The Royal Navy (RN) is the United Kingdom's naval warfare force. Although warships were used by English and Scottish kings from the early medieval period, the first major maritime engagements were fought in the Hundred Years' War against France. The modern Royal Navy traces its origins to the early 16th century; the oldest of the UK's armed services, it is consequently known as the Senior Service.From the middle decades of the 17th century, and through the 18th century, the Royal Navy vied with the Dutch Navy and later with the French Navy for maritime supremacy. From the mid 18th century, it was the world's most powerful navy until the Second World War. The Royal Navy played a key part in establishing and defending the British Empire, and four Imperial fortress colonies and a string of imperial bases and coaling stations secured the Royal Navy's ability to assert naval superiority globally. Owing to this historical prominence, it is common, even among non-Britons, to refer to it as "the Royal Navy" without qualification. Following World War I, it was significantly reduced in size, although at the onset of World War II it was still the world's largest. During the Cold War, the Royal Navy transformed into a primarily anti-submarine force, hunting for Soviet submarines and mostly active in the GIUK gap. Following the collapse of the Soviet Union, its focus has returned to expeditionary operations around the world and it remains one of the world's foremost blue-water navies.The Royal Navy maintains a fleet of technologically sophisticated ships, submarines, and aircraft, including 2 aircraft carriers, 2 amphibious transport docks, 4 ballistic missile submarines (which maintain the nuclear deterrent), 5 nuclear fleet submarines, 6 guided missile destroyers, 12 frigates, 11 mine-countermeasure vessels and 26 patrol vessels. As of June 2022, there are 74 operational commissioned ships (including submarines as well as one historic ship, HMS Victory) in the Royal Navy, plus 11 ships of the Royal Fleet Auxiliary (RFA); there are also five Merchant Navy ships available to the RFA under a private finance initiative. The RFA replenishes Royal Navy warships at sea, and augments the Royal Navy's amphibious warfare capabilities through its three Bay-class landing ship vessels. It also works as a force multiplier for the Royal Navy, often doing patrols that frigates used to do.The Royal Navy is part of Her Majesty's Naval Service, which also includes the Royal Marines. The professional head of the Naval Service is the First Sea Lord who is an admiral and member of the Defence Council of the United Kingdom. The Defence Council delegates management of the Naval Service to the Admiralty Board, chaired by the Secretary of State for Defence. The Royal Navy operates from three bases in Britain where commissioned ships and submarines are based: Portsmouth, Clyde and Devonport, the last being the largest operational naval base in Western Europe, as well as two naval air stations, RNAS Yeovilton and RNAS Culdrose where maritime aircraft are based...
Stroke is a major cause of long-term disability in Indonesia, where family members often become primary caregivers with minimal formal support. In culturally rooted communities like East Java, caregiving is deeply influenced by local values, yet limited research has examined how these values shape caregiver resilience. This study aimed to explore how Javanese cultural beliefs influence the experiences and resilience of family caregivers providing home-based care for stroke survivors. Using a qualitative design, in-depth interviews were conducted with ten caregivers in East Java, employing interpretative phenomenological analysis. Thematic analysis identif ied four key themes: caregiving as a devotion and cultural duty; the family’s understanding of illness as a foundation for meaning; home-based continued care with love, hope, and spirituality; and emotional dynamics in the early stages of caregiving. Caregiving was seen not only as a responsibility, but as a moral and spiritual calling rooted in values such as Ngabekti (devotion), Nrimo (acceptance), and Pasrah (surrender). Participants employed both biomedical and traditional practices, showing creativity in overcoming limited resources. These f indings highlight the importance of culturally responsive nursing care that addresses the emotional, spiritual, and informational needs of caregivers. Supporting caregiver resilience through culturally informed nursing and medical interventions may enhance stroke rehabilitation outcomes and promote caregiver well-being in similar community settings.
Violence against others is recognized worldwide as a significant public health and safety issue. Violent behavior and problems related to anger management, particularly among adolescents and young adults, are on the rise. Therefore, training in basic self-regulation skills, promoting social relationships, and improving social problem-solving skills plays a crucial role in anger management. The aim of this study is therefore to investigate the effects of an anger management training program on the aggression levels and social problem-solving skills of nursing students with high levels of aggression at Shiraz University of Medical Sciences. This study was a randomized controlled trial with a pre-posttest design and a control group. In this study, 40 nursing students from the Fatemeh School of Nursing and Midwifery were assigned to either an intervention group (n = 20) or a control group (n = 20) using simple randomization. The intervention group participated in aggression management training consisting of four 90-minute group workshops, one individual counseling session, and daily motivational text messages over a period of 10 days. The control group did not receive any training. Both groups completed questionnaires on aggression and social problem solving at three points in time: before the intervention, immediately after the intervention, and one month after the intervention. Data analysis was performed using SPSS Version 22 software, with a significance level set at less than 0.05. The results showed that group-based training in anger management significantly reduced aggression scores (P < 0.0001) and increased social problem-solving skills scores (P < 0.0001) in the intervention group compared to the pretest. These changes remained stable at the one-month follow-up. Given the high prevalence of aggression among adolescents and young adults and the positive effects of anger management training programs on reducing tension, regulating emotions, and improving healthy coping strategies and problem-solving skills in this age group, it is recommended that policymakers and university administrators introduce anger management training programs to improve students’ psychological adjustment and emotional resilience. This research project was registered at the Iranian Registry of Clinical Trials with code IRCT20220413054521N2- Date of registration 2021-05-25.
Operation POLARBEAR was the UK Military response to the conflict in Sudan in 2023. This non-combatant evacuation operation (NEO) enabled the evacuation of over 2000 entitled persons with Role 1, Role 2 and a Medical Emergency Response Team providing medical contingency and MEDEVAC capability. The most common clinical presentation was heat illness and disease non-battle injuries, which were more prevalent than trauma. Lessons identified included limitations in current military modules, particularly for the management of chronic disease, paediatrics and environmental illness, as well as difficulties surrounding environmental health considerations. It proved essential for the composition of medical teams to reflect the population-at-risk, with general medical physicians and paediatric subspecialists considered valuable augmentees. With the current geopolitical climate becoming increasingly unstable, future NEOs are likely. We present this analysis to enhance understanding in this sphere and contribute to future preparedness.
BACKGROUND:Up to 10% of patients report a penicillin allergy, yet >90% of these are inaccurate when assessed. Unnecessary second-line antibiotics contribute to poorer outcomes, increased antimicrobial resistance and higher costs. Accurate documentation supports stewardship and operational medical capability by improving clinical risk decisions, particularly in deployed or austere settings. We aimed to improve the proportion of adequately documented penicillin allergy records in a UK Defence primary care setting. METHODS:In a baseline population (n=33/70 labelled patients), 21% (±10%, 95% CI) of records were adequately documented using national standards. A structured patient questionnaire, developed with NHS Lothian guidance, was piloted via email, refined and scaled across a broader primary care setting using SMS text messages plus follow-up email. Records were updated in the electronic health record. Using the Model for Improvement, three PDSA cycles tested usability, refined content and scaled implementation to the full cohort (n=504 coded penicillin allergy). Daily sampling (n=10/day) supported p-chart monitoring from a 21% baseline with a three-sigma upper control limit (UCL) of 60%. RESULTS:270/504 (54%) patients responded. Daily p-chart monitoring demonstrated sustained non-random improvement following intervention (day 8): median shifted from 20% (day 7) to 55% (day 12) and 65% (day 18), reaching the UCL by day 10. 38% of patients were unclear about their index allergic reaction. 33% reported a mild rash, 18% gastrointestinal upset and 18% angioedema. Symptoms associated with potential type 1 hypersensitivity or severe cutaneous reactions were infrequently reported. Using NHS protocols, an estimated 79% of documented penicillin-allergic service personnel would be suitable for drug provocation testing. CONCLUSION:A remote, patient-centred approach with standardised data entry improved documentation quality and is scalable across UK Defence Primary Healthcare. Next steps include embedding driver-diagram-informed actions (clinician awareness and digital templates), assessing prescribing outcomes and developing Defence standard operating procedures.
