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From 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (1-8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1-8).The disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.Targeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital.

Interventions surrounding mindset have recently been applied as a tool for student success in higher education. The current study tested the efficacy of a growth mindset intervention at a universit...

Over the past 50 years conservation genetics has developed a substantive toolbox to inform species management. One of the most long-standing tools available to manage genetics - the pedigree - has been widely used to characterize diversity and maximize evolutionary potential in threatened populations. Now, with the ability to use high throughput sequencing (HTS) to estimate relatedness, inbreeding, and genome-wide functional diversity, some have asked whether it is warranted for conservation biologists to continue collecting and collating pedigrees for species management. In this perspective, we argue that pedigrees remain a relevant tool, and when combined with genomic data, create an invaluable resource for conservation genomic management. Genomic data can address pedigree pitfalls (e.g., founder relatedness, missing data, uncertainty), and in return robust pedigrees allow for more nuanced research design, including well-informed sampling strategies and quantitative analyses (e.g., heritability, linkage) to better inform genomic inquiry. We further contend that building and maintaining pedigrees provides an opportunity to strengthen trusted relationships among conservation researchers, practitioners, Indigenous Peoples, and local communities. Keywords: conservation genomics, quantitative genetics, pedigree, kinship,ex situ , in situ

Over the past 50 years conservation genetics has developed a substantive toolbox to inform species management. One of the most long-standing tools available to manage genetics - the pedigree - has been widely used to characterize diversity and maximize evolutionary potential in threatened populations. Now, with the ability to use high throughput sequencing (HTS) to estimate relatedness, inbreeding, and genome-wide functional diversity, some have asked whether it is warranted for conservation biologists to continue collecting and collating pedigrees for species management. In this perspective, we argue that pedigrees remain a relevant tool, and when combined with genomic data, create an invaluable resource for conservation genomic management. Genomic data can address pedigree pitfalls (e.g., founder relatedness, missing data, uncertainty), and in return robust pedigrees allow for more nuanced research design, including well-informed sampling strategies and quantitative analyses (e.g., heritability, linkage) to better inform genomic inquiry. We further contend that building and maintaining pedigrees provides an opportunity to strengthen trusted relationships among conservation researchers, practitioners, Indigenous Peoples, and local communities.

Genetic swamping resulting from interspecific hybridisation can increase extinction risk for threatened species. The development of high-throughput and reduced-representation genomic sequencing and analyses to generate large numbers of high resolution genomic markers has the potential to reveal introgression previously undetected using small numbers of genetic markers. However, few studies to date have implemented genomic tools to assess the extent of interspecific hybridisation in threatened species. Here we investigate the utility of genome-wide single nucleotide polymorphisms (SNPs) to detect introgression resulting from past interspecific hybridisation in one of the world’s rarest birds. Anthropogenic impacts have resulted in hybridisation and subsequent backcrossing of the critically endangered Aotearoa New Zealand endemic kakī (black stilts; Himantopus novaezelandiae) with the non-threatened self-introduced congeneric poaka (Aotearoa New Zealand population of pied stilts, Himantopus himantopus leucocephalus), yet genetic analyses with a limited set of microsatellite markers revealed no evidence of introgression of poaka genetic material in kakī, excluding one individual. We use genomic data for ∼63% of the wild adult kakī population to reassess the extent of introgression resulting from hybridisation between kakī and poaka. Consistent with previous genetic analyses, we detected no introgression from poaka into kakī. These collective results indicate that, for kakī, existing microsatellite markers provide a robust, cost-effective approach to detect cryptic hybrids. Further, for well-differentiated species, the use of genomic markers may not be required to detect admixed individuals.

Background and introduction The findings of the enquiry into events at the Gosport Hospital, published in June 2018, demonstrated shocking misuse of opioid and benzodiazepine medications and syringe drivers leading to the shortening of many lives. Hospices frequently utilise opioid and benzodiazepine medications, including via syringe driver, and need to be able to demonstrate that their practice is safe and appropriate. Methods Individual hospice units developed their own responses to the Gosport report. Both Prince of Wales and St Catherine’s Hospice undertook retrospective audits of hospice inpatient unit care. St Catherine’s Hospice presented their work for discussion at the regional ‘Learning group’ meeting. Results The two sites utilised different collection proforma and reviewed care given to 93 hospice inpatient unit patients, demonstrating safe and appropriate practice at both hospices. Anticipatory prescribing was personalised to the patient, considering factors such as renal function, and was judged ‘appropriate’ in 82–100% of cases. 80 patients died and, as anticipated, there was significant use of opioids, benzodiazepines and syringe drivers. The use of opioids and syringe drivers was found to be proportionate and appropriate. Areas for improvement included recording of indication for both prescription and administration of medications. Through discussion of these results, it was acknowledged that a regional approach to auditing to allow ‘benchmarking’ between Hospice units would be advantageous in standard setting and comparison. Both pilot proformas had strengths and weaknesses and are being utilised to develop a regional audit proforma with plans to establish regular audit and re-audit cycles. Conclusions As specialists with a high use of opioid and benzodiazepine medications, there is a need to demonstrate that our use of these medications is safe, consistent and of exemplary standard. The hope is that this approach will allow identification of any areas of difference in practice and offer quality assurance across region and Hospice.

ObjectivesIdentifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients.DesignContent for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey.SettingWithin outpatient secondary care.ParticipantsTwelve adult burns patients and MDT members from two regional burns centres.ResultsA total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items).ConclusionsThe Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter.

Conservation management strategies for many highly threatened species include conservation breeding to prevent extinction and enhance recovery. Pairing decisions for these conservation breeding programmes can be informed by pedigree data to minimise relatedness between individuals in an effort to avoid inbreeding, maximise diversity, and maintain evolutionary potential. However, conservation breeding programmes struggle to use this approach when pedigrees are shallow or incomplete. While genetic data (i.e., microsatellites) can be used to estimate relatedness to inform pairing decisions, emerging evidence indicates this approach lacks precision in genetically depauperate species, and more effective estimates will likely be obtained from genomic data (i.e., thousands of genome-wide single nucleotide polymorphisms, or SNPs). Here, we compare relatedness estimates using pedigree-, genetic-, and genomic-based approaches for making pairing decisions in two critically endangered birds endemic to New Zealand: kakī/black stilt (Himantopus novaezelandiae) and kākāriki karaka/orange-fronted parakeet (Cyanoramphus malherbi). Our findings indicate genetic-based estimates of relatedness are indeed the least precise when assessing known parent-offspring and full sibling relationships. Furthermore, our results show that relatedness estimates and subsequent pairing recommendations using PMx are most similar between pedigree- and genomic-based approaches. These combined results indicate that in lieu of robust pedigrees, SNPs are an effective tool for informing pairing decisions, which has exciting implications for many poorly pedigreed conservation breeding programmes worldwide.

Mandibular advancement increases the lateral dimensions of the nasopharynx via a direct connection between the lateral upper airway and the ramus of the mandible (Brown et al. Sleep 2013;36:397-404). However the mechanical properties of this connection are poorly understood. The aim of this study was to investigate whether a tendinous component influences the mechanical properties of the lateral walls and the effect of mandibular advancement on airway dimensions. Methods: Detailed anatomical MRI of the tissues surrounding the nasopharynx of 101 subjects with obstructive sleep apnoea (OSA) with and without mandibular advancement were analysed. Results: The amount of mandibular advancement was significantly increased when the tendinous component was not present (4.0±1.2mm present compared to 4.6±1.4mm absent, p=0.04), but other anatomical measures were not statistically significantly different. Both anterior and lateral dimensions of the nasopharyngeal airway negatively correlated with the increase in length of the lateral connection to the mandible (Pearson correlation=-0.341, -0.430 respectively, p≤0.001 for both measures). The change in anterior airway dimension significantly correlated with the change in lateral dimension (Pearson correlation=0.268, p Conclusion: A tendinous portion of the lateral walls reduced the amount of mandibular advancement achieved in OSA patients. The mechanics of the lateral connection to the mandible modify both the anterior and lateral airway dimension with mandibular advancement, and may explain the variable response to MAS treatment.

New Zealand is a small and sparsely populated country with a penchant for bursts of radical legislation that have earned it a reputation as a social laboratory. One consequence of its size is the comparatively simple structure of its constitutional arrangements, which until recently have included a small legislature comprised of a single chamber tightly controlled by the government of the day.] This permits legislation to be introduced and passed with a speed that has variously been described as exhilarating and terrifying. In this context, it is not surprising that the first Ombudsman outside Scandinavia was appointed in New Zealand (in 1962) nor that the institution of the Ombudsman became one of some constitutional significance particularly after the Official Information Act 1982 gave the Ombudsmen responsibility for determining disputes over access to information held by government departments and agencies. The concept of the Ombudsman as an independent authority of considerable stature took root in the New Zealand popular consciousness and is reflected both in the Maori title for the office Te Kaitiaki Mana Tangatcr and in the statutory protection for the name "Ombudsman", which cannot be used without the consent of the Chief Ombudsman. The institution became seen as one of a limited array of checks on the executive power of government.

Threatened species recovery programmes benefit from incorporating genomic data into conservation management strategies to enhance species recovery. However, a lack of readily available genomic resources, including conspecific reference genomes, often limits the inclusion of genomic data. Here, we investigate the utility of closely related high-quality reference genomes for single nucleotide polymorphism (SNP) discovery using the critically endangered kakī/black stilt (Himantopus novaezelandiae) and four Charadriiform reference genomes as proof of concept. We compare diversity estimates (i.e., nucleotide diversity, individual heterozygosity, and relatedness) based on kakī SNPs discovered from genotyping-by-sequencing and whole genome resequencing reads mapped to conordinal (killdeer, Charadrius vociferus), confamilial (pied avocet, Recurvirostra avosetta), congeneric (pied stilt, Himantopus himantopus) and conspecific reference genomes. Results indicate that diversity estimates calculated from SNPs discovered using closely related reference genomes correlate significantly with estimates calculated from SNPs discovered using a conspecific genome. Congeneric and confamilial references provide higher correlations and more similar measures of nucleotide diversity, individual heterozygosity, and relatedness. While conspecific genomes may be necessary to address other questions in conservation, SNP discovery using high-quality reference genomes of closely related species is a cost-effective approach for estimating diversity measures in threatened species.

Johrei is a form of spiritual healing comprising “energy channelling” and light massage given either by a trained healer or, after some basic training, by anyone. This pilot trial aimed to identify any potential benefits of family-based Johrei practice in childhood eczema and for general health and to establish the feasibility of a subsequent randomised controlled trial. Volunteer families of 3-5 individuals, including at least one child with eczema were recruited to an uncontrolled pilot trial lasting 12 months. Parents were trained in Johrei healing and then practised at home with their family. Participants kept diaries and provided questionnaire data at baseline, 3,6 and 12 months. Eczema symptoms were scored at the same intervals. Scepticism about Johrei is presently an obstacle to recruitment and retention of a representative sample in a clinical trial, and to its potential use in general practice. The frequency and quality of practise at home by families may be insufficient to bring about the putative health benefits. Initial improvements in eczema symptoms and diary recorded illness, could not be separated from seasonal factors and other potential confounders. There were no improvements on other outcomes measuring general health and psychological wellbeing of family members.

Complications following paediatric burns are well documented and care needs to be taken to ensure the appropriate follow up of these patients. Historically this has meant follow up into adulthood however this is often not necessary. The centralisation of burns services in the UK means that patients and their parents may have to travel significant distances to receive this follow up care. To optimise our burns service we have introduced a burns outreach service to enable the patients to be treated closer to home. The aim of this study is to investigate the impact of the introduction of the burns outreach service and within this environment define the optimum length of time needed to follow up these patients. A retrospective analysis was carried out of 100 consecutive paediatric burns patients who underwent surgical management of their burn. During the follow up period there were 43 complications in 32 patients (32%). These included adverse scarring (either hypertrophic or keloid), delayed healing (taking >1 month to heal) and contractures (utilising either splinting or surgical correction). Fifty-nine percent of these complications occurred within 6 months of injury and all occurred within 18 months. Size of burn was directly correlated to the risk of developing a complication. The outreach service reduced the distance the patient needs to travel for follow up by more than 50%. There was also a significant financial benefit for the service as the follow up clinics were on average 50% cheaper with burns outreach than burns physician. Burns outreach is a feasible service that not only benefits the patients but also is cheaper for the burns service. The optimum length of follow up for paediatric burns in 18 months, after which if there have not been any complications they can be discharged.

In 2012 Transparency International New Zealand (TINZ) decided that during 2013 it would conduct a National Integrity System (NIS) assessment for New Zealand. New Zealand has always rated highly on the Corruption Perceptions Index (CPI) published by Transparency International, and in recent years has consistently ranked first or first equal. However, the CPI is precisely what its name suggests, an index based on perceptions of a country’s corruption status, the perceptions being those of a number of international agencies. TINZ considered the time was ripe to test the reality behind the perceptions and assess the strengths and weaknesses of New Zealand’s system.

WHY THIS MATTERS TO US: In April 2009 we launched the RCGP Junior International Committee, the UK representative body to the Vasco da Gama Movement. Since then we have worked hard to establish a network of UK trainees and junior GPs with an interest in international primary care, as well as promote international exchange and research. This year's WONCA Europe conference was a great success for the group with the presence of a strong UK contingent. We hope to repeat this success next year and inspire an even greater number of trainees and junior GPs to take part in international conferences and clinical exchange.

Objective To determine the effectiveness of commercially available magnetic bracelets for pain control in osteoarthritis of the hip and knee. Design Randomised, placebo controlled trial with three parallel groups. Setting Five rural general practices. Participants 194 men and women aged 45-80 years with osteoarthritis of the hip or knee. Intervention Wearing a standard strength static bipolar magnetic bracelet, a weak magnetic bracelet, or a non-magnetic (dummy) bracelet for 12 weeks. Main outcome measures Change in the Western Ontario and McMaster Universities osteoarthritis lower limb pain scale (WOMAC A) after 12 weeks, with the primary comparison between the standard and dummy groups. Secondary outcomes included changes in WOMAC B and C scales and a visual analogue scale for pain. Results Mean pain scores were reduced more in the standard magnet group than in the dummy group (mean difference 1.3 points, 95% confidence interval 0.05 to 2.55). Self reported blinding status did not affect the results. The scores for secondary outcome measures were consistent with the WOMAC A scores. Conclusion Pain from osteoarthritis of the hip and knee decreases when wearing magnetic bracelets. It is uncertain whether this response is due to specific or non-specific (placebo) effects.