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This exploratory study investigated the disruption to schools ministry caused by the COVID-19 pandemic. Perspectives of church leaders, Christian parents, Christian teachers and organisations involved in schools ministry were consulted using online surveys, interviews and focus groups, to examine how schools ministry could be rebuilt, incorporating reflective practice and hence bringing positive change. The severe impact of extensive school closures and restrictions strongly solidified the move from being largely provision of RE, lunchtime events and collective worship, to much broader methods in response to listening to the needs of the school (both staff and pupils in a secular/mainstream setting). A striking observation was that schools ministry was viewed in many of these case study settings as a peripheral aspect of local church ministry and often devolved to specialist organisations. Arising needs and models of ministry have emphasised the value and effectiveness of relational approaches and listening to the needs of schools and responding accordingly. This reinforces the need for collaborative approaches and long-term development of relationships between church and school. Training needs identified concerned relationship building and vision and strategy development, with many stakeholders perceiving this as the way forward to more effective ministry activity. [ABSTRACT FROM AUTHOR]

Mathematical models highlighted the importance of pathogen‐mediated invasion, with the replacement of red squirrels by squirrelpox virus (SQPV) carrying grey squirrels in the UK, a well‐known example.In this study, we combine new epidemiological models, with a range of infection characteristics, with recent longitudinal field and experimental studies on the SQPV dynamics in red and grey squirrel populations to better infer the mechanistic basis of the disease interaction.A key finding is that a model with either partial immunity or waning immunity and reinfection, where individuals become seropositive on the second exposure to infection, that up to now has been shown in experimental data only, can capture the key aspects of the field study observations.By fitting to SQPV epidemic observations in isolated red squirrel populations, we can infer that SQPV transmission between red squirrels is significantly (4×) higher than the transmission between grey squirrels and as a result our model shows that disease‐mediated replacement of red squirrels by greys is considerably more rapid than replacement in the absence of SQPV.Our findings recover the key results of the previous model studies, which highlights the value of simple strategic models that are appropriate when there are limited data, but also emphasise the likely complexity of immune interactions in wildlife disease and how models can help infer disease processes from field data. [ABSTRACT FROM AUTHOR]

Oilfield production is controlled by a wide range of geological and engineering parameters, many of which are at least partially interrelated. This paper uses multivariate statistical methods (principal component analysis, regression analysis and analysis of variance) to determine how these parameters are related, and which of them are most significant in controlling and predicting oilfield performance. The analysis is based on a database of publicly available oilfield data from the United Kingdom Continental Shelf (UKCS), from which a series of geological, engineering and fluid‐related control variables from 136 fields were pre‐processed and analyzed. This dataset is a subset of a much wider project database for UKCS oil, gas and condensate fields. For this study, the project database was divided into two datasets: a first dataset with 10 parameters from 136 fields, and a second, more detailed dataset with 27 parameters from 38 fields. Both datasets were analysed using principal component analysis in order to investigate possible correlations between numerically/statistically interrogable predictor variables such as porosity, permeability, number of production wells, gas‐oil ratio and reservoir temperature. A regression analysis was then carried out on the predictor variables in order to obtain a ranking of predictability (i.e. how indicative a predictor is of a particular outcome) and sensitivity (how sensitive an outcome is to slight changes in a predictor) in relation to recovery factor based on R‐squared and regression coefficient values. The results showed that key variables from the principal component analysis included field size, number of production wells, PVT, gross depositional environment and reservoir quality. High‐ranking parameters of predictability and sensitivity from the regression analysis were found to include API, net‐to‐gross, porosity and reservoir depth. These results are consistent with previous studies and suggest that it should be possible to forecast oilfield recovery based on only a few selected input variables. As a preliminary test of forecasting ability of the variable permutations put forward, a best‐subsets multiple regression was carried out using a statistical software package and yielded results which corroborated the main findings. [ABSTRACT FROM AUTHOR]

Background. There are many different haematological malignancy subtypes. Most follow chronic pathways that are uncertain and unpredictable, which may lead to feelings of anxiety and distress. The provision of information can ameliorate such difficulties, but patients are known to have unmet needs in this regard. The aim of this study is to explore experiences of information sharing among patients with chronic blood cancers and the factors impacting this process. Methods. The study is set within a UK cohort of blood cancer patients, where care is provided across 14 hospitals according to national clinical guidelines. Purposive sampling was used to identify expert participants (based on experience), and in-depth qualitative interviews were conducted with 35 patients, 10 with a relative present. The study was intended to inform practice and utilised qualitative description, with thematic content analysis and systematic data coding. Results. Experiences of information sharing varied. Most patients described this positively, but not all. Several barriers and facilitators were identified, which are discussed within five themes: (1) shock affects ability to process information, (2) the importance of time to facilitate information exchange, (3) personal relationships have an impact on meeting information needs, (4) HCP interpersonal skills are central to good information sharing, and (5) communication skills and terminology. Conclusions. Patients with chronic blood cancers prefer to engage in information sharing when they are not in a state of shock, and when they have adequate time to process material that is effectively and sensitively delivered, by HCPs they know and trust. [ABSTRACT FROM AUTHOR]

Purpose: End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count. Methods: A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan–Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV. Results: Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973–2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5–1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported. Conclusion: Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies. [ABSTRACT FROM AUTHOR]

In the wake of COP 26, the international community is aiming to reduce carbon emissions by adopting alternative and renewable energy sources. Deep geothermal energy can help to achieve this as it represents a low carbon‐emitting energy resource that can provide a constant base load of energy. In the United Kingdom, the development of deep geothermal has been limited due to high geological uncertainty and risk. Past exploration has focused on hot sedimentary aquifers and hot dry‐rock granites, with limited success. To mitigate risk and extract heat with a lower reliance on geological properties, such as permeability, new development methods have been conceived using deep borehole heat exchangers, where fluid is circulated in a closed‐loop system. Feasibility studies have been undertaken through modelling of deep borehole heat exchangers with the hope that these novel technologies can be used to exploit geothermal energy. [ABSTRACT FROM AUTHOR]

Background: The UK is rolling out a national childhood influenza immunisation programme for children, delivered through primary care and schools. Behaviourally-informed letters and reminders have been successful at increasing uptake of other public health interventions. Therefore, we investigated the effects of a behaviourally-informed letter on uptake of the vaccine at GP practices, and of a letter and a reminder (SMS/ email) on uptake at schools. Methods and results: Study 1 was a cluster-randomised parallel trial of 21,786 two- and three-year olds in 250 GP practices, conducted during flu season (September to January inclusive) 2016/7. The intervention was a centrally-sent behaviourally-informed invitation letter, control was usual care. The proportion of two- and three-year olds in each practice who received a vaccination by 31st January 2017 was 23.4% in the control group compared to 37.1% in the intervention group (OR = 1.93; 95% CI = 1.82, 2.05, p < 0.001). Study 2 was a 2 (behavioural letter vs standard letter) × 2 (reminder vs no reminder) factorial trial of 1108 primary schools which included 3010 school years 1–3. Letters were sent to parents from providers, and reminders sent to parents from the schools. In the standard-letter-no-reminder arm, an average of 61.6% of eligible children in each school year were vaccinated, compared to 61.9% in the behavioural-letter-no-reminder arm, 63.5% in the standard-letter-plus-reminder arm, and 62.9% in the behavioural-letter-plus reminder condition, F(3, 2990) = 2.68, p = 0.046. In a multi-level model, with demographic variables as fixed effects, the proportion of eligible students in the school year who were vaccinated increased with the reminder, β = 0.086 (0.041), p < 0.036, but there was no effect of the letter nor any interaction effect. Conclusion: Sending a behaviourally informed invitation letter can increase uptake of childhood influenza vaccines at the GP surgery compared to usual practice. A reminder SMS or email can increase uptake of the influenza vaccine in schools, but the effect size was minimal. Trial registration: Study 1: Trial registration: ClinicalTrials.gov Identifier: NCT02921633. Study 2: Trial registration: ClinicalTrials.gov Identifier: NCT02883972. [ABSTRACT FROM AUTHOR]

Hydrocarbon production from oil and gas fields is controlled by a variety of interconnected factors with a hierarchy of significance that is, for the most part, difficult to untangle. This article documents and investigates the spatial and temporal distribution of key hydrocarbon field parameters on the UK Continental Shelf. Data have been compiled from publicly available sources for 424 fields. Variables are considered as "descriptive parameters," "control parameters" and "outcomes". Descriptive parameters are metadata such as field name, location, etc. Control Parameters include depositional environment, present depth of burial, porosity, permeability, reservoir formation pressure, reservoir temperature, average net‐to‐gross, number of fault populations, hydrocarbon API, field area, bulk rock volume, well density, number of wells (production and injection), well spacing, gas oil ratio, reservoir thickness, fluid saturation, compartmentalization (quantitated by number of observable non‐communicating fault compartments), structural complexity (scaled from 0 to 5), field production strategy, trap type and stratigraphic heterogeneity. Outcomes are used to assess field performance and include final recovery factor (estimated), maximum production rate, and cumulative monthly production. Analysis of the database illustrates a number of empirical observations regarding hydrocarbon production on the UKCS. The Jurassic plays have been the most successful in the region in terms of total volumes produced while the Permian reservoirs of the SNS account for the majority of the gas. Most of the UKCS reservoirs record top depths between 2000 and 4500 m with good reservoir quality. The best reservoir quality is observed in reservoirs that were deposited within deep marine systems. The largest hydrocarbon reserves are found in the Northern North Sea basin in these deep marine (as well as paralic and shallow marine) reservoirs. Using the data from this article and affiliated data, potential exists for extracting insight beyond spatio‐temporal distributions. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of completing household chores appear to transfer beyond managing day‐to‐day living. It is possible that chore engagement may improve executive functions, as engagement in chores require individuals to plan, self‐regulate, switch between tasks, and remember instructions. To date, little research has been conducted on household chores and executive functions in children, for whom these skills are still developing. Methods: Parents and guardians (N = 207) of children aged 5–13 years (M = 9.38, SD = 2.15) were asked to complete parent‐report questionnaires on their child's engagement in household chores and their child's executive functioning. Results: Results of the regression model indicated that engagement in self‐care chores (e.g., making self a meal) and family‐care chores (e.g., making someone else a meal) significantly predicted working memory and inhibition, after controlling for the influence of age, gender, and presence or absence of a disability. For families with a pet, there was no significant relationship between engagement in pet‐care chores and executive function skills. Conclusion: We strongly recommend that further research explore the relationship between chores and executive functions. It is possible that parents may be able to facilitate their child's executive function development through encouraging participation in chores, whereas chore‐based interventions (e.g., cooking programmes) may also be used to target deficits in ability. [ABSTRACT FROM AUTHOR]

Background: Support, such as information, advice and therapies, can play a vital role in the lives of families of autistic children. However, little is known about the support experiences of UK parents and carers. Aim: To explore experiences of and access to support for families of children with autism and sensory processing difficulties, from the perspective of parents and carers. Methods: Semi‐structured, timeline‐assisted interviews were conducted with parents/carers of 30 children aged 5–11, exploring experiences of support. Framework analysis was used to identify themes in the interview data. Results: Support varied widely and was not accessed equitably. Specialist autism support, together with support from other parents and voluntary organizations, was perceived as more useful than statutory and nonspecialist provision. Unmet support needs included an ongoing point of contact for information and advice for parents, and access to direct therapy and specialist mental health provision for children. Conclusions: Findings emphasize the need for a clear pathway of support following autism diagnosis, autism‐specific training for professional service providers and specialist provision tailored to the needs of autistic children. Patient or Public Contribution: An advisory group of four parents of children with autism provided feedback on study procedures and materials, including participant information sheets and timeline completion instructions. [ABSTRACT FROM AUTHOR]

Objectives: By 2030 the majority of the people living with HIV in the United Kingdom will be over the age of 50. HIV services globally must adapt to manage people living with HIV as they age. Currently these services are often designed based on data from the wider population or from the experiences of HIV clinicians. This article aims to help clinicians designing inclusive HIV services by presenting the most common needs identified during the first year of a specialist clinic for older people living with HIV at the Ian Charleson Day Centre, Royal Free Hospital in London, United Kingdom. Methods: The records of all thirty‐five patients attending the inaugural nine sessions were reviewed. Results: The median age of attendees was 69 (53–93) with 77% being male, 63% being White, 49% being heterosexual and 97% being virally suppressed respectively. The majority (83%) met the criteria for frailty using the Fried frailty phenotype. Eighteen issues linked to ageing were identified with the most common being affective symptoms (51%), memory loss (37%) and falls (29%). Conclusions: Whilst older people living with HIV are a heterogeneous group frailty is common and appears to present earlier. HIV services either need to adapt to meet these additional needs or must support users in transitioning to existing services. We feel that our multidisciplinary model is successful in identifying problems associated with ageing in people living with HIV and could be successfully replicated elsewhere. [ABSTRACT FROM AUTHOR]

The interests of children in a climate-challenged future are under-represented within UK policy-making and public discourse. Debates on intergenerational equity have centred on economic logic rather than the moral issue of harms to the next generation, or the responsibilities of today's generation. Civil movements play an important role in changing public and political thinking on this issue; however, research on intergenerational climate justice activism has so far been confined to the youth movement. This study uses an in-depth diary and interview dataset of 20 UK-based activist mothers and fathers to explore the emotional spaces of parenting and campaigning for intergenerational climate justice. Attention was paid to the role of parenthood in the framing and motivation for action, and the way that campaigning was sustained or impeded by activist parents' personal relationships. The study found that the emotional spaces of activist parenting were managed and demarcated through moral boundary work that was used to define, distinguish and legitimise a collective representation. These boundaries were relational and drawn selectively to include similar others and to form bridges with politicians; boundaries also functioned to delegitimise the role of adults without children, and to exclude and excuse younger children and older relatives from playing a part in justice activism. The paper concludes by considering how these processes might impede the movement and have implications for wider social justice. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) are comparatively rare in UK social work, but can offer distinct advantages. Confidence in Care (CiC) is an RCT with embedded process evaluation evaluating Fostering Changes (FC), a 12-week training programme for foster and kinship carers to increase skills and coping strategies. In order to mitigate challenges in participant recruitment, an engagement strategy was designed to maximise this. Our aim is to explore experiences of key study stakeholders towards trial recruitment and identify broader messages about recruitment to social care trials.Methods: Three focus groups were conducted, two with field-based recruiting staff (n = 7) and one with carers who attended the FC programme (n = 8). Five interviews were conducted with trainers who delivered FC, eight with foster carers who attended the programme, 18 with Foster Carers who elected not to take part in the programme, and 12 with social workers from participating trial sites. In addition, an away day for FC trainers was observed and discussions related to recruitment were noted. Transcribed audio-recorded data were inductively coded, double-coded by a second researcher, and thematically analysed.Results: Six themes were identified. The first addressed pragmatic aspects of the intervention affecting recruitment (e.g. committing to a 12-week programme). A second focussed on accuracy of communication about the trial between provider agencies and carers. A third concerned the ability of recruiting staff to contact carers, a particular challenge in group-based recruitment. A fourth addressed trial methods and their communication (e.g. relationship between trial team and recruiting staff). A fifth explored lack of differentiation by carers between the roles of the various professionals (e.g. FC facilitators and provider agencies). The sixth addressed perceived differences between recruitment into social care and health studies.Conclusions: Recruitment challenges in this social care setting were similar to those in healthcare. Some (e.g. gatekeeping by professional staff) may be rooted in randomisation anxiety, or unfamiliarity with research methods. Researchers more familiar with healthcare recruitment were however encouraged about the experience of working in this care setting. The original recruitment strategy and adaptations form the basis of further recommendations for research practice.Trial Registration: ISRCTN19090228 . Registered on 11 January 2017. [ABSTRACT FROM AUTHOR]

The UK's collective investment scheme ('CIS') sector is a key aspect of UK financial services. With the UK's departure from the EU, it has also become a politically salient topic, with various Member States competing to lure business to their financial centres in the light of Brexit. Brexit prompts hard choices and a key question arising for the CIS industry is whether the UK should continue to shadow EU law or whether elements of regulatory divergence could be envisaged. The paper suggests that, over the short to medium term, the UK should ensure it is likely to be deemed equivalent under EU law. Be that as it may, the paper also suggests that there may be areas within UK CIS regulation where some limited divergence can be considered. This would be provided that the UK remains in line with international standards, and (ideally) continues to be recognisably similar to remain equivalent. This certainly holds true in the event that equivalence is interpreted as more of a holistic assessment that could extend to embrace an element of regulatory competition. Any such divergence could also be framed as being of an optional nature, in order to grant CIS businesses full flexibility with respect to which regime they wish to comply. Writ large, Brexit may also help to stimulate broader conversations about the longer-term challenges the CIS industry faces in today's world. Viewed in this light, leaving the union could also inspire innovative and proportionate solutions to support and strengthen this pivotal sector. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently available drug-free treatments include Enterosgel®, an intestinal adsorbent approved for use in IBS-D and acute diarrhoea and available over-the-counter in the UK and 30 countries worldwide. The aim of this randomised, double-blind, placebo-controlled, multi-centre study is to test the efficacy and safety of Enterosgel® compared to placebo in symptomatic treatment in IBS-D.Methods/design: We will recruit 430 participants with IBS-D from approximately 30 primary and secondary care sites in England. Participants meeting the required abdominal pain and stool consistency criteria over a 2-week screening period will be randomly allocated to receive blinded treatment (Enterosgel® or placebo) for 8 weeks. This will be followed by an 8-week open-label treatment phase with Enterosgel®. Participants will be allowed to adjust their daily dosage during both phases based on their symptoms. Participants will then return to standard care and those who responded to treatment will receive a follow-up call 8 weeks later. Co-medication with loperamide will be permitted and use recorded. The primary outcome measure is the percentage of participants defined as responders for abdominal pain and stool consistency during at least 4 weeks in the 8-week blinded phase. Secondary outcome measures include stool frequency, stool consistency, abdominal pain, bloating, urgency, adequate relief, questionnaire scores and rescue medication use. Exploratory outcomes will be assessed in subsets of participants including qualitative and quantitative data on faecal microorganisms and biomarkers and gut-related measurements from magnetic resonance imaging data.Discussion: This is the first large scale randomised controlled trial investigating Enterosgel® in IBS-D. A study design with blinded phase followed by an open-label phase was chosen to encourage participation and study completion. Demonstrating that Enterosgel® is effective and safe in IBS-D could encourage adoption by patients and healthcare professionals and foster future clinical trials assessing its use in related conditions.Trial Registration: ISRCTN17149988. Prospectively registered on 14 November 2017. [ABSTRACT FROM AUTHOR]

This article is a systematic methodological literature review with the goal of understanding how and why health communication researchers are using mixed methods research (MMR) to better understand interpersonal communication between diabetes patients, their loved ones, and health care professionals. First, we provide a brief overview of MMR, followed by a discussion of the appropriateness of using MMR in health research. We then explain our search procedures for identifying MMR studies about interpersonal diabetes communication and describe our analysis of the identified studies. We then offer a brief, quantitative summary of our findings and provide details of exemplar studies to illustrate the unique value added by using MMR. We conclude the article with a discussion of implications and recommendations for the use of MMR in diabetes communication research. [ABSTRACT FROM AUTHOR]

The Carboniferous northern Pennine Basin remains the type locality for the 'block and basin' tectonic framework model. It has been widely believed that during periods of tectonic extension, large low‐density bodies within the basement permit buoyant blocks to resist isostatic subsidence. However, lithosphere‐scale structural and geodynamic modelling experiments dispute this; suggesting instead that the formation of intra‐basinal highs occurs prior to lithospheric extension. In northern UK, this tectonic framework is controlled by a combination of tectonic stress, isostasy and the buoyancy forces of low‐density granite, lithospheric flexure and, importantly, the inherited structural framework. It is hoped that further study can lead to a greater appreciation of the interplay of structural and geodynamic process that control the 'block and basin' framework. [ABSTRACT FROM AUTHOR]

Background Non-Hodgkin lymphoma (NHL) is often diagnosed after emergency presentation, a route associated with poor survival and an indicator of diagnostic delay. Accounting for around half of all NHLs, diffuse large B-cell lymphoma (DLBCL) is of particular interest since although it is potentially curable with standardised chemotherapy it can be challenging to identify at an early stage in the primary care setting. Patients and methods Set within a socio-demographically representative United Kingdom population of around 4 million people, data are from an established patient cohort. This report includes all patients (≥18 years) diagnosed with DLBCL 2004–2011 (n = 1660). Emergency admissions were identified via linkage to Hospital Episode Statistics using standard methods, and survival was examined using proportional hazards regression. Results Two out of every five patients were diagnosed following an emergency admission, and this was associated with advanced disease and poor survival (p < 0.001). Among the 80% of patients treated with curative chemotherapy, survival discrepancies emerged at the point of diagnosis; the adjusted hazard ratio (emergency versus non-emergency) at one month being 4.0 (95% confidence interval 1.9–8.2). No lasting impact was evident in patients who survived for 12 months or more. Conclusion Emergency presentation impacts negatively on DLBCL survival; patients presenting via this route have significantly poorer outcomes than patients with similar clinical characteristics who present via other routes. [ABSTRACT FROM AUTHOR]

Riley’s (1994) Stuttering Severity Instrument (SSI) has three components: a symptom frequency measure (%SS), average duration of the three longest stutters, and a physical concomitant (PC) score. An assessment of whether it was necessary to use all of these when using SSI-3 to identify which children are at risk of speech difficulties was performed. Participants were 879 reception class children aged 4–6 years from UK schools. The distributions of the separate components of SSI-3 were examined. Departures from normality were noted for each component. The features seen in the distribution of the individual components were also apparent in the distribution of the overall scores (this was not normal and had multiple modes). These findings undermine the usefulness of the overall measure for identifying children at risk of speech difficulties. Prior work used a fixed SSI-3 threshold to identify at risk children. Classification of children as fluent or at risk based on this threshold was compared with classifications based on thresholds applied to the individual components. Classifications were comparable for %SS, but less satisfactory for duration and PC. These findings suggest that %SS performs similarly to the overall SSI-3 scores when used to identify at risk children. Procedures for identifying at risk children in schools need to be short and easy to administer. Thus, since there is no justification for including all components of SSI-3 and duration and physical concomitants are not sensitive measures of fluency, a procedure based on the frequency measure alone is appropriate for use in schools. [ABSTRACT FROM PUBLISHER]

Background: Supradiaphragmatic radiotherapy (SRT) to treat Hodgkin's lymphoma (HL) at a young age increases the risk of breast cancer (BC). A national notification risk assessment and screening programme (NRASP) for women who were treated with SRT before the age of 36 years was instituted in the United Kingdom in 2003. In this study, we report the implementation and screening results from the largest English Cancer Network.Methods: A total of 417 eligible women were identified through cancer registry/hospital databases and from follow-up (FU) clinics. Screening results were collated retrospectively, and registry searches were used to capture BC cases.Results: Of the 417 women invited for clinical review, 243 (58%) attended. Of these 417 women, 23 (5.5%) have been diagnosed with BC, a standardised incidence ratio of 2.9 compared with the age-matched general population. Of five invasive BCs diagnosed within the NRASP, none involved axillary lymph nodes compared with 7 of 13 (54%) diagnosed outside the programme (P<0.10). The mean latency for BC cases was 19.5+/-8.35 years and the mean FU duration for those unaffected by BC was 14.6+/-9.11 years (P<0.01), suggesting that those unaffected by BC remain at high risk. Recall and negative biopsy rates were acceptable (10.5 and 0.8%, respectively).Conclusions: The NRASP appears to detect BC at an early stage with acceptable biopsy rates, although numbers are small. Determination of NRASP results on a national basis is required for the accurate evaluation of screening efficacy in women previously treated with SRT. [ABSTRACT FROM AUTHOR]

Museums have long served as a source of inspiration for horror and fiction writers. The cultural institutions maintain an aura of mystery, making them the ideal setting for stories of the macabre. Graphic novel authors have also made liberal use of these buildings as setting, and make frequent use of museum employees as key figures in narrative development. What though, is the role of the museum as depicted in graphic novels? What function do they play, and how are museum employees represented? Does the graphic novel offer a way in which museums can reach out to and develop new audiences, or will the medium serve only to confuse and mislead potential visitors about the reality of museums? [ABSTRACT FROM PUBLISHER]

The views of experienced educational practitioners were examined with respect to the terminology used to describe children with speech, language and communication needs (SLCN), associated problems and the impact of speech and language difficulties in the classroom. Results showed that education staff continue to experience challenges with the range of terminology used to refer to the children's needs. Terms used to refer to difficulties with speech were least familiar to the respondents. Difficulties were noted in distinguishing between children with SLCN and children where English was an additional language. Respondents indicated a variety of additional difficulties experienced by the children. Literacy difficulties were reported to be more prevalent in children with language difficulties, while levels of bullying and anxiety were reported to be higher in children with speech problems. Respondents reported that tools for identifying speech and language difficulties and procedures for accessing effective resources are required. [ABSTRACT FROM AUTHOR]

Background: UK policy aims to improve cancer outcomes by promoting early diagnosis, which for many haematological malignancies is particularly challenging as the pathways leading to diagnosis can be difficult and prolonged.Methods: A survey about symptoms was sent to patients in England with acute leukaemia, chronic lymphocytic leukaemia (CLL), chronic myeloid leukaemia (CML), myeloma and non-Hodgkin lymphoma (NHL). Symptoms and barriers to first help seeking were examined for each subtype, along with the relative risk of waiting >3 months' time from symptom onset to first presentation to a doctor, controlling for age, sex and deprivation.Results: Of the 785 respondents, 654 (83.3%) reported symptoms; most commonly for NHL (95%) and least commonly for CLL (67.9%). Some symptoms were frequent across diseases while others were more disease-specific. Overall, 16% of patients (n=114) waited >3 months before presentation; most often in CML (24%) and least in acute leukaemia (9%). Significant risk factors for >3 months to presentation were: night sweats (particularly CLL and NHL), thirst, abdominal pain/discomfort, looking pale (particularly acute leukaemias), and extreme fatigue/tiredness (particularly CML and NHL); and not realising symptom(s) were serious.Conclusions: These findings demonstrate important differences by subtype, which should be considered in strategies promoting early presentation. Not realising the seriousness of some symptoms indicates a worrying lack of public awareness. [ABSTRACT FROM AUTHOR]

The article focuses on resilience in politics in Great Britain in 2015. Topics include the concept of ‘resilience as governance,’ neoliberalism in government, and responsibilisation, which describes the intersection of political economy and governance. Information is provided on government accountability.

Edward Thompson'sThe Making of the English Working Class(London: Gollancz, 1963) was a creative work in both substance and methodology. The insistence on recovering the neglected experience of a class through history from below was complemented by a methodological commitment. The latter agenda was elaborated briefly and assertively in the Preface and subsequently practised throughout the richly detailed text. Actors must be understood in context as acting creatively within constraints. Their assessments of shared experience provide a basis for shared consciousness, organisation and collective action. This methodological agenda is critically assessed through an examination of the propositions within the Preface. The analysis is linked to a consideration of the agenda's previous employment in Thompson's essay ‘Homage to Tom Maguire’ (InEssays in Labour History, edited by Asa Briggs, and John Saville. London: Macmillan, 1960). Thompson's creativity is itself located within the constraints within which he worked. These were intellectual and political Marxism and a-historical sociology, earlier experiences in the Communist Party and the hopes and frustrations of the New Left. [ABSTRACT FROM PUBLISHER]

Simple Summary: This study reports the management of women at high risk for breast cancer over a 33 years period. The aim was to summarize the numbers seen and to report the results of our studies on gene testing, the outcomes of screening and the success of preventive methods including lifestyle change, chemoprevention and risk-reducing mastectomy. We also discuss how the clinical Family History Service may be improved in the future. Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results. [ABSTRACT FROM AUTHOR]

Effective Education for Sustainable Development (ESD) requires appropriate pedagogies that engage learners in transformative learning. These pedagogies include reflective and active learning, involving experiential, collaborative and learner-centred activities. This paper discusses student experiences and perceptions of an interdisciplinary social science ESD course at a UK university that incorporated reflective and active learning by using a 'flipped classroom' (FC) design and innovative assessments. FC creates time in class for reflective and active learning by moving content acquisition to pre-class study. Adoption of the flipped classroom in social sciences is rare and literature on use of FC for ESD is very scarce; hence this paper offers valuable insights into the design of a flipped social science ESD course, and participants' responses. Results of two surveys demonstrate very positive student perceptions of the course, and illustrate several benefits of the FC design. Over 90% of respondents agreed that in-class active learning exercises made the classes more engaging and the material more memorable than usual, offering useful opportunities to put information/learning into practice, with most students expressing strong agreement. In-class mini-lectures were nevertheless also appreciated, as were reflective practices. A large majority of the students considered the workload reasonable. Findings also reveal the importance of incentivising pre-class preparation using graded assessments such as quizzes, which additionally helped students understand/remember content, and gave confidence about contributing in class. It is clear that the active and reflective learning that FC facilitates engages students in ESD. The paper concludes by offering recommendations for successfully implementing this approach. • Discusses an interdisciplinary ESD course that uses a 'flipped classroom' design. • >90% of students said in-class active learning exercises made classes more engaging. • Reflective practices and in-class mini-lectures were also appreciated. • Incentivising pre-class preparation using graded assessments is important. • Flipped class facilitates active and reflective learning that engages students in ESD. [ABSTRACT FROM AUTHOR]

Good dental health is essential for good communication, nutrition and self-esteem. There is evidence of a correlation between special needs, unequal access to dental care, poor dental health and insufficient improvement in dental services, particularly for children with special healthcare needs. Factors contributing to this situation include the characteristics of the individual's disability, parental education and socioeconomic status, lack of appropriately trained dentists and a lack of research in the UK to guide progress. [ABSTRACT FROM AUTHOR]

Background: The reasons patients with haematological malignancies die in hospital more often than those with other cancers is the subject of much speculation. We examined variations in place of death by disease sub-type and time from diagnosis to death, to identify groups of 'at-risk' patients. Methods: The study is based in the United Kingdom within the infrastructure of the Haematological Malignancy Research Network (HMRN), a large on-going population-based cohort including all patients newly diagnosed with haematological malignancies in the north of England. Diagnostic, demographic, prognostic, treatment and outcome data are collected for each patient and individuals are 'flagged' for death. This study includes all adults (?18 years) diagnosed 1st September 2004 to 31st August 2010 (n = 10,325), focussing on those who died on/before 31st August 2012 (n = 4829). Results: Most deaths occurred in hospital (65.9%), followed by home (15.6%), nursing home (11%) and hospice (7.5%) and there was little variation by diagnostic sub-type overall. Differences in place of death were, however, observed by time from diagnosis to death, and this was closely related to sub-type; 87.7% of deaths within a month of diagnosis happened in hospital and these largely occurred in patients with acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma. Patients surviving longer, and particularly beyond 1 year, were less likely to die in hospital and this corresponded with an increase in the proportion of home deaths. Conclusions: Time from diagnosis to death was clearly a major determinant of place of death and many patients that died within three months of diagnosis did so in hospital. This was closely related to disease sub-type, with early deaths occurring most notable in the more aggressive diseases. This is likely to be due to a combination of factors including acute presentation, rapid disease progression without transition to a palliative approach to care and complications of treatment. Nonetheless, hospital deaths also occurred frequently in indolent diseases, suggesting that other factors were likely to contribute to the large proportion of hospital deaths overall. More evidence is needed to fully understand these complex cancers. [ABSTRACT FROM AUTHOR]

Background Formal research priority setting is a recognized way of identifying important clinical research questions and promoting these as topics for commissioned research. This paper describes a research priority setting exercise conducted by the National Institute of Academic Anaesthesia (NIAA). Methods Possible research questions were identified from a questionnaire sent to holders of the Final Fellowship in Anaesthesia in Great Britain and Ireland and to lay representatives. The responses to the first questionnaire were collated to produce a list of potential research questions which were then sent to the same constituency for scoring. The results of this scoring process were considered by an expert panel and statements of research need generated for selected questions. The questions from the first round were also reviewed with the help of representatives of NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC). Results For the first questionnaire, 308 responses with 447 suggestions for research were received. A total of 15 questions were included in the second questionnaire, for which 2226 responses were received. The expert panel identified five questions for prioritization. A further nine were identified from discussions with representatives of NETSCC. Conclusions A total of 14 research priorities were identified by the exercise, two of which have been submitted to the NIHR Health Technology Assessment (HTA) programme as statements of research need. Potential funding streams for the remaining questions are being sought. We discuss some implications of this exercise for research strategy in the speciality. [ABSTRACT FROM PUBLISHER]

The authors reflect on the recommendations from the Safety of Blood, Tissues and Organs (SaBTO) in Great Britain considering the issue on informed patient consent for blood transfusion. They mention the inconsistencies and debate over the practice of obtaining patient consent and argue that doctors should coordinate with their patients to obtain consent to medical treatment. They also outline the consultation guidelines, objectives, and best practices for patient safety.

Background: Ascertainment of cases and disease classification is an acknowledged problem for epidemiological research into haematological malignancies.Methods: The Haematological Malignancy Research Network comprises an ongoing population-based patient cohort. All diagnoses (paediatric and adult) across two UK Cancer Networks (population 3.6 million, >2000 diagnoses annually, socio-demographically representative of the UK) are made by an integrated haematopathology laboratory. Diagnostics, prognostics, and treatment are recorded to clinical trial standards, and socio-demographic measures are routinely obtained.Results: A total of 10,729 haematological malignancies (myeloid=2706, lymphoid=8023) were diagnosed over the 5 years, that is, from 2004 to 2009. Descriptive data (age, sex, and deprivation), sex-specific age-standardised (European population) rates, and estimated UK frequencies are presented for 24 sub-types. The age of patients ranged from 4 weeks to 99 years (median 70.6 years), and the male rate was more than double the female rate for several myeloid and lymphoid sub-types, this difference being evident in both children and adults. No relationship with deprivation was detected.Conclusion: Accurate population-based data on haematological malignancies can be collected to the standard required to deliver reproducible results that can be extrapolated to national populations. Our analyses emphasise the importance of gender and age as disease determinants, and suggest that aetiological investigations that focus on socio-economic factors are unlikely to be rewarding. [ABSTRACT FROM AUTHOR]

This article, based on a lecture delivered in London, sets out why the Commonwealth is important and why it is ideally placed as a network for the future, with a unique role in the 21st century. It argues that the Commonwealth is the 'world's best soft power network'. The author sets out how the Coalition government in Britain, headed by Prime Minister David Cameron, is actively upgrading its engagement with the Commonwealth and how it is committed to putting the 'C' back into the Foreign and Commonwealth Office. The article also outlines the UK's hopes for the work of the Eminent Persons' Group, the Commonwealth Ministerial Action Group and the Perth Commonwealth Heads of Government Meeting. [ABSTRACT FROM AUTHOR]

Aim: To determine whether UK optometrists routinely prescribe the subjective refraction result, or whether adjustments are made to aid patient comfort and adaptation. Method: A questionnaire was distributed by post and via the internet to UK optometrists. It incorporated eight case scenarios that included information regarding a patient’s age, symptoms, habitual refractive correction, subjective refraction and any other pertinent clinical information. For each case, they were asked to indicate what refractive correction they would prescribe. Results: A total of 426 questionnaires were completed. In three cases with asymptomatic patients with negligible changes in visual acuity, about 45% of respondents indicated that they would prescribe the subjective refraction result and about 40% would prescribe the habitual correction. In a further case involving a 75 year-old asymptomatic patient, 55% prescribed the habitual correction. In two cases with large cylinder power changes, about 40% of respondents indicated they would partially prescribe the cylinder power. However, there was a large variation in the suggested modification of sphere powers to accompany the partial cylinder changes. Conclusion: A large sample of UK optometrists indicated that they would prescribe the subjective refraction result regardless of patient age, symptoms and difference between habitual correction and subjective refraction. Optometrists who partially prescribe, employ a wide variety of techniques including some that conflict with conventional teaching. [ABSTRACT FROM AUTHOR]

The article explains why the rule of letting a British government minister to do anything which any individual may do is considered a misconception, and why the conception of prerogative should be rejected under the constitutional law. It discusses the two substantive issues of the constitutional law; who is to decide on what activities the executive may engage into, and what is the scope in creating such a rule to avoid abuse. It highlights how the Crown is being recognised to have established non-statutory powers for a purpose.

Abstract: As an input to projections of sub-national populations by ethnicity, this paper develops the first estimates of the mortality risks experienced by the UK ethnic groups. Two estimates were developed using alternative methods. In the first, UK 2001 Census data on limiting long-term illness to predict mortality levels and regression equations between local Standardized Illness and Mortality Ratios for all ethnicities are assumed to apply to individual ethnic groups. In the second, the geographical distribution of ethnic groups by local areas is combined with local mortality for all ethnicities to estimate national mortality rates by ethnicity, which are then employed to estimate local ethnic mortality. A comparison of the two estimates indicates that the method based on illness rates produces more plausible outcomes. The local SMRs produced for each ethnic group were used to generate ethnic group life tables for 432 UK local authority areas in 2001, which included estimates of survivorship probabilities by single year of age, gender and ethnic group for each local area for use in a projection model. [Copyright &y& Elsevier]

Sir Oswald Mosley's New Party initiative was shaped significantly by his experiences in the Labour Party. These experiences are situated within the complexities of that party's culture. The degree to which Mosley's political identity can be regarded as distinctive within this culture is assessed. This helps to elucidate the strengths and limitations of his appeal to the diverse elements within the party. [ABSTRACT FROM AUTHOR]

Young people's alcohol consumption has been the focus of heightened concern over 'binge drinking' in social policy, academic research and popular culture. A normalized culture of intoxication is now central to many young people's social lives, playing an important role in the night-time economy of towns and cities across the UK. In this article we draw on the findings of a study on the significance of alcohol consumption in the everyday lives of 'ordinary' young adult drinkers to explore the significance of loss of consciousness and loss of memory in their drinking stories. Through an analysis of focus group discussions with 89 young women and men aged 18 to 25, we explore the role of 'passing out stories' in the classed and gendered domain of young people's alcohol consumption in the neo-liberal social order, focussing on the constitution of risk and pleasure in their accounts. [ABSTRACT FROM AUTHOR]

The article presents a study on the key factors that affect care home catherisation rates in Great Britain. The study aimed to audit the catheterisation rates in Gloucestershire care homes. It revealed that the overall prevalence of catheterisation was 8% and prevalence between care homes ranged from 0 to 47%. Seventy-three percent of those catheters identified were urethral and 27% were suprapublic.

This article illustrates British Black women's hermeneutical approach to reading and retelling biblical narratives in such a way that they unearth rather than bury the vitality and centrality of women, Black people and the poor in the fulfilment of the gospel. Based on an ethnographic study of six Black women (including the author) ill one-to-one Bible study sessions engaging with the Mary and Martha texts, it highlights how Black women rely on an experiential knowledge base that reflects a Black feminist epistemology, which moves, in turn, towards a Womanist Pneumatological Pedagogy (WPP). Thus, it argues that the key anti-oppressive reading strategy employed by Black women is an expanded experiential imagination which allows them to transpose and/or link their marginalized experiences/stories onto/with the marginalized biblical characters. In this way they enhance their understanding of God. [ABSTRACT FROM AUTHOR]

Objectives: To examine stuttering by children speaking an alternative language exclusively (LE) or with English (BIL) and to study onset of stuttering, school performance and recovery rate relative to monolingual speakers who stutter (MONO). Design: Clinical referral sample with supplementary data obtained from speech recordings and interviews. Setting: South-East England, 1999-2007. Participants: Children aged 8-12 plus who stuttered (monolingual and bilingual) and fluent bilingual controls )FB). Main outcome measures: Participants' stuttering history, SATS scores, measures of recovery or persistence of stuttering. Results: 69 (21.8%) of 317 children were bilingual. Of 38 children who used a language other than English at home, 36 (94.7%) stuttered in both languages. Fewer LE (15/38, 39.5%) than BIL (23/38, 60.5%) children stuttered at first referral to clinic, but more children in the fluent control sample were LE (28/38, 73.7%) than BIL (10/38, 26.3%). The association between stuttering and bilingual group )LE/BIL) was significant by x2 test; BIL speakers have more chance of stuttering than LE speakers. Age at stuttering onset and male/female ratio for LE, BIL and MONO speakers were similar (4 years 9 months, 4 years 10 months and 4 years 3 months, and 4.1:1, 4.75:1 and 4.43:1, respectively). Educational achievement was not affected by bilingualism relative to the MONO and FB groups. The recovery rate for the LE and MONO controls together (55%) was significantly higher by x2 test than for the BIL group (25%). Conclusions: BIL children had an increased risk of stuttering and a lower chance of recovery from stuttering than LE and MONO speakers. [ABSTRACT FROM AUTHOR]

Background: General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods: Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results: Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion: The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice. [ABSTRACT FROM AUTHOR]

In this article, we critically reflect on the constitution of the UK's alcohol problem in the government's 'Safe, Social, Sensible' policy document, referring to findings from a 3-year ESRC funded study on young people, alcohol and identity. We suggest that discursive themes running throughout 'Safe, Sensible, Social' include 'shared responsibility' for implementing a 'cultural change', 'youth and binge drinking' and the need to promote 'sensible' levels of alcohol consumption to individual drinkers. We argue that, in constituting the problem around these themes, the policy document risks diluting responsibility and obscuring the role of government, media and alcohol manufacturers. In addition, the way young drinkers are constituted carries a risk of isolating this group as both cause and effect of the alcohol problem, placing an unrealistic burden of responsibility on local communities and agencies and exacerbating the gap between policy assumptions and the lived reality of young drinkers within their cultural context. We conclude that alcohol policy requires a more substantive, clearly specified and evidence-based approach which acknowledges the complexities of drinking contexts and drinker motivations in the allocation of responsibility and formulation of policy. In particular, policy needs to address the role of legislation and licensing laws, and the branding and marketing activities of the drinks industry in the structure of UK alcohol consumption. [ABSTRACT FROM AUTHOR]

Referral pathways and diagnosis: UK government actions fail to recognise complexity of lymphoma To gain survival advantages potentially associated with prompt diagnosis, the UK government introduced identical waiting-time targets for all cancers, and guidelines to ensure that general practitioners make appropriate hospital referrals. For lymphoma, the evidence guiding these actions is limited. This study examined referral pathways in patients with lymphoma and variations in time to diagnosis by discipline of first referral. A case series study was conducted including all patients aged over 25 years, newly diagnosed with lymphoma in the UK county of West Yorkshire, during 2000. Data were extracted from primary care and hospital records of 189 patients. Referral pathways were described, and the number of days between first referral and diagnosis calculated. A distinct referral pathway did not exist; patients were initially referred to many disciplines. Surgical referrals predominated, and only 12% of patients were sent directly to haematology. Time to diagnosis varied by discipline and was shorter for patients sent to haematology than for most other common disciplines. UK government actions to ensure the prompt diagnosis of patients with lymphoma are not evidence-based. The complexity of the referral pathway in patients with lymphoma, which affects time to diagnosis, has been underestimated. Further government actions should be evidence-based, ensuring prompt diagnosis of lymphoma from whatever discipline patients originate. [ABSTRACT FROM AUTHOR]

This paper explores how motorcars and car-based cultural practices operate in the construction of young working-class masculine identities. It draws on ethnographic fieldwork conducted during the summer of 2002 with young male car modifiers from the Midlands and North Wales who associated with the British cruising scene. Although this study is broadly framed by the youth cultural world of cruising, it does not approach car modification as a collective cultural phenomenon or draw on subcultural theory, but instead examines young men's relationships with their cars in terms of general theories of consumption and identity and theories of cultural production. The car modifiers participating in this study frequently resisted calls to collectivity and repeatedly endorsed a heavily individualised discourse of consumption. As consumers of the motorcar, they constituted themselves as absolutely individual on the basis of their ownership of modified cars that they constituted as culturally unique. Car modification operated as a set of identity practices organised around the active consumption and symbolic manipulation of standard motorcars and the cultural production of idiosyncratic signifiers of masculine identity. Through car modification, young working-class men discursively distanced themselves from the mass of standard car-owning subjects and constituted themselves as 'unique' car-owning individuals who were culturally privileged. This claim to privilege was predicated on their capacity to produce highly conspicuous motorcars, which they viewed as a source of considerable cultural capital. [ABSTRACT FROM AUTHOR]

This study examines illness trajectories of patients with lymphoma and assesses whether UK government targets to reduce waiting time for diagnosis and treatment are achievable and appropriate. One hundred and ninety-four patients, residents in West Yorkshire, aged more than 25 years and newly diagnosed with lymphoma during 2000 were included. Data collected from interviews, primary care and hospital records were used to examine time between critical events on the illness trajectory and characteristics of patients not meeting proposed targets. Forty-two per cent of patients did not receive a hospital appointment within 2 weeks of general practitioner referral, 26% were not treated within 1 month of diagnosis and 64% were not treated within 2 months of referral. Target achievement differed by diagnostic group, and trends were seen by age and deprivation. The interval from onset of symptoms to treatment averaged more than 1 year and approximately half of this occurred before first medical contact. Results suggest that significant improvements are needed to achieve targets. Although existing targets particularly address referral and treatment intervals, these were the shortest intervals on the trajectory. Generalized targets may be inappropriate and unachievable for lymphoma as they do not consider individual disease characteristics or allow for variations in the urgency with which treatment is needed. [ABSTRACT FROM AUTHOR]

The article focuses on an intercalated degree which involves an additional year of study usually between the second and third years of a medical course in Great Britain. Some medical schools in the country have made intercalated degrees compulsory. Others have reserved them for those students who scored the highest marks in the previous years' examinations.