewer post-transplant complications. Limitations in typing technologies used for the hyperpolymorphic HLA genes have meant that variations outside of the antigen recognition domain (ARD) have not been previously characterized in HCT. Our aim was to explore the extent of diversity outside of the ARD and determine the impact of this diversity on transplant outcome. Eight hundred ninety-one VUD-HCT donors and their recipients transplanted for a hematologic malignancy in the United Kingdom were retrospectively HLA typed at an ultra-high resolution (UHR) for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 using next-generation sequencing technology. Matching was determined at full gene level for HLA class I and at a coding DNA sequence level for HLA class II genes. The HLA matching status changed in 29.1% of pairs after UHR HLA typing. The 12/12 UHR HLA matched patients had significantly improved 5-year overall survival when compared with those believed to be 12/12 HLA matches based on their original HLA typing but were found to be mismatched after UHR HLA typing (54.8% versus 30.1%, P =.022). Survival was also significantly better in 12/12 UHR HLA-matched patients when compared with those with any degree of mismatch at this level of resolution (55.1% versus 40.1%, P =.005). This study shows that better HLA matching, found when typing is done at UHR that includes exons outside of the ARD, introns, and untranslated regions, can significantly improve outcomes for recipients of a VUD-HCT for a hematologic malignancy and should be prospectively performed at donor selection. [ABSTRACT FROM AUTHOR]

We also thank Professor Dise for her contributions to writing the LOCATE proposal and acquiring funding. Correction to: Biogeochemistry https://doi.org/10.1007/s10533-021-00762-2 In this article we inadvertently omitted acknowledging the contributions of Professor Nancy Dise (UK Centre for Ecology & Hydrology) to the work. [Extracted from the article]

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Abstract: Nonepileptic attack disorder (NEAD) is one of the commonest differential diagnoses of epilepsy. A number of approaches to the communication of this diagnosis and its treatment have been described; however, there are currently no evidence-based management pathways. This study captures the care currently received by patients with NEAD in the United Kingdom and Ireland. The findings are based on 130 responses to an Internet survey of clinicians from the United Kingdom and the Republic of Ireland (65.6% neurologists). The responses indicate that there is much variability in the approaches to diagnosis of NEAS and communication of the diagnosis to the patient. Although there is good access to diagnostic equipment, 30% of diagnoses are made on clinical grounds alone. While 93% of respondents endorsed psychological treatment as the treatment of choice, only 35% were able to refer all of their patients for this treatment and 15% were unable to refer any patients. [Copyright &y& Elsevier]

Abstract: We use a model of international and domestic tourist numbers and flows to investigate the effect of various climate policy instruments implemented in Europe on arrivals and emissions for the countries concerned. We find that these schemes do not fulfil their desired effects. The introduction of aviation into the European trading system results in a fall in the number of tourists travelling into the European Union in favour of other destinations. It also causes a significant welfare loss with only a small reduction in emissions. The flight taxes in the Netherlands and the UK result in different substitution effects across destinations (depending on the zones being taxed) but both policies do have the same consequence of inducing global welfare losses and also reducing visitor numbers to the countries. We find that when these policies are combined their effects are additive. Welfare impacts are robust to variations in the underlying assumptions and changes in the scope of the taxes examined have the expected effects. [Copyright &y& Elsevier]

Background and objectives: This study follows up an initial audit in 1992 indicating that anaesthetic machine checking practices were often incomplete. The aims were to ascertain if there has been any improvement during this period with special reference to the latest guidelines. Methods: Following the Association of Anaesthetists of Great Britain and Ireland machine checking guidelines, a structured questionnaire, was used to interview 41 anaesthetists in the South West region on one particular day. Results: Despite 80% of subjects stating that they had read the latest guidelines recently, only one undertook a complete check and 39/41 (95%) performed partial checks (omitting one or more steps in the guidelines). Steps most commonly omitted were additional monitoring, ventilator function, availability of an alternative means of ventilation and function of ancillary equipment such as laryngoscopes. Only 5/41 subjects performed any check between cases. Several of these checks have been introduced in the 2004 guidelines. Conclusions: Although there has been a significant increase in the proportion of anaesthetists undertaking machine checks since 1992 (P = 0.0007), we conclude that machine checking guidelines are still poorly followed, with checks specific to the latest guidelines most likely to be omitted. [ABSTRACT FROM AUTHOR]

Abstract: We use a model of domestic and international tourist numbers and flows to estimate the impact of the recent and proposed changes in the Air Passenger Duty (APD) of the United Kingdom. We look at four different scenarios (abolishing the APD, keeping the 2001 APD level, the 2007 APD and the Conservative Party''s “Green Miles” proposal) using base, high and very high elasticity levels as well as assumptions about the substitutability between domestic and international holidays and the effects of a carbon tax. We find that the recent doubling of the APD has the perverse effect of increasing carbon dioxide emissions, albeit only slightly, because it reduces the relative price difference between near and far holidays. Tourists arriving into the UK would fall slightly. The number of tourists travelling from the UK would fall in the countries near to the UK, and this drop would be only partly offset by displaced tourists from the UK. Tourists leaving the UK for countries further a field would increase. The proposal of the Conservative Party to exempt the first 2000miles (for UK residents) would decrease emissions by roughly the same amount as abolishing the APD altogether—but the number of tourists arriving into the UK would not rise. These results are reversed if we assume that domestic holidays and foreign holidays are close substitutes. If the same revenue were raised with a carbon tax rather than a boarding tax, emissions would fall rather than rise. [Copyright &y& Elsevier]

Research conducted in the context of the IELTS Research Program indicates that there are recurrent features in the writing under test conditions of candidates from Chinese language backgrounds, particularly in terms of interpersonal tenor. These include a high level of interpersonal reference, combined with a heavily dialogic and hortatory style. Chinese candidates in the study used significantly more interrogatives and imperatives than a similar sample of Greek candidates, along with a range of other grammatical devices which perform a hortatory function, calling for a mental or physical response on the part of the individual reader or collective. Together, these features lend a polemical tone to the English-medium writing of the Chinese candidates. It seems reasonable that Chinese students who wish to succeed in English-medium higher education should aim ultimately towards models of writing commonly expected of students in that context. However, in order to fairly assess the potential of Chinese candidates, it is important to recognise that some students who may have performed well in the Chinese educational system may import into their English writing a range of hitherto valued practices from their Chinese writing and/or their English language classes which may be affecting their test scores. [ABSTRACT FROM AUTHOR]

Background: During the influenza outbreak of 1999/2000, in the United Kingdom between weeks 49/99 and 06/00. We set out to prospectively recruit all adult patients with respiratory symptoms admitted to the largest non-teaching hospital in the country. Methods: All patients 18 years and older admitted with acute respiratory symptoms to a large district general hospital, serving a population of 190,000, during a period of influenza activity, were seen and if they fulfilled the case definition criteria for the study were recruited. Details were recorded of their age, chronic disease status, smoking behaviour, alcohol consumption, influenza and pneumococcal vaccination status. Each was matched with community controls for family physician, age, sex, socio-economic and chronic disease status. In addition, the study generated a 2:1 pool of unmatched controls to cases. Using case-control methodology, we set out to estimate the clinical effectiveness of influenza vaccination in preventing hospitalisation and the risks associated with chronic disease, alcohol consumption, smoking behaviour and previous hospitalisation. Presented here are the results for the matched subjects. Results: 346 cases were recruited, 89% with pre-existing chronic disease, matched community controls were found for 326 (95%). In total, the study generated 725 unmatched controls. Matched pair analysis revealed that vaccination protects against hospitalisation with an Odds Ratio of 0.38 (95% CI 0.25 to 0.51) indicating a strong protective effect, giving vaccine effectiveness of 62±13% in preventing hospitalisations. Overwhelmingly previous hospitalisation for respiratory disease (OR 7.6) contributed the greatest risk of being hospitalised with influenza, yet only 33% of cases in recommended groups received vaccination. Conclusions: This study has advantages over some other studies and again shows the benefits of vaccination and reinforces the contribution chronic ill health contributes to the complications of influenza infection and the missed opportunities for protection. [Copyright &y& Elsevier]

Background: This paper describes the personal and societal impact of a small outbreak of influenza in the United Kingdom over the winter 1999/2000. Methods: All adults hospitalised with acute respiratory symptoms were recruited into a case control study to examine the effectiveness of the influenza vaccination. All patients were admitted to a large district general hospital, serving a population of 190,000. Details were recorded of age, chronic disease, smoking behaviour, alcohol consumption, influenza and pneumococcal vaccination status. While in hospital, utilisation of hospital facilities, length of stay, use of critical care facilities and fatality were recorded. Clinical specimens were taken for serology and chest X-ray findings recorded. These individuals and community controls were followed up for an addition 2 years to compare their pre- and post-influenza morbidity and health-seeking behaviour. Results: Case recruitment occurred from week 51/99 to week 5/00 when influenza was circulating in the community. A total of 186 women and 160 men were recruited with an average age of 68.6 years. Eighty-nine percent had pre-existing chronic disease, stayed on average at least 10 days, the length of stay increasing dramatically with extreme age; 11% of the cases received intensive or critical care during the admission and, overall, the case fatality rate was 15%, 23% in the over-65 age group while hospitalised. Only 33% of the patients with pre-existing chronic disease received the influenza vaccination and only 21% pneumococcal. Follow-up of cases over a further 2 years showed that 94 (28%) had died compared to 25 (3.8%) of the matched controls. They suffered an increased number of hospital admissions, poorer heath and increased morbidity and mortality. Conclusions: Even small outbreaks of influenza have a profound impact on the lives of individuals and society. This study reinforces the need for increased efforts to improve vaccine uptake in those most at risk and the consequences for not taking such action. [Copyright &y& Elsevier]

Presents the findings of a qualitative study on the use of personality-held record for cancer patients in Great Britain. Discussion of treatment processes; Importance of communication and information on cancer patient treatment; Use of patient-held records in health care settings.

Presents an overview of issues discussed at the British Medical Association's (BMA) 2000 representative meeting. Need for clarification of BMA policy regarding resuscitation; Call for the resignation of the president of the Royal College of Obstetricians and Gynecologists; Development of measures to integrate refugee doctors into clinical practice in Great Britain; Debate surrounding the expansion of the National Health Service (NHS) Direct telephone advice service; Others.

Examines the influence of the time of immunosuppressive administration on graft survival after renal transplantation in Great Britain. Factors affecting renal transplantation outcome; Incidence of graft rejection in several patients; Considerations in drug administration.

Presents information on the British Medical Association's annual representative meeting held in Cardiff, Wales during 6-9 of July, 1998. Details on a call for the restructuring of the National Health Service in Great Britain; Information on a consensus for doctor assisted suicide; Discussion on aggression and violence against staff; In-depth look at the usage of clinical scoring systems. INSET: The BMA in Cardiff.

Presents several medical studies in Great Britain. Manifestation of metastatic breast cancer as serous effusions; Effect of active chronic otitis media on adults; Incidence of malignant disease in patients with renal transplants.

The article focuses on the analysis of patient level data from general practices in central London, England which started piloting seven day opening at various times paid for by the Prime Minister's Challenge Fund. Topics covered include the similarity in the number of visits to emergency departments made by patients registered at the pilot practices and those in the control practices and the decline in the number of elderly people taken to hospital by ambulance at weekends.

The article announces that Roger Boyle has retired as national director for heart disease and stroke in England.

The article discusses a study which reviewed the literature on the safety of labor and birth across Great Britain, conducted by Jane Sandall and colleagues. Study authors discovered that the widespread use of midwife-led care among women who have no major problems could improve the safety of maternity services in Great Britain. They suggested transferring appropriate tasks from doctors and midwives to nurses and support staff to effectively use staff time.

The article reports on the decision of the British Medical Research Council (MRC) not to provide funding to researchers whose worked led to the birth of the first baby conceived as a result of in vitro fertilization (IVF) in 1978, because they worked outside established centres.

The article focuses on the argument of addiction specialists against the recommendation of England's National Treatment Agency for Substance Misuse to limit the length of time for methadone prescription. Addiction specialists argue that such recommendation could cause more harm than good. They add that the agency did not base its recommendation on evidence. Roy Robertson, a general practice principal, claims that the recommendation will cost lives and will damage the society.

The article reports that Great Britain ranks top for terminal care services based on the quality of death index by Economist Intelligence Unit Ltd.

The article focuses on a campaign to be launched by the Human Tissue Authority on the collection of umbilical cord blood by trained people. The campaign is aimed at reminding British health professionals and the public in response to reports on unlawful collections. Regulations were unveiled in July 2008, but 140 cases of unlawful cord blood collections still emerged since their enforcement. The campaign is also aimed at preventing cord blood contamination.

The article focuses on a major technology assessment in Great Britain which revealed that the addition of magnetic resonance imaging (MRI) to the preoperative process of women with small breast cancers failed to reduce the rate of reoperation for completely excised tumours.

The article focuses on a report from the research institute King's Fund that has found that gardening improves mental and physical health at all ages.

The article discusses research on obstetric outcomes among babies delivered in normal working hours with a consultant or delivered out of hours, referencing a study by Hannah Knight et al, published in the journal "PLoS Medicine." Topics covered include the lack of significant difference in the rate of babies with Apgar score five minutes after delivery and the lower rates of intrapartum caesarean section in women who delivered out of hours.

An interview with Chris Rudge, chair of the Donation Ethics Committee of Great Britain, about the impact of the government's withdrawal of funding, ethical basis of organ donation, and the increasing interests of the dying patient in terms of organ donation is presented.

The article presents British Joint Committee on Vaccination and Immunisation chairman Andrew Pollard's explanation for the decision to limit the meningitis B vaccination.

The article discusses guidelines developed by the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society which aim to reduce surgery cancellations due to high blood pressure (BP). The guidelines provide national recommendations for the measurement, diagnosis and management of raised BP in adults prior to planned surgery. It suggests for general practitioners to include information on a patient's BP in referral letters for elective surgery.

The article reports on a consultation launched by British researchers into the scientific, ethical, safety and regulatory issues associated with the use in scientific studies of animals that contain human material. According to chairman of the working group Martin Bobrow, the consultation will focus on transgenic animals that contain cells of human origin, such as rhesus macaques that carry a human form of the gene for Huntington's disease. The research team will also consult with experts from various research fields including developmental genetics and veterinary medicine.

The article focuses on a report published by the Office for National Statistics regarding the drug related deaths in Great Britain in 2008. Deaths related to drugs were reported to have increased to their highest level since 2001. During the year, drug-related deaths were 2,928, compared to 2,640 in 2007. In another report, a 2.7 percent increase in the number of drug related deaths was confirmed.

The article focuses on a report published by the National Audit Office (NAO) in Great Britain which warned that many cases of rheumatoid arthritis (RA) are not being diagnosed or treated quickly to stop preventable damage to joints. As part of the role of NAO to scrutinise public spending on behalf of parliament, it examined the efficiency and effectiveness of services offered to people suffering from RA. The NAO report found that the average time from onset of symptoms to treatment of RA is nine months. Audit manager for the report Chris Groom said that this delay can increase the risk of damage to the joint as well as the need for more costly treatments.