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The Church of England's historic buildings represent the single largest group of heritage sites in the UK, playing a key public-facing role in the church's 'cultural witness'. However, they are complex historic environments implicated in the recent focus on 'contested heritage' and imperial legacies. The wider heritage sector's answer to the adversarial nature of this debate has been to turn contested histories into dialogical opportunities; participatory and collaborative approaches to interpretation and curation have become an important feature of much recent secular heritage work. Yet, the CofE has not yet articulated or embraced the value of similar initiatives for its own collections, with guidance at the institutional level aimed primarily at conservation and protection. This paper initiates a discussion about how engagement with sensitive memories enhances the importance of CofE's cultural heritage. It offers a preliminary report of a research project led by the author titled 'Inclusive Interpretations of Christian Heritage', carried out between 2021 and 2022 at iconic churches in central London. After discussing the theoretical context, project rationale, and method, the paper discusses the connections which Christians from ethnic minority or immigrant backgrounds have to ecclesiastical spaces usually associated with national history. The perspectives of previously unrepresented groups can supplement expert assessments concerning a site's significance, revealing important areas in which the CofE's cultural assets hold meaning beyond national or aesthetic importance. The paper argues that widening community engagement represents a crucial task for accentuating the social and civic importance of the CofE's cultural heritage. [ABSTRACT FROM AUTHOR]

We identified and compared patients diagnosed with Plasmodium falciparum malaria at a large hospital in London, UK prior to the COVID-19 pandemic versus following relaxation of COVID-19-associated restrictions. We found that parasitaemias, rates of hyperpasitaemia and severe malaria were significantly higher in the period post-relaxation of COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer is the sixth most common cause of cancer-related death in the UK amongst women. Ovarian cancer presents particular challenges for general practitioners (GPs) to diagnose due to its rarity and presentation with non-specific symptoms. Methods: A narrative overview of the literature was conducted by searching PubMed and Researchgate for relevant articles, using keywords such as "ovarian cancer," "primary care" and "diagnosis." Results and Discussion: Studies have shown that in the UK, GPs have a lower readiness to refer and investigate potential cancer symptoms compared with their international counterparts; and this has been correlated with reduced survival. Early diagnosis can be facilitated through a people-focussed and system-based approach which involves both educating GPs and using risk algorithms, rapid diagnostic centres/multi-disciplinary centres and being data-driven through the identification of best practice from national audits. Further research is required into the best evidence-based early investigations for ovarian cancer and more effective biomarkers. [ABSTRACT FROM AUTHOR]

Objective To quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA. Methods A prospective study recruiting across 83 centres in the UK. Clinical information and patient-reported measures were available, including 2011 criteria for FM. Multivariable linear regression was used to model the effect of meeting the FM criteria on disease activity, QoL and response to TNFis. Results A total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ − FM− 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component. Conclusion Fulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM. [ABSTRACT FROM AUTHOR]

Aims: Controversy exists regarding the importance of glycaemic control in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) based on conflicting reports using single baseline glycosyated haemoglobin (HbA1c ). Using the time-weighted mean of serial HbA1c measurements has been found to be a better predictor of diabetic complications as it reflects the glycaemic burden for that individual over time. We therefore sought to confirm this in a large cohort of patients with T2DM and incident CHF.Methods and Results: A time-weighted mean HbA1c was calculated using all HbA1c measurements following CHF diagnosis. Patients were grouped into five categories of HbA1c (≤6.0%, 6.1-7.0%, 7.1-8.0%, 8.1-9.0%, and >9.0%). The relationship between time-weighted mean HbA1c and all-cause death after CHF diagnosis was assessed. A total of 1447 patients with T2DM met the study criteria. During a median follow-up of 2.8 years, there were 826 (57.1%) deaths, with a crude death rate of 155 deaths per 1000 person-years [95% confidence interval (CI) 144-166]. A Cox regression model, adjusted for all significant predictors, with the middle HbA1c category (7.1-8.0%) as the reference, showed a U-shaped relationship between HbA1c and outcome [HbA1c <6.0%, hazard ratio (HR) 2.5, 95% CI 1.8-3.4; HbA1c 6.1-7.0%, HR 1.4, 95% 1.1-1.7; HbA1c 8.1-9.0%, HR 1.3, 95% CI 1.0-1.6; and HbA1c >9.0%, HR 1.8, 95% CI 1.4-2.3]. Further analysis revealed a protective effect of insulin sensitizers (i.e. metformin) (HR 0.7, 95% CI 0.61-0.93) but not other drug classes.Conclusions: In patients with T2DM and CHF, our study shows a U-shaped relationship between HbA1c and mortality, with the lowest risk in patients with modest glycaemic control (HbA1c 7.1-8.0%) and those treated with insulin sensitizers. [ABSTRACT FROM AUTHOR]

Objectives. RA is associated with early ischaemic heart disease. This appears to be driven largely by the presence of chronic inflammation. Studies suggest that treatment with disease-modifying drugs such as MTX may reduce the incidence of cardiovascular events in RA. Anti-TNF therapies significantly reduce inflammation in RA. However, the extent to which these agents also reduce cardiovascular disease (CVD) is uncertain. The purpose of this study was to explore the effect of anti-TNF agents on CVD in RA using a systematic literature review.Methods. We searched for studies of adults with RA treated with TNF antagonists where cardiovascular outcomes were recorded using MEDLINE, EMBASE, Cochrane Database, Database of Abstracts and Reviews of Effects, Health Technology Appraisal, Science Citation Index and Clinical Evidence from 1989 to 2010. Conference proceedings for the British Society of Rheumatology, ACR and EULAR between 2005 and 2009 were hand searched. Two reviewers assessed abstracts for inclusion and then quality of selected papers was assessed.Results. A total of 1840 abstracts were identified and 20 articles were suitable for inclusion. Information was obtained on the effect of TNF antagonists on overall CVD events, myocardial infarction, strokes and heart failure.Conclusion. In many studies, TNF antagonists appear to reduce the likelihood of CVD in individuals with RA. Reassuringly, there does not appear to be an increased risk of cardiac failure. However, the reduction in CVD is not as consistently seen as with studies of MTX. [ABSTRACT FROM PUBLISHER]

The UK Refractory Asthma Stratification Programme (RASP-UK) will explore novel biomarker stratification strategies in severe asthma to improve clinical management and accelerate development of new therapies. Prior asthma mechanistic studies have not stratified on inflammatory phenotype and the understanding of pathophysiological mechanisms in asthma without Type 2 cytokine inflammation is limited. RASP-UK will objectively assess adherence to corticosteroids (CS) and examine a novel composite biomarker strategy to optimise CS dose; this will also address what proportion of patients with severe asthma have persistent symptoms without eosinophilic airways inflammation after progressive CS withdrawal. There will be interactive partnership with the pharmaceutical industry to facilitate access to stratified populations for novel therapeutic studies. [ABSTRACT FROM AUTHOR]

The article discusses the effects of globalisation on the trade sector in Great Britain. Globalisation is a general term that covers three overlapping processes, including the changing nature of goods and computer-based technologies which have lightened goods and made dispersed production more possible. European integration has been a continuing process which is affecting the British trade sector for at least three decades, with barriers to trade being removed and competition increased. With an increase in demand for information and communication technologies products over the past decade, countries with a higher proportion of high-technology products in their export structure are expected to experience a gain in trade share.

The article presents various prospects for the economy of Great Britain. Looking to the components of demand for an account of recent economic weakness the strong growth last year was led by domestic demand, which accounted for 3.8 percentage points of Gross Domestic Product growth in 2004. The downward revision to the projection for growth in 2005 is accounted for by downward revisions to gross fixed capital formation and government consumption spending. All components of gross fixed capital formation, that is, stockbuilding, housing, business and government investment, are significantly weaker than expected.

This article presents information on exchange rates in Great Britain. Movements in exchange rates attract much attention, both for the signals they may contain about future inflation prospects and for their implications for the competitiveness of firms. However, movements in bilateral exchange rates, for instance in sterling against the dollar or the euro, do not convey enough information for either policymakers or for firms except in relation to specific bilateral transactions. The effective sterling exchange rate measures the value of the pound against a basket of currencies of Great Britain's main trading partners.

Focuses on developments in consumption behavior and housing market in Great Britain as of October 2003. Relationship of consumption and housing market; Increase in financial liabilities of the personal sector; Growth of real housing wealth and real house prices; Impact of changes in house prices on the consumption behavior in the economy.

The article presents information on the 2013 British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guideline regarding the intravenous use of the immunosuppressive drug tocilizumab (TCZ) in adult patients with rheumatoid arthritis (RA). Topics discussed include the European League Against Rheumatism's general agreement on the use of TCZ, the guideline's benefits to rheumatology professionals, and guideline limitations.

To report our experience with the Heineke-Mikulicz non-transecting (HMNT) urethroplasty, a relatively new approach to urethral stricture, and to assess functional and surgical outcomes. Methods From November 2015 to November 2018, 21 men underwent HMNT bulbar urethroplasty for short strictures. Conclusion The debate concerning whether newer non-transecting bulbar urethroplasty techniques are superior to traditional transecting techniques for shorter urethral strictures remains controversial. [Extracted from the article]

Presents a letter to the author regarding factors leading to recurrence or death after surgical resection of phyllodes tumors of the breast in Great Britain. Prevalence of recurrence in patients with malignant tumors; Necessity of the identification of biological markers; Role of telomerase as a biological marker.

Classical veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a serious complication post allogeneic hematopoietic stem cell transplantation (HSCT). Before the recently revised EBMT criteria, the Baltimore and modified Seattle criteria failed to recognize the syndrome of late-onset VOD. We present real-world experience from a large UK transplant center reporting on VOD/SOS in consecutive HSCT adult patients (n = 530), transplanted for hematological cancers. We identified 27 patients treated with Defibrotide for VOD/SOS diagnosis, where detailed data were available for final analysis. Using standard definitions including EBMT criteria, around 30% (n = 8/27) of cases classified as late-onset VOD presenting at median of 46 (22-93) days but with D100 survival (63% vs 58%, Log-rank; P = 0.81) comparable to classical VOD. Hazard ratio for D100 mortality was 2.82 (95% CI: 1.74-4.56, P < .001, Gray test) with all VOD/SOS events. Twenty percent (n = 2/8) of late-onset VOD patients were anicteric and 42% (n = 8) classical VOD patients presented with refractory thrombocytopenia, while less than half met EBMT criteria for classical VOD in adults, highlighting gaps in real-world diagnostic limitations using EBMT criteria. However, challenges remain about underrecognition and difficulties related to early defibrotide access for treatment of late-onset VOD in current treatment guidelines. Our report strongly supports early Defibrotide for the treatment of severe VOD/SOS in adults regardless of time of onset., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)