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Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% (95% CI 37–63) for WB-MRI and 54% (41–67) for standard pathways, a difference of 4% (−7 to 15, p=0·73). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88–96]) and standard pathways (95% [91–98], p=0·45). Agreement with the multidisciplinary team's final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12–14]) than for the standard pathway (19 days [17–21]); a 6-day (4–8) difference. The number of tests required was similar WB-MRI (one [1–1]) and standard pathways (one [1–2]). Mean per-patient costs were £317 (273–361) for WBI-MRI and £620 (574–666) for standard pathways. WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs. UK National Institute for Health Research. [ABSTRACT FROM AUTHOR]

Details are given of all serologically confirmed Mycoplasma pneumoniae infections in children referred to Bristol hospitals during an epidemic lasting 18 months. 44 children, many below school age, had lower respiratory infections. The majority had cough and malaise which had failed to respond to antibiotics given before referral. Chest x-rays showed no pathognomonic features: segmental or patchy consolidation was common; 3 cases of lobar consolidation. Cold agglutinins were raised in 9 out of 12 cases. In the majority of cases the total leucocyte count was normal and the absolute neutrophil count raised. Mean duration of symptoms was 4.2 weeks (range 1-16). Treatment with erythromycin or tetracycline appeared to have little effect in most cases. Seven nonrespiratory manifestations were seen in 6 children. These were meningitis (2 cases), Stevens-Johnson syndrome (4 cases, 1 case complicated by toxic epidermal necrolysis), and acute haemolytic anaemia (1 case). [ABSTRACT FROM AUTHOR]

The article focuses on the history of imprisonment and recently closed prison HMP Shepton Mallet and HMP Gloucester in England and Wales respectively. It presents the views of Chantel King, governor of HMP Gloucester on the closer of the prison and its condition. It also mentions the declination in the prison population in twentieth century.

Individuals' occupational and educational attainment is influenced by their ethnicity, religion and colour in the UK and elsewhere. In this paper, we analyse the impact of ethnicity, religion and colour along with residential segregation1 and socio-economic deprivation on returns to education for men in England and Wales. We analyse the 2001 UK census data by employing multi-level logistic regression models. It is found that non-White groups including Christian Black-African, UK born Sikh-Indians and South Asian Muslims are found to suffer an ethnic penalty compared to Christian White-British. While there is evidence to suggest that Muslim men may experience a greater penalty compared to some non-Whites other non-Muslim groups too face ethno-religious penalties, sometimes even more severely such as in the case of Christian Black-Africans. Socio-economic difficulties faced by ethnic minorities are also linked to spatial segregation only when associated with high levels of area deprivation. This suggests that what matters may not be segregation per se, but whether or not it is associated with deprivation. [ABSTRACT FROM AUTHOR]

This article describes a research study still in its earliest days. Our primary reason for publishing so soon in the project's life is that we want to appeal for information. If you have any official or personal information or documentary material - including private diaries and journals, letters, service medals or~ simply informed thoughts - about prisons in England during either of the World Wars, please see the contact information at the end of the article and get in touch. We would particularly value any information from ex-prisoners, prison officers and governors - or relatives of such individuals - who experienced prisons during the Wars. [ABSTRACT FROM AUTHOR]

This research investigates what prompts a wide variety of students, studying at different colleges throughout the University of London, to volunteer for London Nightline. Nightline is a registered charity run by students for students, which offers listening, support and information via a telephone helpline. Forty-four percent of the 2003-04 London Nightline volunteers completed a questionnaire asking about all aspects of their experience volunteering. The results indicated that students volunteered for a variety of different reasons, many have changed their future or career plans as a result and that the training and support networks operating within the organisation are appropriate. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of Easter play in England. It says that the combination of the liturgical and the mimetic is an external reference for the characteristic of English Easter drama due to its association with worshipping communities such as religious houses, secular households and parishes. It states that the evidence of parish Easter plays started at the end of the fifteenth century coming from parishes across the country and the fullest accounts of a parish Resurrection play come from St. Laurence in Reading, England beginning in 1507. It mentions several Easter or Resurrection plays including "Shrewsbury Fragments," "Burial and Resurrection" and "Christus Redivivus," by Nicholas Grimald.

Investigates the liver transplantation program results of children at hospitals in England. Percentage of one year actuarial patient and graft survival; Observation on the growth and development of the children; Details on liver transplantation in children.

Background: Non-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective., Aim: To determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED., Design and Setting: Retrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England., Method: From 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as 'green' using the Manchester Triage System (non-urgent) were considered to be 'GP appropriate'. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared., Results: Of 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as 'GP appropriate'; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16-108 min) in the GP group and 165 min (IQR 104-222 min) in the ED group ( P <0.001). Children in the GP group were less likely to be admitted as inpatients (odds ratio [OR] 0.16; 95% confidence interval [CI] = 0.13 to 0.20) and less likely to wait >4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP ( P <0.0001)., Conclusion: Given the rising demand for children's emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required., (©The Authors.)

Background and Aims: The continued professional development of staff and associate specialist doctors in the UK was ill served prior to the introduction of the new staff and associate specialist doctor's contract in 2008. The aim of this study was to independently evaluate NHS Education for Scotland's approach to improving professional development for staff and associate specialist doctors, the staff and associate specialist Professional Development Fund., Methods: Semi-structured telephone interviews with key stakeholders, framed by a realistic approach to evaluate what works, for whom and in how and under what circumstances. An inductive and data-driven thematic analysis was carried out and then the realist framework was applied to the data., Results: We interviewed 22 key stakeholders: staff and associate specialist doctors, staff and associate specialist educational advisors, programme architects and clinical directors, between end February and May 2014. The resultant data indicated five broad themes: organisational barriers to continued professional development for staff and associate specialist doctors, the purpose of funding, gains from funding, the need for better communication about the staff and associate specialist Programme Development Fund, and the interplay between individual and systems factors., Conclusion: The staff and associate specialist Programme Development Fund has changed the opportunities available to staff and associate specialist doctors in Scotland and, in that sense, has changed the context for this group - or at least those who have realised the opportunities., (© The Author(s) 2016.)

Locally acquired HEV infection is increasingly recognized in developed countries. Anti-HEV IgG seroprevalence has been shown to be high in haemodialysis patients in a number of previous studies, employing assays of uncertain sensitivity. The aim of this study was to investigate anti-HEV IgG seroprevalence in recipients of haemodialysis and renal transplants compared to a control group using a validated, highly sensitive assay. Eighty-eight patients with functioning renal transplants and 76 receiving chronic haemodialysis were tested for HEV RNA and anti-HEV IgG and IgM. Six hundred seventy controls were tested for anti-HEV IgG. Anti-HEV IgG was positive in 28/76 (36.8%) of haemodialysis and 16/88 (18.2%) of transplant patients. HEV RNA was not found in any patient. 126/670 (18.8%) of control subjects were anti-HEV IgG positive. After adjusting for age and sex, there was a significantly higher anti-HEV IgG seroprevalence amongst haemodialysis patients compared to controls (OR = 1.97, 95% CI = 1.16-3.31, P = 0.01) or transplant recipients (OR = 2.63, 95% CI = 1.18-6.07, P = 0.02). Patients with a functioning transplant showed no difference in anti-HEV IgG seroprevalence compared to controls. The duration of haemodialysis or receipt of blood products were not significant risk factors for HEV IgG positivity. Patients receiving haemodialysis have a higher seroprevalence of anti-HEV IgG than both age- and sex-matched controls and a cohort of renal transplant patients. None of the haemodialysis patients had evidence of chronic infection. The reason haemodialysis patients have a high seroprevalence remains uncertain and merits further study., (Copyright © 2012 Wiley Periodicals, Inc.)

We analysed the characteristics and outcome for 467 hip fracture patients, who reported that they were currently smoking at the time of admission, against 3150 non-smoking hip fracture patients. Those patients who smoked were younger (72 years versus 81 years mean age), more likely to be male (35.3% versus 19.5%), more mobile and less likely to be living in institutional care (7.5% versus 25.0%). Preoperative outcomes and complication rates were similar, despite the smokers' relative youth. Mortality at 30 days was similar for the two groups (6.2% versus 7.6%), but lower for the smokers at one year (22.7% versus 27.6%). However, with adjustment for the younger age and sex of these patients, this difference in mortality was not statistically significant. These findings suggest that smoking results in hip fracture occurring at a younger age. Despite this, the outcome for smokers was similar to that for the average hip fracture patient.

Introduction: To assess the effectiveness of infection control measures (pre-admission screening and patient segregation) on reducing in-patient exposure to methicillin-resistant Staphylococcus aureus (MRSA)., Patients and Methods: A prospective case-control study in a district general hospital. All admissions to 3 wards over an 83-month period from September 1995 to July 2002 inclusive (a total of approximately 34,000 patients). Outcome measures were a statistical analysis of the difference in numbers of new cases of MRSA colonisation or infection between the 3 wards., Results: There was a statistical significance in incidence of new MRSA cases between the ward with active infection control measures in place and the control wards., Conclusions: The described infection control measures reduced the exposure of patients to MRSA. This reduces the risk of MRSA infection, which is of importance in orthopaedics, and has further benefits that may also be applied in other surgical specialties.

Objective: To review the results of the Addenbrooke's and King's College Hospital children's liver transplantation programme., Design: Retrospective analysis of the first 100 children to receive liver grafts at Addenbrooke's Hospital, Cambridge, from December 1983 to March 1990., Setting: Addenbrooke's Hospital, Cambridge, and King's College Hospital, London., Subjects: 153 children assessed for liver transplantation, of whom 22 died before a donor became available and 31 were considered unsuitable. 100 children received grafts, of whom 27 had second grafts., Results: One year actuarial patient survival was 71%, with 57% one year graft survival. In the last two years survival rates had improved considerably, with 86% of patients and 63% of grafts surviving for at least one year. Sixty five children were alive 12 to 86 months after transplantation; 63 were well and leading normal active lives and 56 had entirely normal liver function. Children's growth and development were essentially normal, with many showing remarkable catch up growth., Conclusions: Liver transplantation offers children with terminal liver disease a high chance of a return to full quality life and normal development. Improved surgical and medical care have progressively improved survival. The timing of transplantation is critical but has been constrained particularly by the availability of donors and resources.

Liver grafting is now established as the optimal treatment for patients with end-stage parenchymal liver disease. Twenty-three years of experience at a single center is presented. The 1-year actuarial patient survival rate for all cases transplanted in Cambridge has now risen from 10% in 1968 to 1970 to 80% in 1990 to 1991. Increasing numbers of patients are being referred for transplantation with an ever-increasing range of indications being developed. Many inborn errors of metabolism can now be cured by liver grafting. There is still, however, considerable scope for improvement in many areas of patient treatment from operative and postoperative care to long-term immunosuppressive management. Much remains to be done to minimize early sepsis- and rejection-related deaths and late immunosuppression-related morbidity.