Alcohol dependence in public policy: towards its (re)inclusion

Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association’s recent attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents

The predicament of primary physical education: a consequence of 'insufficient' ITT and 'ineffective' CPD?

Background: Research on primary physical education (PE) in England and other countries has shown that it is an aspect of the curriculum that has suffered from sparse initial teacher training (ITT). As a consequence of ‘insufficient’ time spent on PE in ITT (PE-ITT), primary teachers often have low levels of confidence and competence with respect to teaching the subject. Evidence also points to inadequacies in traditional forms of professional development in PE (PE-CPD), leading to calls for more effective ways of developing teachers' competence to deliver high quality PE. Purpose: To explore primary school teachers' experiences of PE during ITT and the PE context in their schools prior to them engaging in a national PE-CPD programme, and their perceptions of the immediate and longer-term effects of this programme. Setting and participants: Primary school teachers in five local education authorities in England. Research design and data collection: A combination of quantitative and qualitative methodological approaches were adopted, including: pre-course audits, course evaluations, focus groups and semi-structured interviews. The pre-course audits captured information about the teachers' experiences of PE-ITT and the PE context in their schools prior to them engaging in the CPD. The course evaluations focused on initial impressions of the PE-CPD, and the focus groups and interviews captured the teachers' perceptions of its longer-term effects. Findings: For up to half of the teachers, their PE-ITT was ‘insufficient’ in terms of the time dedicated to it and the breadth of coverage of the subject. The PE-CPD programme, which was designed in the light of ‘insufficient’ PE-ITT, demonstrated features of ‘effective’ CPD in that it was considered relevant to classroom practice and partially addressed some of their many needs (especially in relation to content ideas and inclusive practice). However, its effectiveness was undoubtedly limited due to: its short time span and minimal engagement with teachers; a heavy reliance on resources; and the absence of follow-up support. In addition, it did not adequately address known areas of development for primary PE (such as medium to long-term planning and assessment) and was challenged in meeting the diverse needs of primary teachers of 5–11 year olds. Furthermore, inadequate PE time and reduced opportunities to teach PE in some schools limited implementation of learning from the PE-CPD. Conclusions: The findings of this study confirmed that PE-ITT continues to be ‘insufficient’ for many primary teachers and that the PE-CPD in question, whilst partially ‘effective’, was not, and could never have been, the panacea for the inherent issues within and predicament of primary PE. In effect, this PE-CPD programme with its limited duration and engagement with teachers, a heavy reliance on resources, and no planned follow-up support was not sufficiently different to forms of CPD described in the literature as ‘ineffective’; consequently, it could not hope to compensate for long-term systemic weaknesses such as inadequate primary PE-ITT. These weaknesses need to be addressed through a dual approach of ‘sufficient’ PE-ITT followed by ‘effective’ PE-CPD which engages teachers and their colleagues in long-term collaborative endeavours that support transformative practice

Measurement of the t(t)over-bar production cross section in p(p)over-bar collisions at root s=1.96 TeV

We present a measurement of the top quark pair production cross section in pp̄ collisions at s=1.96TeV using 318pb-1 of data collected with the Collider Detector at Fermilab. We select tt̄ decays into the final states eν+jets and μν+jets, in which at least one b quark from the t-quark decays is identified using a secondary vertex-finding algorithm. Assuming a top quark mass of 178GeV/c2, we measure a cross section of 8.7±0.9(stat)-0. 9+1.1(syst)pb. We also report the first observation of tt̄ with significance greater than 5σ in the subsample in which both b quarks are identified, corresponding to a cross section of 10.1-1.4+1.6(stat)-1.3+2.0(syst) pb. © 2006 The American Physical Society

Life course trajectories of alcohol consumption in the United Kingdom using longitudinal data from nine cohort studies.

Background Alcohol consumption patterns change across life and this is not fully captured in cross-sectional series data. Analysis of longitudinal data, with repeat alcohol measures, is necessary to reveal changes within the same individuals as they age. Such data are scarce and few studies are able to capture multiple decades of the life course. Therefore, we examined alcohol consumption trajectories, reporting both average weekly volume and frequency, using data from cohorts with repeated measures that cover different and overlapping periods of life. Methods Data were from nine UK-based prospective cohorts with at least three repeated alcohol consumption measures on individuals (combined sample size of 59,397 with 174,666 alcohol observations), with data spanning from adolescence to very old age (90 years plus). Information on volume and frequency of drinking were harmonised across the cohorts. Predicted volume of alcohol by age was estimated using random effect multilevel models fitted to each cohort. Quadratic and cubic polynomial terms were used to describe non-linear age trajectories. Changes in drinking frequency by age were calculated from observed data within each cohort and then smoothed using locally weighted scatterplot smoothing. Models were fitted for men and women separately. Results We found that, for men, mean consumption rose sharply during adolescence, peaked at around 25 years at 20 units per week, and then declined and plateaued during mid-life, before declining from around 60 years. A similar trajectory was seen for women, but with lower overall consumption (peak of around 7 to 8 units per week). Frequent drinking (daily or most days of the week) became more common during mid to older age, most notably among men, reaching above 50% of men. Conclusions This is the first attempt to synthesise longitudinal data on alcohol consumption from several overlapping cohorts to represent the entire life course and illustrates the importance of recognising that this behaviour is dynamic. The aetiological findings from epidemiological studies using just one exposure measure of alcohol, as is typically done, should be treated with caution. Having a better understanding of how drinking changes with age may help design intervention strategies

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research