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In recent years Bournemouth University (BU) has witnessed a growth in undergraduate projects aimed at resolving problems in low-resource communities, with an emphasis on sustainability through the use of locally-available resources and production methods. BU academics have also been involved in helping the Royal National Lifeboat Institute (RNLI) to develop product solutions to help prevent global drowning, with an initial focus on the Bangladeshi context. Alongside the potential to enrich or even save lives in the target communities, such projects can offer considerable benefits to a range of domestic stakeholders: from the students and staff themselves to local businesses and non-government organisations (NGO's). But they can also offer considerable challenges--educationally, ethically and practically--including issues with design validation, the reliability and availability of information, and the barriers of differing cultures and languages. How can educators support low-resource projects successfully? Can students truly gain sufficient understanding of all the relevant issues to design products for an unfamiliar culture, no matter how diverse? And why are low-resource communities looking to designers from the other side of the world to provide low-tech solutions to local problems? Bournemouth University's low-resource projects have achieved varying degrees of success. By examining some of these--including the RNLI's Bottle Buoy, which has recently gained international acclaim--the authors explore the complex issues relating to the use of such projects in an educational context, and present a proposal for future success using jugaad strategies and greater collaboration.

Diagnosing Autism Spectrum Disorders (ASD) is important throughout the lifespan. The objective was to investigate the transcultural diagnostic validity of the Social Communication Questionnaire (SCQ) in a clinical sample of 451 adults with Intellectual Developmental Disorder (IDD) with and without ASD in Germany, the U.S.A. and Great Britain. Variables associated with higher SCQ sum-scores were higher levels of IDD, male gender, a diagnosis of ASD and the study site (Germany > U.S.A > G.B.). An ROC analysis revealed a cut-score of 13, which resulted in a sensitivity of 0.87 and a specificity of 0.58. It is recommended to adjust the cut-score according to level of IDD and gender. Further research is needed to align diagnostic assignment of ASD across different sites and countries.

Purpose: The purpose of this paper is to focus on approaches that acknowledge and make explicit the role of emotion in the entrepreneurship education classroom. As entrepreneurship educators, the authors are aware of the affective impacts that entrepreneurship education has on the students and the authors continuously reflect on and support the students through, what is acknowledged in practice, an emotionally charged experience. With this in mind, the authors outline how a variety of disciplines engage with the role of emotions and how an interdisciplinary approach to the topic can support pedagogy. Design/methodology/approach: The authors synthesise relevant arguments from four discrete disciplines: neuroscience; psychology, education and entrepreneurship, which have not previously been combined. The authors argue that the role of emotion in learning generally, has been investigated across these disparate disciplines, but has not been brought together in a way that provides practical implications for the development of pedagogy. Findings: By synthesising the findings from four bodies of knowledge that engage with emotion, entrepreneurship and education, the authors start to develop a theoretical model based around the concept of the emotional ecology of the classroom. Practical implications: The role of emotion in entrepreneurship education is an emerging topic and the authors' synthesis of research supports further investigation. The authors' insights will support educators to develop classroom environments that acknowledge relationships between students and between students and educators. Such engagement could help educators and students to appreciate, acknowledge and address the emotional aspects of entrepreneurship education. Originality/value: The paper starts to develop new theory around emotions in entrepreneurship education, developing the idea of the emotional "ecology" of teaching environments and highlighting how this might support future research agendas.

Steroid sulphatase (STS) cleaves sulphate groups from steroid hormones, and steroid (sulphate) levels correlate with mood and age‐related cognitive decline. In animals, STS inhibition or deletion of the associated gene, enhances memory/neuroprotection and alters hippocampal neurochemistry. Little is known about the consequences of constitutive STS deficiency on memory‐related processes in humans. We investigated self‐reported memory performance (Multifactorial Memory Questionnaire), word‐picture recall and recent mood (Kessler Psychological Distress Scale, K10) in adult males with STS deficiency diagnosed with the dermatological condition X‐linked ichthyosis (XLI; n = 41) and in adult female carriers of XLI‐associated genetic variants (n = 79); we compared results to those obtained from matched control subjects [diagnosed with ichthyosis vulgaris (IV, n = 98) or recruited from the general population (n = 250)]. Using the UK Biobank, we compared mood/memory‐related neuroanatomy in carriers of genetic deletions encompassing STS (n = 28) and non‐carriers (n = 34,522). We found poorer word‐picture recall and lower perceived memory abilities in males with XLI and female carriers compared with control groups. XLI‐associated variant carriers and individuals with IV reported more adverse mood symptoms, reduced memory contentment and greater use of memory aids, compared with general population controls. Mood and memory findings appeared largely independent. Neuroanatomical analysis only indicated a nominally‐significantly larger molecular layer in the right hippocampal body of deletion carriers relative to non‐carriers. In humans, constitutive STS deficiency appears associated with mood‐independent impairments in memory but not with large effects on underlying brain structure; the mediating psychobiological mechanisms might be explored further in individuals with XLI and in new mammalian models lacking STS developmentally. [ABSTRACT FROM AUTHOR]

Background: Phase three trials of the monoclonal antibodies lecanemab and donanemab, which target brain amyloid, have reported statistically significant differences in clinical end-points in early Alzheimer's disease. These drugs are already in use in some countries and are going through the regulatory approval process for use in the UK. Concerns have been raised about the ability of healthcare systems, including those in the UK, to deliver these treatments, considering the resources required for their administration and monitoring. Aims: To estimate the scale of real-world demand for monoclonal antibodies for Alzheimer's disease in the UK. Method: We used anonymised patient record databases from two National Health Service trusts for the year 2019 to collect clinical, demographic, cognitive and neuroimaging data for these cohorts. Eligibility for treatment was assessed using the inclusion criteria from the clinical trials of donanemab and lecanemab, with consideration given to diagnosis, cognitive performance, cerebrovascular disease and willingness to receive treatment. Results: We examined the records of 82 386 people referred to services covering around 2.2 million people. After applying the trial criteria, we estimate that a maximum of 906 people per year would start treatment with monoclonal antibodies in the two services, equating to 30 200 people if extrapolated nationally. Conclusions: Monoclonal antibody treatments for Alzheimer's disease are likely to present a significant challenge for healthcare services to deliver in terms of the neuroimaging and treatment delivery. The data provided here allows health services to understand the potential demand and plan accordingly. [ABSTRACT FROM AUTHOR]

Recent re-conceptualisation of paternal involvement (Pleck, J. H. (2010). Paternal involvement: Revised conceptualization and theoretical linkages with child outcomes. In M. Lamb (Ed.), "The role of the father in child development" (5th ed., pp. 67-107). London: Wiley), while proving fruitful, has yet to be applied to investigations into what extent a father's level of involvement may affect child-peer interactions in the preschool age range, over and above the effects of mother-child attachment quality and socio-economic status (SES). Patterns of associations between attachment quality, sensitivity and general caregiving behaviours have also yet to be compared in equally involved mothers and fathers. Thirty preschool children (17 males:13 females) with similar SES profiles and their immediate caregivers participated in hour-long observations, conducted in the home. Even when attachment quality was controlled for, children with low paternal involvement were found to have higher levels of child-peer aggression. Further, patterns of effects between caregiver sensitivity, child-caregiver attachment quality and general caregiver interactions were similar for equally involved mothers and fathers. These preliminary data support the concept of applying Pleck's (2010) re-conceptualisation of paternal involvement to preschool attachment, and have implications towards the wider study of child-father attachment. Limitations of the current study and directions for future research are discussed.

There have been significant advance in educational technology but they have not always brought about measurable shifts in user behavior. This study examined the relationship between teachers' knowledge about a tool and their use of that tool. In many secondary schools use of a Learning Platforms (LPs) is no longer optional although the degree of engagement with the technology remains a matter of choice. However, individual decisions to use selected functionalities of these systems are not well captured in current models of technology acceptance. In a best-case scenario, self-reported possible and actual use of LPs was acquired for 50 teachers from eight technology-rich schools. Three key barriers to use were identified: the functionality of the software, workloads and personal interest. Based on teachers' knowledge of LP functionality and perceived barriers to use, four distinct groups of teachers emerged. A low-user group identified all three barriers, showed little enthusiasm for use of this technology and had a markedly impoverished perception of the LP. There were three distinct higher use groups based on perceived barriers. While the functions used by these three groups showed less variation, with innovative functions such Blogs and Wikis remaining aspirational, there were differences in how such limitations were viewed. Whether the response was one of complacency and frustration has implications for professional development programmes.

The increasing power demands of spacecraft payloads and the realistic prospect of space based solar power (SBSP) stations as a means of providing zero carbon electricity in the 2030s, means that there is an emerging requirement for large area, yet lightweight, solar photovoltaic (PV) arrays that will provide far greater power (kW peak) than is currently available. To be practical, such arrays will need to use solar cells which have a much higher specific power (i.e., power per unit mass) and a much lower cost per watt than current space-rated solar PV technologies. To this end, the Centre for Solar Energy Research (CSER) at Swansea University have been working on a new solar cell technology, based on thin-film cadmium telluride (CdTe), deposited directly onto ultra-thin space qualified cover glass material. This offers a potentially high specific power and when adopting the conventional CdTe manufacturing process, a low-cost technology. The ultra-thin glass can produce a solar cell which is sufficiently flexible to allow "roll-out" deployment strategies. Four prototype cells were flown as part of the Thin-Film Solar Cell (TFSC) experimental payload, developed by CSER and the Surrey Space Centre (SSC), on the joint Algerian Space Agency (ASAL) – UK Space Agency AlSAT-1N Technology Demonstration CubeSat, launched into a 661 km × 700 km, 98.20° Sun Synchronous orbit, on September 26, 2016. The experiment has provided the first in-orbit current/voltage (I/V) measurements of this novel technology, and more than five years of flight results have now yielded new insights into its longer-term performance and inherent radiation hardness, which makes them particularly attractive for maintaining high end-of-life (EOL) performance for long duration space missions. The results help to strengthen the argument for further development of this technology for space application. The data, collected over ∼30,000 orbits, show no signs of cell delamination (a potential risk for such technologies), no deterioration in short circuit current or in series resistance. However, all four cell's fill factors were observed to decrease over the duration of the mission, caused primarily by a decrease in their shunt resistance. This has been attributed to the diffusion of gold atoms from the back electrical contacts. We conclude therefore that further development of this technology should utilize more stable back contacting methodologies more commonly employed for terrestrial CdTe modules. However, this flight has proven the basic soundness of the technology for use in space. • First detailed study of thin-film cadmium telluride solar cells operating in space. • Novel low-cost lightweight solar cell structure laid down on ultra-thin glass. • Thin-Film cadmium telluride solar cells show excellent radiation tolerance. • International spaceflight cooperation between Algeria and the UK via a CubeSat. [ABSTRACT FROM AUTHOR]

From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score. Adult participants (aged ≥18 years) were enrolled from 22 hospitals across the UK. Patients with a risk score indicating a 40% risk of admission to an intensive care unit or death were randomly assigned 1:1:1 to standard of care alone, standard of care with baricitinib, or standard of care with ravulizumab. The composite primary outcome was the time from randomisation to incidence (up to and including day 14) of the first event of death, invasive mechanical ventilation, extracorporeal membrane oxygenation, cardiovascular organ support, or renal failure. The primary interim analysis was triggered when 125 patient datasets were available up to day 14 in each study group and we included in the analysis all participants who were randomly assigned. The trial was registered on ClinicalTrials.gov (NCT04390464). Between May 8, 2020, and May 7, 2021, 417 participants were recruited and randomly assigned to standard of care alone (145 patients), baricitinib (137 patients), or ravulizumab (135 patients). Only 54 (39%) of 137 patients in the baricitinib group received the maximum 14-day course, whereas 132 (98%) of 135 patients in the ravulizumab group received the intended dose. The trial was stopped after the primary interim analysis on grounds of futility. The estimated hazard ratio (HR) for reaching the composite primary endpoint was 1·11 (95% CI 0·62–1·99) for patients on baricitinib compared with standard of care alone, and 1·53 (0·88–2·67) for ravulizumab compared with standard of care alone. 45 serious adverse events (21 deaths) were reported in the standard-of-care group, 57 (24 deaths) in the baricitinib group, and 60 (18 deaths) in the ravulizumab group. Neither baricitinib nor ravulizumab, as administered in this study, was effective in reducing disease severity in patients selected for severe COVID-19. Safety was similar between treatments and standard of care. The short period of dosing with baricitinib might explain the discrepancy between our findings and those of other trials. The therapeutic potential of targeting complement C5 activation product C5a, rather than the cleavage of C5, warrants further evaluation. UK Medical Research Council, UK National Institute for Health Research Cambridge Biomedical Research Centre, Eli Lilly and Company, Alexion Pharmaceuticals, and Addenbrooke's Charitable Trust. [ABSTRACT FROM AUTHOR]

Background: Migraine is the world's second most common disabling disorder, affecting 15% of UK adults and costing the UK over £1.5 billion per year. Several costly new drugs have been approved by National Institute for Health and Care Excellence. Aim: To assess the cost-effectiveness of drugs used to treat adults with chronic migraine. Methods: We did a systematic review of placebo-controlled trials of preventive drugs for chronic migraine. We then assessed the cost-effectiveness of the currently prescribable drugs included in the review: Onabotulinum toxin A (BTA), Eptinezumab (100mg or 300mg), Fremanezumab (monthly or quarterly dose), Galcanezumab or Topiramate, each compared to placebo, and we evaluated them jointly. We developed a Markov (state-transition) model with a three-month cycle length to estimate the costs and quality-adjusted life years (QALYs) for the different medications from a UK NHS and Personal Social Services perspective. We used a two-year time horizon with a starting age of 30 years for the patient cohort. We estimated transition probabilities based on monthly headache days using a network meta-analysis (NMA) developed by us, and from published literature. We obtained costs from published sources and applied discount rates of 3.5% to both costs and outcomes. Results: Deterministic results suggest Topiramate was the least costly option and generated slightly more QALYs than the placebo, whereas Eptinezumab 300mg was the more costly option and generated the most QALYs. After excluding dominated options, the incremental cost-effectiveness ratio (ICER) between BTA and Topiramate was £68,000 per QALY gained and the ICER between Eptinezumab 300mg and BTA was not within plausible cost-effectiveness thresholds. The cost-effectiveness acceptability frontier showed that Topiramate is the most cost-effective medication for any amount the decision maker is willing-to-pay per QALY. Conclusions: Among the various prophylactic medications for managing chronic migraine, only Topiramate was within typical cost-effectiveness threshold ranges. Further research is needed, ideally an economic evaluation alongside a randomised trial, to compare these newer, expensive CGRP MAbs with the cheaper oral medications. [ABSTRACT FROM AUTHOR]

Background: Nearly 50 million people worldwide have dementia and the increasing numbers requiring end-of-life and palliative care, has led to national efforts to define standards of care for this patient group. Little research, however, has been done to date about the experience of hospice care for people with dementia accessing these services. This study explores the views of hospice dementia care for bereaved carers of people with dementia and hospice clinicians. Methods: We used purposive sampling for participant recruitment. Semi-structured qualitative interviews were conducted with bereaved carers and hospice clinical staff. Interviews were audio recorded and the transcriptions were analysed through thematic analysis. A total of 12 participants were interviewed from one service in the Northwest region in the UK. All were female and white British. Results: Participants described their experience of hospice dementia care in three main themes: Pre-access to service, roles and responsibility within hospice care, ease and difficulty of last period of end-of-life care. Conclusion: Rapid response teams delivering hospice home care could represent a better option to inpatient care and may be preferred by patients. This type of service, however, may require joined-up care with other community services, and this type of care needs to be considered and planned. Future studies should evaluate this type of community care. [ABSTRACT FROM AUTHOR]

A considerable number of adults who are currently living with posttraumatic stress disorder (PTSD) are also parents caring for at least one biological child. Evidence suggests that parental PTSD can be associated with impairments to certain parenting behaviours, particularly increasing the use of more negative practices. However, most of the evidence to date has been collected using quantitative methodology, which gives limited insight into why such effects might occur. The current study qualitatively explored study the lived experiences of parents currently living with PTSD, within the United Kingdom. Interviews were conducted with 30 parents (16 mothers, 14 fathers) who were recruited via a PTSD research registry, and who had children living at home under the age of 18 years at the time they experienced their trauma. Three main themes were identified: key impacts of the trauma to the parent personally; negative changes to specific parenting outcomes; impact of these parenting changes on the parent's sense of parental efficacy; and recovery and coping. These findings provide novel insight into the experiences of both mothers and fathers with PTSD, and highlight the multiple challenges faced by parents living with PTSD that extend beyond impairments to themselves as individuals. Potential implications for the implementation of effective support for parents and their families following trauma exposure are considered. Highlights: This study addressed gaps in the literature exploring the perceived impact of parental PTSD from a qualitative perspective. 30 parents were invited to take part in an interview about the day-to-day challenges of parenting following trauma. The current study offers a unique insight into the experiences of both mothers and fathers, as 47% of the sample were fathers. Three themes were identified perceived negative changes to specific parenting outcomes; impact of these parenting changes on the parent's sense of parental efficacy; and recovery and coping. The findings provide insight to the lived experiences of parents with PTSD, as well as highlighting several clinical implications for family well-being and effective functioning. [ABSTRACT FROM AUTHOR]

Gastro-esophageal reflux disease (GERD) is a common, significant health burden. United Kingdom guidance states that surgery should be considered for patients with a diagnosis of GERD not suitable for long-term acid suppression. There is no consensus on many aspects of patient pathways and optimal surgical technique, and an absence of information on how patients are currently selected for surgery. Further detail on the delivery of anti-reflux surgery (ARS) is required. A United Kingdom-wide survey was designed to gather surgeon opinion regarding pre-, peri- and post-operative practice of ARS. Responses were received from 155 surgeons at 57 institutions. Most agreed that endoscopy (99%), 24-hour pH monitoring (83%) and esophageal manometry (83%) were essential investigations prior to surgery. Of 57 units, 30 (53%) had access to a multidisciplinary team to discuss cases; case-loads were higher in those units (median 50 vs. 30, P < 0.024). The most popular form of fundoplication was a Nissen posterior 360° (75% of surgeons), followed by a posterior 270° Toupet (48%). Only seven surgeons stated they had no upper limit of body mass index prior to surgery. A total of 46% of respondents maintain a database of their practice and less than a fifth routinely record quality of life scores before (19%) or after (14%) surgery. While there are areas of consensus, a lack of evidence to support workup, intervention and outcome evaluation is reflected in the variability of practice. ARS patients are not receiving the same level of evidence-based care as other patient groups. [ABSTRACT FROM AUTHOR]

Background: Fractures are rare events and can occur because of a fall. Fracture counts are distinct from other count data in that these data are positively skewed, inflated by excess zero counts, and events can recur over time. Analytical methods used to assess fracture data and account for these characteristics are limited in the literature. Methods: Commonly used models for count data include Poisson regression, negative binomial regression, hurdle regression, and zero-inflated regression models. In this paper, we compare four alternative statistical models to fit fracture counts using data from a large UK based clinical trial evaluating the clinical and cost-effectiveness of alternative falls prevention interventions in older people (Prevention of Falls Injury Trial; PreFIT). Results: The values of Akaike information criterion and Bayesian information criterion, the goodness-of-fit statistics, were the lowest for negative binomial model. The likelihood ratio test of no dispersion in the data showed strong evidence of dispersion (chi-square = 225.68, p-value < 0.001). This indicates that the negative binomial model fits the data better compared to the Poisson regression model. We also compared the standard negative binomial regression and mixed effects negative binomial models. The LR test showed no gain in fitting the data using mixed effects negative binomial model (chi-square = 1.67, p-value = 0.098) compared to standard negative binomial model. Conclusions: The negative binomial regression model was the most appropriate and optimal fit model for fracture count analyses. Trial registration: The PreFIT trial was registered as ISRCTN71002650. [ABSTRACT FROM AUTHOR]

Transferring from mainstream primary to secondary school can be especially problematic for children with an autism spectrum disorder. Two groups of parents (nine pretransition and six posttransition parents) contributed to this 15-month-long study. Perceptions of the pretransition group were captured through focus groups and in-depth interviews at three critical times: before transition, one term in, and after a full year of secondary schooling. The posttransition group provided retrospective perceptions. The data, coded using a grounded theory approach, confirmed that transition was problematic in the first year, although there were signs of integration by the second year of secondary school. The establishment of friendship groups and peer acceptance appeared to be the key criteria for successful transition. (Contains 3 tables.)

This article presents a case study of how a business school has developed enterprise education to incorporate ethics and social responsibility. The authors describe the process of developing volunteering opportunities and embedding them in the curriculum, and outline the underlying pedagogy. They describe how existing approaches to project-based and problem-based learning may be applied to the different stages of learning and teaching development in enterprise, ethics and volunteering education. Finally, they offer their own adaptation of these frameworks to create an entrepreneurial volunteering-based learning, whereby student volunteering opportunities are embedded into enterprise education with a clear disciplinary knowledge base and explicit and assessed learning outcomes in both skills and knowledge. (Contains 4 tables, 2 figures and 2 notes.)

The teaching profession's response to the inexorable march of new technology into education has been a focus of research for some 30 years. Linked with the impact of ICT on measurable performance outcomes, teacher attitudes to technology and the impact on pedagogic practice have been central to that research, a research that has often seen teachers as a barrier, not a force for change. The current article brings together findings from a decade of studies that have explored the ways in which teaching staff have responded to the growing notion that ICT is a core part of the teaching toolkit. In doing so we question the simplistic stereotyping of Luddite teachers. Drawing on findings from rare, but crucially important, longitudinal projects the article discusses hopes and fears raised by teaching staff when confronted with changes to existing pedagogy, before moving on to explore issues such as the "technology dip", how maturity modelling can inform our understanding of technological change in schools and ways forward for helping teaching staff to embed technology into their teaching. The article concludes with a discussion of why it is important that the educational system meets this challenge from a learner's perspective. (Contains 3 figures, 1 table and 2 notes.)

The poor performance and inefficiencies of the construction industry are well recognized and documented. Through a variety of combined industry and government initiatives there has been a continual expression in the UK over the last decade of the urgent need to address the fragmented nature of the industry to improve its performance. A major challenge is for education and industry stakeholders to create closer and more effective relationships with each other to facilitate greater mutual understanding. "Accelerating Change in Built Environment Education" (ACBEE) is a sponsored initiative designed to encourage the closer working together of industry, education and professional bodies to provide more relevant training and education. This paper introduces ACBEE, along with an evaluation framework for measuring the performance of engagements at various levels. This is followed by an analysis of the application of this performance measurement framework through case studies of industry-education engagement. A number of case studies were identified as operating at the grades of "strategic alliance" and "partnership" (as classified in the ACBEE evaluation framework). The analysis of these cases focuses on the drivers behind and the purpose of the engagement, and how these are aligned with the business strategy of the collaborating organizations and measurement of the activity. Evidence of meeting the explicit business needs and strategic objectives and the contribution to good practice knowledge are also discussed. (Contains 2 tables, 2 figures, and 2 notes.)

Engaging students in science learning can be challenging, and incorporating new forms of technology into science has been shown to provide creative learning experiences. However most technology enhanced learning and e-Science experiences to date have been designed and run by researchers. There is significant challenge in moving these experiences into the hands of teachers to become an everyday part of learning. One step forward is to understand better the work involved in making these learning experiences work. We present a retrospective analysis of two educational e-Science research projects, each involving access to and analysis of scientific data from remote and handheld sensors; collaboration; and reviewing shared data using advanced software tools. We identify key categories of work from the effort, resources and issues entailed in setting-up and running these experiences. We propose these categories can be used: to help plan other technology enhanced learning experiences, to be further tested and evolved in future research, and as a basis for an overall experience framework to capture the process- and context-related aspects in which these tasks are embedded. Ultimately, the goal is to develop tools and resources that will support categories of significant work, enabling full classroom integration of e-Science learning experiences. (Contains 4 figures and 10 tables.)

Joseph Rotblat was one of the most distinguished nuclear physicists and peace campaigners of the post Second World War period. His peace activities rank alongside those of Albert Einstein and Bertrand Russell; he won the Nobel Peace Prize, jointly with the Pugwash movement, that he helped found. However, he made significant contributions to science, and in particular to the medical applications of accelerators, radiation and radio-nuclides. In this article his early work and influences in Poland are described. He then joined James Chadwick at Liverpool University and began work on the cyclotron recently constructed there. Rotblat then, together with Chadwick, joined the Manhattan Project. This experience was to shape his life. He stayed at Los Alamos for less than a year before walking out. He was suspected of being a spy. Rotblat then became Professor of Physics at St Bartholomew's Medical College and pioneered the use of a 15 MeV linear accelerator in treatment and research. He made fundamental contributions to understanding the effects of the fallout from nuclear bomb tests. He also, together with Patricia Lindop, made important contributions to understanding the biological effects of radiation.

The opening premise of this paper is that education must change but that the nature and direction of that change is uncertain. In England, but not necessarily the UK as a whole, the policy is to produce a more personalised learning experience for all pupils. The policy of personalisation is to be delivered in part by increased use of digital technologies in our schools. While few would disagree with this educational aim, to deliver on that aim there needs to be a level of agreement as to the meaning of personalisation. The personalisation of learning and self-regulated learning are overlapping concepts. While the former acts at the operational level, that is it is the support provided by others to the learner, self-regulation and metacognitive awareness are subsumed under the individual. The Impact 2007 study explored the understanding of personalisation by key educational stakeholders, that is policy makers, schools managers, teachers and of course the pupils. The study found disparities in the perceptions of the nature and level of personalisation by these key groups, which question the delivery of this core government policy. (Contains 6 tables, 5 figures, and 2 notes.)

In this study we assess whether and how the Homework System was effective in creating greater continuity of understanding between home and school. Children in a mixed Year 1 and Year 2 class (aged 5-6 years old) were taught numeracy using the Homework System on tablet PCs, and they were assigned activities to carry out on the tablet PC for homework. The Homework System blurs the boundaries between home and school by making learning materials, individual learning histories and information of aims and objectives available in both the school and home context. Six families took part in two semi-structured interviews, pre and post the introduction of the system. Themes that emerged from these data suggest that the Homework System was successful in empowering parents with a new understanding of classroom teaching methods and materials. Overall, children's levels of enthusiasm, confidence, responsibility and independence in numeracy increased significantly in all the households. Moreover, the way in which home and school numeracy activities could be inter-dependant was made more transparent. Thus, homework was seen less as schoolwork to be done at home, but instead as an integral part of a seamless learning experience. The adoption of this approach would be of benefit to schools and may increase the effectiveness of their attempts to engage parents with their children's learning. (Contains 3 figures.) [This study was funded by EPSRC/ESRC/DTI PACCIT.]

This article describes a comparative study of the introduction of student portfolios in two departments of the Vrije Universiteit Amsterdam in the Netherlands and Nottingham Trent University in the UK. Portfolios are designed to facilitate effective management of lifelong learning, to provide a record of achievements and to encourage self-reflection by students. The justifications for the portfolio initiative are different in the two countries. At the Vrije Universiteit, the initiative arose within the University but is being implemented by individual faculties. There is no standard model of implementation. At Nottingham Trent University, portfolios are being introduced as a response to a government directive, as part of a lifelong learning portfolio that each individual will carry forward into their working life. The University's response to this imperative is top-down and a University-wide model is being sought. The department model is one of several models that are being evaluated for this purpose. This research project investigates whether these alternative starting points lead to differential responses from student users or not. Data are drawn from quantitative (questionnaires) and qualitative (interviews with managers, consultants and teachers) sources. Similarities and differences in students' responses to the portfolio exercise are identified and discussed in terms of factors such as the way the portfolios are introduced, the incentives offered to complete them, the role of the lecturer and peers in the monitoring of study progress, the quality of self-regulative skills, and students' learning expectations.

The assumption tested here is whether the introduction of enhanced communication technologies in the form of high-speed broadband connectivity has removed or ameliorated any of the barriers to efficient and effective teaching and learning. Evidence is presented of how enhanced communication technologies have facilitated self-regulated learning. The examples are drawn from a range of subject areas in secondary (11-18 years) and primary (5-11 years) schools in the UK. Evidence is also presented of the new challenges to self-regulated learning that are created by enhanced communication technologies, for example, non-selective searching, plagiarism and issues of filtering. Case studies were developed in 37 schools in the public sector, from rural and urban areas. Field workers conducted interviews with teachers and made classroom observations. Further interviews were also conducted with headteachers and ICT coordinators. These studies showed some outstanding examples of students taking ownership of the learning process. However, these enhanced communication technologies raised concerns for school management, for teacher workloads and for the parents. These findings are not parochial. International comparisons indicate that we are studying a trans-national phenomenon. Similarly, costs and benefits of such technologies are not sector specific; the outcomes of this research can inform debate in higher education.

Traditionally, the construction industry has been renowned for its deep fragmentation, with various stakeholders and disciplines brought together as virtual teams, in many instances for one-off projects. In addition, the industry is extremely information-intensive and document-driven. Such traits have been major contributors to the poor performance and inefficiency of the construction industry. For the last 30 years researchers have focused attention on the field of construction-related information technology with a view to improving industrial performance through the innovative application of information and communications technologies (ICT). In addition, in the mid-1990s member-based network organizations emerged, which aimed to bring together the various industry stakeholders in a neutral environment so that they could identify common problems and propose pragmatic ways of addressing them. Construct IT for Business (CIT) is an international industry-led collaborative network of leading-edge construction organizations. In the UK, CIT has a membership of over 50 organizations, including major construction companies, client organizations, suppliers and IT and communications companies, as well as professional institutes and R&D and academic institutions. This paper addresses the impact of CIT and the key challenges it has encountered in pursuing its objectives, derived from its mission "to be an effective enabling and coordinating force in the application of IT within the construction process as a contribution to innovation and development of best practice." It is concluded that the needs of the industry are diverse and can be served in various ways but that there is a strong desire to network, fuelled by firms' needs to be aware of IT developments and specifically of the likely future applications of IT in construction. (Contains 2 tables.)

Background: Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54–94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. Methods: This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation Results: All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24–10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. Conclusions: We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population. [ABSTRACT FROM AUTHOR]

Current research suggests that ornithischians originated in the Middle–Late Triassic and achieved a global distribution by the Early Jurassic, but the Middle Jurassic was a pivotal period in which the clade underwent rapid diversification and radiation. However, Middle Jurassic ornithischian fossils are rare, with few named taxa and numerous occurrences of isolated teeth with disputed identifications. Here, we apply detailed morphological comparisons to a suite of isolated ornithischian teeth from Bathonian microvertebrate sites in the U.K., to assess their taxonomic affinities. These reveal a hitherto unknown, highly diverse ornithischian fauna that significantly increases the known diversity of ornithischians from this time period in the U.K. Comparisons indicate the presence of six ornithischian morphotypes: an indeterminate ornithischian, a heterodontosaurid, two indeterminate thyreophorans, a stegosaur, and an ankylosaur. These results confirm the predictions made by phylogenetic studies that Ornithischia rapidly diversified in the Middle Jurassic, fill in temporal gaps within lineages, and also include recognition of one of the oldest global occurrences of stegosaurs. In addition, the mixture of non-eurypodan and eurypodan morphotypes identified suggests that not only did non-eurypodans survive until at least the Middle Jurassic but they also co-existed with early eurypodans. [ABSTRACT FROM AUTHOR]

Investigated the attitudes to, and extent of, self-reported involvement in Internet-supported dishonest academic practices such as plagiarism among United Kingdom undergraduates. Discusses Internet experience, acceptability of cheating, assessment of risk, gender, frequency of Internet use, and maturity of students, and outlines responses that should be considered by faculty to address this problem. (Author/LRW)

Characterizes Subject Review, a new scrutiny process for British higher education, evaluating its effectiveness against the purposes it has set itself in the area of funding policy, enhancement of provision, and public information. The paper offers a case study of factors which come into account when systems for measuring the quality of higher education are themselves exposed to measurement. (SM)

Discusses empirical evaluations of Integrated Learning Systems (ILS) in United Kingdom classrooms that were conducted to determine their effectiveness in gains in numeracy and literacy. Results were inconclusive, and influencing factors including research methodology, conceptual analysis, and ways in which technology are assimilated into teaching and learning practices are considered. (Author/LRW)

Background Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. Aims The aim of this work was to develop recommendations to guide all research relevant to older people. Methods A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. Results A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. Conclusion Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research. [ABSTRACT FROM AUTHOR]

Simple Summary: In this analysis, we look at the number of new breast, lung, colorectal and prostate cancer diagnoses among women who have sex with women and men who have sex with men. In order to do this, we used data from UK Biobank, which is a research database that contains in-depth health information from approximately half a million people in the UK. We found no differences in the number of new cases for breast, prostate and colorectal cancer, but we did find that sexual minority adults have a higher risk for lung cancer, due to greater exposure to smoking. Background. There is limited evidence about cancer incidence for lesbian, gay and bisexual women and men, although the prevalence of cancer risk factors may be higher. Aim. To describe cancer incidence for four common cancers (breast, lung, colorectal and prostate). Methods. This project used UK Biobank participant data. We explored risk factor prevalence (age, deprivation, ethnicity, smoking, alcohol intake, obesity, parity, and sexual history), and calculated cancer risk, for six groups defined based on sexual history; women who have sex exclusively with men (WSEM), or women (WSEW), women who have sex with men and women (WSWM); men who have sex exclusively with women (MSEW), or men (MSEM), and men who have sex with women and men (MSWM). Results. WSEW, WSWM, MSEM, and MSMW were younger, more likely to smoke, and to live in more deprived neighbourhoods. We found no evidence of an association between sexual history and breast, colorectal, or prostate cancer in age-adjusted models. Lung cancer incidence was higher for WSWM compared with WSEM, HR (95%CI) 1.78 (1.28–2.48), p = 0.0005, and MSWM compared with MSEW, 1.43 (1.03–1.99), p = 0.031; after adjustment for smoking, this difference was no longer significant. Conclusions. Sexual minority groups have a higher risk for lung cancer, due to greater exposure to smoking. [ABSTRACT FROM AUTHOR]

Current research suggests that the initial radiation of maniraptoran theropods occurred in the Middle Jurassic, although their fossil record is known almost exclusively from the Cretaceous. However, fossils of Jurassic maniraptorans are scarce, usually consisting solely of isolated teeth, and their identifications are often disputed. Here, we apply different machine learning models, in conjunction with morphological comparisons, to a suite of isolated theropod teeth from Bathonian microvertebrate sites in the UK to determine whether any of these can be confidently assigned to Maniraptora. We generated three independent models developed on a training dataset with a wide range of theropod taxa and broad geographical and temporal coverage. Classification of the Middle Jurassic teeth in our sample against these models and comparison of the morphology indicates the presence of at least three distinct dromaeosaur morphotypes, plus a therizinosaur and troodontid in these assemblages. These new referrals significantly extend the ranges of Therizinosauroidea and Troodontidae by some 27 myr. These results indicate that not only were maniraptorans present in the Middle Jurassic, as predicted by previous phylogenetic analyses, but they had already radiated into a diverse fauna that pre‐dated the break‐up of Pangaea. This study also demonstrates the power of machine learning to provide quantitative assessments of isolated teeth in providing a robust, testable framework for taxonomic identifications, and highlights the importance of assessing and including evidence from microvertebrate sites in faunal and evolutionary analyses. [ABSTRACT FROM AUTHOR]

Background: Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic performance of a postal risk screener used in the UK Prevention of Falls Injury Trial (PreFIT; ISRCTN71002650), to predict any fall, recurrent falls, and fractures over 12 months. We tested whether adding variables would improve screener performance. Methods: Nine thousand eight hundred and eight community-dwelling participants, aged 70 years and older, and 63 general practices in the UK National Health Service (NHS) were included in a large, pragmatic cluster randomised trial comparing screen and treat fall prevention interventions. The short postal screener was sent to all participants in the trial intervention arms as an A4 sheet to be completed and returned to the GP (n = 6,580). The postal screener items were embedded in the baseline pre-randomisation postal questionnaire for all arms of the trial (n = 9,808). We assessed discrimination and calibration using area under the curve (AUC). We identified additional predictors using data from the control arm and applied these coefficients to internal validation models in the intervention arm participants. We used logistic regression to identify additional predictor variables. Findings: A total of 10,743 falls and 307 fractures were reported over 12 months. Over one third of participants 3,349/8,136 (41%) fell at least once over 12 month follow up. Response to the postal screener was high (5,779/6,580; 88%). Prediction models showed similar discriminatory ability in both control and intervention arms, with discrimination values for any fall AUC 0.67 (95% CI 0.65 to 0.68), and recurrent falls (AUC 0.71; 95% CI 0.69, 0.72) but poorer discrimination for fractures (AUC 0.60; 95% CI 0.56, 0.64). Additional predictor variables improved prediction of falls but had modest effect on fracture, where AUC rose to 0.71 (95% CI 0.67 to 0.74). Calibration slopes were very close to 1. Conclusion: A short fall risk postal screener was acceptable for use in primary care but fall prediction was limited, although consistent with other tools. Fracture and fall prediction were only partially reliant on fall risk although were improved with the additional variables. [ABSTRACT FROM AUTHOR]

Background: The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention. Methods: The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised. Results: The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected 'dose'of the intervention was delivered to participants and intervention fidelity was high. Attendance ("dose received") fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised. Conclusions: From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time. Trial registration: ISRCTN79708100. [ABSTRACT FROM AUTHOR]

Background: Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. Methods: With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. Results: Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. Conclusion: Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented. [ABSTRACT FROM AUTHOR]

Species‐specific responses to landscape configuration and landscape composition have been studied extensively. However, little work has been done to compare intraspecific differences in habitat preferences. Bats have potential as good bioindicator taxa in woodland habitats. Therefore, studying sex differences in responses to woodland and the wider landscape can allow us to gain insight into the relative importance of these habitats for both bats and other taxa. In this study, we aimed to test the predictions that (i) habitat type and connectivity will influence the probability of recording female bats in woodlands and (ii) sex differences in response to habitat type and connectivity will be species‐specific. Bat capture data was collected in 206 woodlands over 3 years in England. The probability of detecting females relative to males was modeled in response to a range of woodland characteristics and landscape metrics for six bat species. We recorded sex differences in responses to landscape features in three species. We found a higher probability of capturing female Myotis nattereri in woodlands that were surrounded by a higher proportion of improved grasslands, whereas female Myotis mystacinus were less likely to be recorded in woodlands surrounded by semi‐natural vegetation. Female Plecotus auritus were more likely to be recorded in isolated woodlands with less connectivity to other woodlands and where agriculture dominated the surrounding landscape. Our findings indicate that sexual segregation occurs across several UK bat species in response to landscape connectivity and composition. Sexual segregation in response to landscape characteristics in bats should therefore be an important consideration in the management of fragmented agricultural landscapes. [ABSTRACT FROM AUTHOR]

Background: For patients with oesophagogastric adenocarcinoma, surgery is the only curative option and despite the use of multimodality therapy, which combines it with chemotherapy and/or radiotherapy, more than 50% of patients will relapse and die. Many UK patients present with advanced disease which is already inoperable or metastatic at diagnosis. For these patients, standard care chemotherapy only offers them survival of less than a year. Nivolumab, a checkpoint blockade inhibitor, has been found to work in some advanced cancers. It is proposed, for those where immunotherapy hasn't worked, that these immunologically evasive tumours need to be sensitized to immunotherapy drugs to allow them to act.Methods: ELEVATE is a single arm phase II trial testing the overall response to nivolumab following temozolomide treatment in patients with advanced unresectable previously treated adenocarcinoma which is O6-methylguanine-DNA-methyltransferase (MGMT) methylated. 18 patients are being recruited from UK secondary care sites. To be eligible, participants must have been treated with at least 3 months of platinum and fluoropyrimidine chemotherapy. Participants will receive 50 mg/m2 temozolomide continuously for 3 months. If their disease progresses during the 3 months, they will stop temozolomide and start nivolumab at a dose of 240mg every 2 weeks. If there is no progression after 3 months the participant will continue taking temozolomide in combination with nivolumab. All treatment will stop once the participant progresses on nivolumab. The primary endpoint is the best overall response to nivolumab, using both Response Evaluation Criteria in Solid Tumours version 1.1 and immunotherapy modified Response Evaluation Criteria in Solid Tumours. Secondary endpoints include progression-free survival, overall survival, and quality of life.Discussion: ELEVATE will provide evidence for whether giving nivolumab after temozolomide in patients with previously treated advanced oesophagogastric adenocarcinoma is safe and biologically effective prior to future randomised trials.Trial Registrations: EudraCT Number: 2020-004771-41 (issued 01 October 2020); ISCRTN11398887 (registered 14 July 2021). [ABSTRACT FROM AUTHOR]

Simple Summary: Modern zoos aim to provide the best facilities possible for their animals, staff and visitors. Here, we present findings from a study focusing on the behaviour and visibility of four species pre- and post-translocation to a new environment, Islands, within Chester Zoo, UK: the Sumatran orangutan (Pongo abelii), crested macaque (Macaca nigra), Malayan tapir (Tapirus indicus) and the Malayan sun bear (Helarctos malayanus). We used full activity budgets to demonstrate that the move to new, custom-built facilities influenced the behaviour of all four species. Following relocation, both non-human primate species were found to spend more time interacting socially with group members and abnormal behaviours remained low for all four species. Malayan tapirs and crested macaques chose to spend more time in areas out of public view post-move, whilst Malayan sun bears were more visible to visitors in their new environment. We demonstrate the value of giving animals choice and control over how they interact with their surroundings, the importance in investment in behavioural monitoring throughout translocation events and add to the knowledge-base of this understudied area. Modern zoos strive to construct habitats which both enable and encourage animals to engage in species-specific behaviour, without compromising their visibility to visitors. Here, we present the findings of a within-zoo move to a custom-built exhibit (Islands at Chester Zoo, UK) with respect to the behaviour of four mammal species; the Sumatran orangutan (Pongo abelii), crested macaque (Macaca nigra), Malayan tapir (Tapirus indicus) and the Malayan sun bear (Helarctos malayanus). We used full activity budgets along with Compositional Data Analysis (CoDA) to gain insight into how the move to a more naturalistic exhibit influenced behaviour. Engagement in abnormal behaviour remained low during the study period for all four species, suggesting no adverse responses to the change in environment. Following the move, both the non-human primate species spent more time engaged in positive social interactions with conspecifics, highlighting the importance of social support during enclosure moves. Time spent visible to the public was largely unaffected by the enclosure move for the Sumatran orangutan, whilst the movement to a new environment increased visibility for the Malayan sun bear and decreased visibility for the crested macaque and Malayan tapir. We demonstrate the value of monitoring behaviour throughout the translocation of zoo-housed species and outline the positive behavioral impacts of providing individuals with naturalistic, species-appropriate environments. [ABSTRACT FROM AUTHOR]

Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation. An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data. Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions. Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection. [ABSTRACT FROM AUTHOR]

Background: Dementia is the leading cause of death in elderly Western populations. Preventative interventions that could delay dementia onset even modestly would provide a major public health impact. There are no disease-modifying treatments currently available. Lithium has been proposed as a potential treatment. We assessed the association between lithium use and the incidence of dementia and its subtypes. Methods and findings: We conducted a retrospective cohort study comparing patients treated between January 1, 2005 and December 31, 2019, using data from electronic clinical records of secondary care mental health (MH) services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million). Eligible patients were those aged 50 years or over at baseline and who had at least 1 year follow-up, excluding patients with a diagnosis of mild cognitive impairment (MCI) or dementia before, or less than 1 year after, their start date. The intervention was the use of lithium. The main outcomes were dementia and its subtypes, diagnosed and classified according to the International Classification of Diseases-10th Revision (ICD-10). In this cohort, 29,618 patients (of whom 548 were exposed to lithium) were included. Their mean age was 73.9 years. A total of 40.2% were male, 33.3% were married or in a civil partnership, and 71.0% were of white ethnicity. Lithium-exposed patients were more likely to be married, cohabiting or in a civil partnership, to be a current/former smoker, to have used antipsychotics, and to have comorbid depression, mania/bipolar affective disorder (BPAD), hypertension, central vascular disease, diabetes mellitus, or hyperlipidemias. No significant difference between the 2 groups was observed for other characteristics, including age, sex, and alcohol-related disorders. In the exposed cohort, 53 (9.7%) patients were diagnosed with dementia, including 36 (6.8%) with Alzheimer disease (AD) and 13 (2.6%) with vascular dementia (VD). In the unexposed cohort, corresponding numbers were the following: dementia 3,244 (11.2%), AD 2,276 (8.1%), and VD 698 (2.6%). After controlling for sociodemographic factors, smoking status, other medications, other mental comorbidities, and physical comorbidities, lithium use was associated with a lower risk of dementia (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.40 to 0.78), including AD (HR 0.55, 95% CI 0.37 to 0.82) and VD (HR 0.36, 95% CI 0.19 to 0.69). Lithium appeared protective in short-term (≤1-year exposure) and long-term lithium users (>5-year exposure); a lack of difference for intermediate durations was likely due to lack of power, but there was some evidence for additional benefit with longer exposure durations. The main limitation was the handling of BPAD, the most common reason for lithium prescription but also a risk factor for dementia. This potential confounder would most likely cause an increase in dementia in the exposed group, whereas we found the opposite, and the sensitivity analysis confirmed the primary results. However, the specific nature of the group of patients exposed to lithium means that caution is needed in extending these findings to the general population. Another limitation is that our sample size of patients using lithium was small, reflected in the wide CIs for results relating to some durations of lithium exposure, although again sensitivity analyses remained consistent with our primary findings. Conclusions: We observed an association between lithium use and a decreased risk of developing dementia. This lends further support to the idea that lithium may be a disease-modifying treatment for dementia and that this is a promising treatment to take forwards to larger randomised controlled trials (RCTs) for this indication. Shanquan Chen and colleagues investigate the association between lithium use and the incidence of dementia and its subtypes. Author summary: Why was this study done?: Dementia is the leading cause of death and disability in elderly Western populations. Preventative interventions that could delay dementia onset even modestly would provide a major public health impact. Lithium has been proposed as a potential treatment, but limited population-level research has been conducted to support the idea that lithium might delay the onset of dementia. What did the researchers do and find?: We identified 548 patients who were exposed to lithium and 29,070 patients who were not exposed to lithium between January 1, 2005 and December 31, 2019, using data from electronic clinical records of secondary care mental health (MH) services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK. We assessed the association between lithium use and the incidence of dementia and its subtypes, including Alzheimer disease (AD) and vascular dementia (VD). We found that lithium was associated with a lower risk of receiving a diagnosis of dementia, including a lower risk of being diagnosed with either AD or VD. The extended analysis by the duration of lithium treatment indicated that both short- (≤1-year exposure) and long-term (>5-year exposure) lithium exposure (but not medium term, 1- to 5-year lithium exposure) was associated with decreased incidence of dementia and its subtypes. Power was less for the intermediate durations. There was some evidence for additional benefit with longer exposure durations. What do these findings mean?: Our findings support the possibility that lithium treatment could decrease the risk of developing dementia and supports the need for further randomised controlled trials (RCTs) to test the efficacy of lithium as a disease-modifying drug in dementia. The main limitation is that 73% of the patients in lithium-exposed group had mania/bipolar affective disorder (BPAD), which is a significant risk factor for dementia. Our results were in the opposite direction, however, and were supported by sensitivity analyses. [ABSTRACT FROM AUTHOR]

This ratio has increased as psychiatric beds for older people has reduced and the number of people living with dementia has increased.8 Patient complexity is likely reflected in length of stay, with typical admissions measured in months and some patients staying longer. REFERENCES 1 Alanen HM, Pitkänen A, Suontaka-Jamalainen K, Kampman O, Leinonen E. Acute psychogeriatric inpatient treatment improves neuropsychiatric symptoms but impairs the level of functioning in patients with dementia. Keywords: Alzheimer; dementia; inpatient; treatment EN Alzheimer dementia inpatient treatment 1 4 4 02/01/22 20220201 NES 220201 DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. [Extracted from the article]

Esophago-gastric malignancies are associated with a high recurrence rate; yet there is a lack of evidence to inform guidelines for the standardization and structure of postoperative surveillance after curatively intended treatment. This study aimed to capture the variation in postoperative surveillance strategies across the UK and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians. A web-based survey consisting of 40 questions was sent to surgeons or allied health professionals performing or involved in surgical care for esophago-gastric cancers at high-volume centers in the UK. Respondents from each center completed the survey on what best represented their center. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centers. The second section evaluated respondents perspective on how surveillance can be structured. Thirty-five respondents from 27 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire; 45.7% of responders arranged clinical follow-up at 2–4 weeks. Twenty responders had a specific postoperative surveillance protocol for their patients. Of these, 31.4% had a standardized protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practiced. There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomized controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different postoperative surveillance strategies. [ABSTRACT FROM AUTHOR]

Discussion of the use of computer-based information retrieval systems in schools focuses on three paper and pencil experiments conducted in the United Kingdom that were designed to investigate how 9- to 11-year-olds organized and retrieved information from four organizational structures: lists, hierarchies, networks, and tables. (18 references) (LRW)

Objective: To investigate factors contributing to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID‐19. Methods: Retrospective cohort study comparing patients treated between 23 March 2020 and 14 June 2020, deemed exposed to the pandemic/lockdown, to patients treated between 18 December 2019 and 10 March 2020, deemed to be unexposed. Data came from electronic clinical records from secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ∼0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days' follow‐up, excluding patients diagnosed with confirmed or suspected SARS‐CoV‐2 infection. The primary outcome was all‐cause mortality. Findings: In the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, patients with dementia suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02–2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42–3.49). No significant additional mortality risks were identified from physical comorbidities, potentially due to low statistical power in that respect. Conclusion: During lockdown people with dementia or severe mental illness had a higher risk of death without confirmed COVID‐19. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of this or a similar infectious disease. Key points: Previous studies have explored the risk factors for death following COVID‐19 infection, but data regarding the totality of excess deaths is sparseWe conducted a retrospective cohort study based on a large clinical record database, making a comparison with a historical control groupWe found that older people with dementia or serious mental illness had a higher risk of death without confirmed COVID‐19 under the circumstance of lockdownThis study could have an impact on existing health systems and clinical practice in response to the excess death associated with COVID‐19 lockdown, and inform preparation for possible future outbreaks [ABSTRACT FROM AUTHOR]

Background: Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers' perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods: The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results: Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients' needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions: Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency. [ABSTRACT FROM AUTHOR]