No / Rainwater harvesting (RWH) can be used to reduce the demand for potable mains water. At the single-building scale, previous research has focused on water-saving potential, while financial assessment has either been omitted or considered in an ad hoc manner. This paper reports on the application of a more rigorous financial analysis of domestic RWH systems than had been conducted previously. Whole life costing was selected as the most appropriate financial assessment technique. A total of 3840 domestic system configurations were assessed at a daily time step, taking into account various stakeholder perspectives and future cost scenarios. In each case, it was found that harvesting rainwater was significantly less cost effective than relying solely on mains-only water. The domestic RWH systems generally resulted in financial losses approximately equal to their capital costs. Without significant financial support, domestic RWH is unlikely to be cost effective for all reasonably foreseeable scenarios.

No / Objectives This paper describes DCM 8 and reports on the initial validation study of DCM 8. Methods Between 2001-2003, a series of international expert working groups were established to examine various aspects of DCM with the intention of revising and refining it. During 2004-2005 the revised tool (DCM 8) was piloted in seven service settings in the UK and validated against DCM 7th edition. Results At a group score level, WIB scores and spread of Behavioural Category Codes were very similar, suggesting that group scores are comparable between DCM 7 and 8. Interviews with mappers and focus groups with staff teams suggested that DCM 8 was preferable to DCM 7th edition because of the clarification and simplification of codes; the addition of new codes relevant to person-centred care; and the replacement of Positive Events with a more structured recording of Personal Enhancers. Conclusions DCM 8 appears comparable with DCM 7th edition in terms of data produced and is well received by mappers and dementia care staff.

No / Aims This paper aims to explore and describe how qualified nurses working with in, in-patient surgical areas cope with the daily experiences they are exposed to. It has long been recognised that many aspects of nursing work can result in high levels of stress, with negative consequences for the individual nurse and patient care. Difficulties in coping with nursing work can also result in burnout, as well as raising concerns about cognitive dissonance, emotional labour and the use of emotional barriers. Why some nurses are more prone to experience these phenomena than others, is unclear. Method A descriptive qualitative approach is taken using a purposive, theoretically congruent sample of 16 qualified registered nurses all of whom participated in a semi-structured interview during 2002. All interviews were tape recorded and transcribed verbatim and then analysed using the four stages outlined by Morse and Field [Morse, J.M., Field, P.A., 1996. Nursing Research: The Application of Qualitative Approaches. Chapman & Hall, London]. Findings Three key themes emerged from analysis; relationships with patients, being a person and the effect of experience. All three interlink to describe a process whereby the individual switches off from the environment around them by adopting a working persona which is different but related to their own personal persona and is beneficially enhanced as a consequence of experience. Conclusion Working as a nurse results in exposure to potentially distressing and stressful events from which it is important to protect the self. Participants in this study achieve protection by the development of a working persona which facilitates switching off and is beneficially enhanced by experience.

Yes / Studies have shown that a significant proportion of people with epilepsy use complementary and alternative medicine (CAM). CAM use is known to vary between different ethnic groups and cultural contexts; however, little attention has been devoted to inter-ethnic differences within the UK population. We studied the use of biomedicine, complementary and alternative medicine, and ethnomedicine in a sample of people with epilepsy of South Asian origin living in the north of England. Interviews were conducted with 30 people of South Asian origin and 16 carers drawn from a sampling frame of patients over 18 years old with epilepsy, compiled from epilepsy registers and hospital databases. All interviews were tape-recorded, translated if required and transcribed. A framework approach was adopted to analyse the data. All those interviewed were taking conventional anti-epileptic drugs. Most had also sought help from traditional South Asian practitioners, but only two people had tried conventional CAM. Decisions to consult a traditional healer were taken by families rather than by individuals with epilepsy. Those who made the decision to consult a traditional healer were usually older family members and their motivations and perceptions of safety and efficacy often differed from those of the recipients of the treatment. No-one had discussed the use of traditional therapies with their doctor. The patterns observed in the UK mirrored those reported among people with epilepsy in India and Pakistan. The health care-seeking behaviour of study participants, although mainly confined within the ethnomedicine sector, shared much in common with that of people who use global CAM. The appeal of traditional therapies lay in their religious and moral legitimacy within the South Asian community, especially to the older generation who were disproportionately influential in the determination of treatment choices. As a second generation made up of people of Pakistani origin born in the UK reach the age when they are the influential decision makers in their families, resort to traditional therapies may decline. People had long experience of navigating plural systems of health care and avoided potential conflict by maintaining strict separation between different sectors. Health care practitioners need to approach these issues with sensitivity and to regard traditional healers as potential allies, rather than competitors or quacks.

No / Purpose To determine the test-retest reproducibility of accommodation measurements gathered in an unselected sample of primary school children. Methods Monocular and binocular amplitudes of accommodation (AA) were collected by five different Testers using the push-up method in an unselected sample of school children (n=137, age: 8.1±2.1-years). Testing was conducted on three occasions (average testing interval: 8-days) in 91.2% of the children. Results The median AA was 19.1D, the variation due to the identity of the Tester was 3.1D (p<0.001) and the within-subject variation (which takes the variation due to Tester identity into account) was 5.2D. Around 75-79% of children exhibited monocular AAs-12D when tested on the first occasion, but more than 90% exhibited an AA-12D when subsequently tested. Around 74-80% of those with an AA<12D on the first occasion had values-12D on subsequent testing even though no treatment had been undertaken. Poorer initial AA measurements were less likely to improve on repeat testing. Conclusions Our results reveal substantial intra-individual variation in AA measurements, raising questions about the usefulness of this test in children aged 4-12-years. We suggest that AA assessment may prove most useful in children in this age range as a pass/fail check for substantially reduced AA, for example, where the AA is <12D. Our sample would suggest that the prevalence of persistently reduced AA may be around 3.2% when tested under binocular conditions and 4-6.4% when tested monocularly.

Yes / Asylum seekers in the UK often have complex health needs but face barriers when accessing health services. A family health programme was established in an initial accommodation centre (IAC) in northern England, by trained volunteers who are refugees and therefore peers. The main focus of the programme is peers educating asylum seekers about health services in the United Kingdom (UK), including maternity services, and evaluation research was undertaken to explore the effectiveness of this. Two sessions were observed and participants provided a short verbal evaluation. Data were thematically analysed. Around 30 people from 17 countries attended the sessions which were evaluated positively. Three themes emerged related to asylum seekers' perceptions of their learning: access to health care, living as a family, and the UK as a caring country. The findings suggest that peers educating asylum seekers within an IAC appears helpful in overcoming barriers to accessing health care in the UK and could facilitate pregnant women to attend for maternity care.

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No / The First World War (1914-18) was a period of dramatic and rapid change for both staff and patients in asylums across the UK. Many British asylums were requisitioned by the army from 1915 for use as wartime hospitals, leading to mass evacuation of over 10,000 patients. Using contemporary resources, this article will review the impact of this and other significant changes that took place in wartime, which included variations in working practices, staff shortages, food rationing and a significant rise in the asylum death rate. Contributing factors will be considered with analysis and discussion of eye-witness, historical, documentary, parliamentary and meteorological evidence.

No / As the workforce in the British National Health Service (NHS) has become more diverse, several researchers have reported that experiences of overseas nurses have been largely negative. This paper explores Black African nurses' experiences of equal opportunities, racism, and discrimination in four NHS trusts in northeastern England. Thirty nurses from sub-Saharan countries working in four NHS trusts were interviewed between 2006 and 2008 using semistructured interviews and focus group discussions to gain an insight into their experiences in the NHS. This study suggests that Black African nurses experienced discrimination and racism from White colleagues and other overseas nurses, managers, and patients and their relatives as well as lack of opportunities in their workplaces. Managers seemed to treat British and other overseas nurses more favorably than Black African nurses. Although much progress has been made in valuing and embracing diversity in the NHS, this article highlights areas in which more work is required.

No / Ambulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors infl uencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life-threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated signifi cantly more life-threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing diffi culties (29% versus 14.5%) more commonly. Tackling inequality will require a whole-systems approach, effective leadership, and recognition of the benefi ts of understanding difference. A key relationship will entail engaging with seldom heard communities.