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Aim: The relationships between species and their landscape are important for understanding migration patterns. In fluvial systems, the complexity of the river network can strongly influence the dispersal and colonization rates of invading alien fishes, but habitat quality, species' biological traits and their location of introduction are also potentially important. However, understandings of how these factors interact in the wild to influence the spatial distribution of invasive species over time are limited from empirical studies. Location: "Virtual" and "real‐world" rivers from England and Wales. Method: We developed an individual‐based model (IBM) to predict how these different factors influenced the invasion dynamics and population growth rates (as abundances) of nine "virtual" alien fishes over two timeframes (10 and 30 years). The alien fishes differed in their demographic (r‐ to K‐selected) and dispersal (fast to slow) characteristics and the rivers in their network complexity. Results: Irrespective of river type, species and timeframe, the main drivers of both dispersal and population growth were the location of the introduction and the mean habitat quality of the patch into which the species were released. The introduction location determined whether dispersal was mainly passive in a downstream direction (faster) or active in an upstream direction (slower), with higher habitat quality then enabling faster population growth rates. Over 30 years, invasion rates were predicted to increase as the complexity of the river network increased, as this opened multiple invasion fronts where the invader traits favoured faster dispersal. Main conclusions: This novel IBM revealed how the complexity of the physical environment interacts with the biological traits of alien species to influence invasion outcomes, with the location of the introduction and its habitat quality being the most important factors. These results thus substantially increase understanding of the factors that influence the dispersal and colonization rates of alien freshwater fishes. [ABSTRACT FROM AUTHOR]

1. Temperate regions with fish communities dominated by cold-water species (physiological optima <20 °C) are vulnerable to the effects of warming temperatures caused by climate change, including displacement by non-native cool-water (physiological optima 20–28 °C) and warm-water fishes (physiological optima >28 °C) that are able to establish and invade as the thermal constraints on the expression of their life history traits diminish. 2. England and Wales is a temperate region into which at least 38 freshwater fishes have been introduced, although 14 of these are no longer present. Of the remaining 24 species, some have persisted but failed to establish, some have established populations without becoming invasive and some have become invasive. The aim of the study was to predict the responses of these 24 non-native fishes to the warming temperatures of England and Wales predicted under climate change in 2050. 3. The predictive use of climate-matching models and an air and water temperature regression model suggested that there are six non-native fishes currently persistent but not established in England and Wales whose establishment and subsequent invasion would benefit substantially from the predicted warming temperatures. These included the common carp Cyprinus carpio and European catfish Silurus glanis, fishes that also exert a relatively high propagule pressure through stocking to support angling and whose spatial distribution is currently increasing significantly, including in open systems. 4. The potential ecological impacts of the combined effects of warming temperatures, current spatial distribution and propagule pressure on the establishment and invasion of C.  carpio and S.  glanis were assessed. The ecological consequences of C.  carpio invasion were assessed as potentially severe in England and Wales, with impacts likely to relate to habitat destruction, macrophyte loss and increased water turbidity. However, evidence of ecological impacts of S.  glanis elsewhere in their introduced range was less clear and so their potential impacts in England and Wales remain uncertain. [ABSTRACT FROM AUTHOR]

In England and Wales, freshwater anglers have shifted their behaviour towards visiting catch-and-release lake fisheries that are intensively stocked, mainly of large common carp, Cyprinus carpio L., to maintain high catch rates. Of 187 fish kills investigated in these intensively stocked lake fisheries in 2004 and 2005, most occurred between April and June and were mainly caused by parasitic or bacterial infections. Bacteria were usually associated with ulcerative diseases caused by strains of the bacterium Aeromonas salmonicida (Emmerich & Weibel) and secondary infections of opportunistic bacteria of the Genus Aeromonas (excluding salmonicida) and Pseudomonas. Parasites involved in fish kills included Ichthyophthirius multifiliis (Fouquet), Chilodenella sp., Ichthyobodo necator (Henneguy) and Argulus sp. Outbreaks were typically in fisheries with high extant stock densities (>1500 kg ha−1) and sub-optimal habitats, for example of low habitat heterogeneity with few macrophytes in the littoral zone. Recent stocking was also a key factor when only carp was affected. Thus, certain fisheries management practices that aim to enhance fishery performance may instead trigger fish kills during spring. [ABSTRACT FROM AUTHOR]

The article presents the proliferation of managed, stillwater fisheries with non-native fishes. It gives out a demand for increased angling diversity and large game fishing opportunities. Also, this has enabled the species such as the catfish to achieve a relatively wide distribution, despite the ecological concerns. The existence of legislation in England and Wales regulates the distribution of non-native species in fisheries. Their high angling demand often results in illegal introduction, specifically species of sturgeon of the genus Acipenser.

The article describes the rapid colonization of new water bodies by the invasive topmouth gudgeon, Pseudorasbora parva, which is a small cyprinid, in England and Wales. The dispersal and known distribution of the topmouth gudgeon are also discussed. The report provides an important basis for agencies responsible for protecting aquatic ecosystems in Great Britain. It also identifies sites from which there is an imminent risk of downstream dispersal of Pseudorasbora parva into river networks, an occurrence that would significantly reduce options for controlling the future spread and subsequent impact of the invasive species.

Objective: To quantify the potential protective effect on health associated with study of a clinical medicine degree., Design: Prospective population-based cohort data collected at census and linked over time: cohort born before 1976 and survived to 2011. Subgroup analysis on those who reported having a degree at 1991 census., Setting: England and Wales population-based, including institutions., Participants: 159 116 men and 174 062 women; 13 390 men with degrees and 8143 women with degrees., Main Outcome Measure: Self-reported general health in 2011 based on logistic regression analysis., Results: Male graduates had 92% higher odds of having good or very good health than male non-graduates after adjustment for age and socioeconomic position (CI 1.82 to 2.03). Female graduates had 85% higher odds of having good or very good health than female non-graduates after adjustment for age and socioeconomic position (CI 1.73 to 1.98). Male clinical medicine graduates had 45% higher odds of having good or very good health than male humanities graduates after adjustment for age and socioeconomic position (CI 1.09 to 1.92). Male physical sciences graduates also had higher odds of having good or very good health than male humanities graduates after adjustment for age and socioeconomic position, but life sciences and social science graduates did not. There were no significant differences by degree subject for women., Conclusions: Male graduates in clinical medicine have higher odds of good self-reported health. Knowledge of medicine may confer a health advantage for men above that of other degrees., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this 'teachable moment' is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST., Methods and Analysis: Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019-December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact., Ethics and Dissemination: This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website., Trial Registration Numbers: ISRCTN63825779, NCT03750110., Competing Interests: Competing interests: PAJC has received consultation fees and share options from Everest Detection., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Objective: To determine the trend in the association between socioeconomic status and sex and median age at death from cystic fibrosis in England and Wales, over the past 50 years., Design: Series of annual cross sectional studies of all registered deaths with a diagnosis of cystic fibrosis in England and Wales, from 1959 to 2008., Methods: We obtained national mortality data for cystic fibrosis from the Office for National Statistics. From 1959 to 2000, the Registrar General's Social Class coded socioeconomic status as manual or non-manual. From 2001 onwards, the National Statistics Socioeconomic Classification was implemented and socioeconomic status was split into three groups: professional and managerial, intermediate, and routine and manual. We calculated median age at death for every study year. We calculated the effects of sex and socioeconomic status on the odds of death above the median age at death for every study decade using logistic regression., Results: From 1959 to 2008, 6750 deaths were attributed to cystic fibrosis in England and Wales. Males were more likely to die above the annual median age at death than females (from 1959 to 1999, adjusted odds ratio for socioeconomic status 1.28, 95% confidence intervals 1.13 to 1.45; from 2000 to 2008, 1.57, 1.18 to 2.08). Individuals in the highest socioeconomic class were also more likely to die above the median age of death than those in the lowest socioeconomic class (from 1959 to 2000, adjusted odds ratio for sex 2.50, 2.16 to 2.90; from 2001 to 2008, 1.89, 1.20 to 2.97)., Conclusions: Socioeconomic status and sex remain strong determinants of survival from cystic fibrosis in England and Wales, and the magnitude of these effects does not appear to have substantially reduced over time.

Respiratory failure is an important terminal event in muscular dystrophy, but increasingly is effectively treated by non-invasive ventilation. This study was designed to assess mortality statistics in this patient group in order to get an indication of future demand. Mortality data for all deaths from muscular dystrophy registered by death certification in England and Wales between 1993 and 1999 were analysed. In total, 817 deaths from muscular dystrophy were registered between 1993 and 1999. Annual number of deaths was unchanged over this period. Median age at death (interquartile range) for all cause muscular dystrophy increased from 20 (17-42.5) years in 1993, to 26 (17.5-63) years in 1999. Respiratory failure was the primary or contributory cause of death in 82% of cases. Two thirds of these deaths were during acute infection. We can expect 100 patients with muscular dystrophy to develop respiratory failure in England and Wales each year, so non-invasive ventilation services probably need to be able to provide for 0.2 new patients per 100,000 population annually. Respiratory services also need to provide adequate monitoring and early treatment of infection in these patients.

To determine whether asthma mortality is influenced by geographical or social factors, a retrospective analysis of deaths from asthma in England and Wales between 1979-1987 was performed. Death rates in the 15 Regional Health Authority areas of England and Wales were stratified by sex, age group (0-4, 5-34, 35-64, and > 64 years), and occupational social class. Detailed analysis was restricted to subjects aged 5-64 years because adequate social class data was only available over this age range. Death rates were higher in manual occupational groups (social class IIIb-V) than in non-manual occupations (social class I-IIIa), but on further analysis this effect was confined to males aged 35-64 years. In younger subjects (5-34 years), mortality was higher in the south of the country, and this difference was significant in males (P < 0.05). In older subjects (35-64 years), mortality in both sexes was significantly higher in the north of the country. This study demonstrates that mortality is not evenly distributed between social classes or regions of the country.

Heart-lung transplantation has become an established treatment for end stage respiratory failure secondary to cystic fibrosis. The success of this form of treatment, and the increasing survival of such patients, suggests there will be an increased need for transplantation over the next decade. We have used cystic fibrosis population predictions and all cause mortality data to estimate the number of cardio-pulmonary deaths, due to cystic fibrosis, over the next decade and to estimate the number of such patients who are likely to benefit from heart-lung transplantation. We estimate that there will be between 85 and 127 potential transplant recipients with cystic fibrosis each year over the next decade. During 1990, 1991 and 1992 there were less than 40 transplants each year in such patients. These data emphasize the need to expand transplantation services and to maintain the availability of donor organs.

Background: Survival from cystic fibrosis is increasing rapidly. Estimates of the extent of this improvement should allow health care facilities to be planned to deal with the expanding population of patients with cystic fibrosis. Estimates of life expectancy are also essential if accurate information on current prognosis is to be given to parents of an affected child, or to prospective parents deciding whether to proceed with a pregnancy where the fetus may be affected., Methods: Survival trends in the national data on cystic fibrosis have been analysed to produce estimates of the likely size of the cystic fibrosis population over the next decade and to predict the life expectancy of children born with cystic fibrosis in the years up to 1990., Results: In England and Wales the estimated number of patients with cystic fibrosis is at present about 5200, of whom 3300 (63%) are aged under 16 years. By the year 2000 the total population will increase to 6000, with 3400 (57%) aged under 16. Thus the number of children with cystic fibrosis will remain fairly constant over the next 10 years, whereas adult numbers will increase by about 36% (from 1901 to 2577). The median life expectancy of children with cystic fibrosis born in 1990 is estimated to be 40 years, double that of 20 years ago., Conclusion: This study suggests that health service provision for children will not need to change substantially over the next 10 years whereas services for adults will need to increase by about a third. Parents can be counselled that the median life expectancy of a newborn child with cystic fibrosis is currently likely to be of the order of 40 years.

Objective: To determine the pattern of mortality ascribed to cryptogenic fibrosing alveolitis and to identify factors that might be important in the aetiology of the disease; and to assess the validity of death certification of the disease., Design: A retrospective examination of mortality ascribed to cryptogenic fibrosing alveolitis in England and Wales between 1979 and 1988 with analysis, by multiple logistic regression, of independent effects of age, sex, region of residence, and social class as indicated by occupation on data for 1979-87; also a retrospective review of hospital records of patients certified as having died of cryptogenic fibrosing alveolitis in Nottingham and of the certified cause of death of patients known to have had the disease., Main Outcome Measures: Time trends in mortality nationally; effects on mortality of age, sex, and region of residence; validity of death certification in Nottingham., Results: The annual number of deaths ascribed to cryptogenic fibrosing alveolitis doubled from 336 in 1979 to 702 in 1988, the increase occurring mainly at ages over 65. Mortality standardised for age for both sexes likewise increased steadily over the period. Deaths due to cryptogenic fibrosing alveolitis were commoner in men (odds ratio 2.24, 95% confidence interval 2.11 to 2.33) and increased substantially with age, being 7.84 (7.24 to 8.49) times higher in subjects aged much greater than 75 than those aged 45-64. Odds ratios of death due to cryptogenic fibrosing alveolitis adjusted for age and sex were increased in the traditionally industrialised central areas of England and Wales (p less than 0.02, maximum odds ratio between regions 1.25), but no significant increase in odds of death was found for manual occupations. Of 23 people whose deaths were registered in Nottingham as having been due to cryptogenic fibrosing alveolitis, 19 were ascertained from clinical records to have had the disease. Only 17 of 45 patients known to have had cryptogenic fibrosing alveolitis in life were recorded as having died from the disease., Conclusions: The diagnostic accuracy of death certification of cryptogenic fibrosing alveolitis is high, but the number of deaths recorded as being due to the disease may underestimate the number of patients dying with the disease by up to half. Mortality due to the disease is increasing, and the male predominance and regional differences in mortality suggest that environmental factors are important in its aetiology.

To determine the time trend in age at death from cystic fibrosis and the independent effects of social class, sex, and region of residence mortality data for England and Wales from 1959 to 1986 were analysed. Median age at death increased from 6 months in 1959 to 17 years in 1986 and was higher in most years from 1970 in male patients (by one to six years) and in social classes with non-manual occupations (by one to 12 years). Independent odds ratios for death above the median age for the year of death (calculated for years from 1974, when regions of residence were coded by regional health authority area) were 1.47 (95% confidence interval 1.16 to 1.87) in male compared with female patients and 2.75 (2.16 to 3.52) in non-manual compared with manual social classes. The independent odds of death at above the median age also varied significantly among regions of residence by a ratio of up to 2.67. Social class, sex, and region of residence are all potential determinants of survival of patients with cystic fibrosis. Social class is particularly likely to confound the effect of management in specialist centres on survival.