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Background. Strongly varying timescales of pyrogenic carbon (PyC) degradation have been observed across depositional settings. To date, PyC degradation in UK peatlands has had limited investigation. Aims. This study aims to evaluate how PyC recalcitrance relates to differing production characteristics, fuels and duration of exposure in UK peatlands. Methods. PyC samples produced from key peatland vegetation types were exposed on a peatland surface to assess molecular (by Fourier-transform infrared), leachable carbon (water-extractable organic carbon) and elemental (C, H, N, O) changes occurring over a year. Key results. PyC degradation phases were observed: (1) very rapid (=1 month) loss of leachable carbon; (2) longer-term (1-12 months) changes to PyC characteristics indicative of soil interactions. 'Severity' had a significant effect on all measured variables. Conclusions. This study indicates that PyC is susceptible to changes within short timescales in UK peatlands, particularly low-temperature PyC, but that stabilisation through soil matrix interactions may occur over longer periods (>1 year). Implications. The findings indicate that UK peatland wildfire carbon cycling research should consider early pulses of carbon to the wider environment, as well as longer-term C storage in PyC. [ABSTRACT FROM AUTHOR]

Responding to the conspicuous absence of reference to the local scale in national and global discourses of "green recovery" from COVID‐19, this paper articulates a series of interlinked research agendas united by a focus on what a "green recovery" might involve at a local scale within the context of the United Kingdom. We argue that geography as a discipline is particularly well placed to contribute to theoretical and practical framings of "green recovery" as manifested at and through a range of scales, including the micro (individual), meso (household), and what we term "meso+" (neighbourhood). Specifically, we signpost what might be considered "green shoots" worthy of urgent empirical investigation – shifts in everyday life and practice catalysed by COVID‐19 and with the potential to underpin longer‐lasting transformations towards socially, economically, and environmentally sustainable localities. [ABSTRACT FROM AUTHOR]

This article examines the critical leadership actions that support collaborative public service innovations, drawing on evidence from UK local government led partnerships. It concludes that success is more likely if leaders help the partnership to: build mutual trust; agree clear, well thought through, politically supported ambitions; invest time, resources and energy; galvanize managers and staff; make a long term commitment to achieving the objectives, learning, adapting and growing innovations together. Public sector managers can use the leadership actions highlighted in this paper to reflect on what more they might do to increase the likelihood that their innovative collaborations will succeed. [ABSTRACT FROM AUTHOR]

Community is elusive, desirable, rhetorical; something lost and something to be built; a relationship, a concept, a synonym, a place (real or imagined). This article explores the roles that the complexity of community’s conceptualisation has played in the development of political identities, goals and rationales for action. Drawing on the ways in which it has been conceptualised and utilised in sociological, historical and political understandings of social change, and a series of interviews with members of British socialist organisations, the article examines the relationship and equation between ‘community’, and ‘location’, ‘local’ and ‘place’ that develop as these terms become drawn into a wider project for social transformation. It is argued that ideas of location have not only framed how community is operationalised to imagine and enact this transformation, but that location itself is conceptualised in multiple, equally complex ways through this association. Social change becomes relatable, an articulable experience of large-scale processes, of social problems, of power and resistance. Community is reified, and change is made possible through a sense of locality. [ABSTRACT FROM AUTHOR]

Background Although widely used in maternity care, the risks associated with local anaesthetic (LA) agents are commonly overlooked. The most serious avoidable risk associated with LA use is local anaesthetic systemic toxicity (LAST). Incidence in maternity settings is known to be underestimated due to under-recognition and under-reporting. LAST is a considerable problem, with potential financial and medico-legal as well as implications for patient safety. Methods A standardised, anonymised questionnaire was used to evaluate LAST awareness among staff of all disciplines. Awareness was examined across four domains: LA safe maximum doses, signs and symptoms of toxicity, immediate management, and the antidote type and location. Findings Poor LAST awareness was identified across all staff disciplines, with scope for substantial improvement with an interprofessional educational intervention. Only 17% were aware of any guidelines relating to LAST. Conclusion There is a need for greater focus on interdisciplinary education and the importance of shared responsibility in optimising patient safety. [ABSTRACT FROM AUTHOR]

Mobilising citizens as investors in local solar photovoltaic and onshore wind energy projects can help meet climate objectives, generate local development opportunities, and build social support for low carbon transition. This can be achieved through the introduction of financial incentives attractive to local actors. To investigate what types of financial incentives are effective at the feasibility, development, construction, and operation stages of project development, we undertake a comparative case study of their use in Denmark; Germany; the UK; and Ontario, Canada. We find that a requirement for incentives such as grants and soft loans at the feasibility and development stages is a distinguishing feature of projects with citizen involvement, reflecting their greater risk aversion, lack of technical experience and financial capacity, and their inability to balance risk across a portfolio of projects. At later project stages, market-independent supports (feed in tariffs, grants, and tax incentives) have been effective in mobilising investment, but market-based supports (feed in premiums and quota schemes) can also be tailored to the specific needs of local community actors. These findings add a new dimension to the growing academic and policy debate about how Governments can effectively mobilise investment from local communities and citizens in distributed renewable technologies. [ABSTRACT FROM AUTHOR]

This article aims to explore the implications for local radio news in the UK commercial radio industry of a series of changes to the regulation of the sector since it was first established in the 1970s. A recent regulatory focus on product rather than process has enabled groups of stations to move not only programming production but also much news journalism out of the editorial areas it is intended to serve and into news 'hubs' intended to rationalize the process of news gathering and bulletin presentation and enable the groups to become increasingly profitable. The article considers a number of issues around the management of commercial radio groups in the United Kingdom, the development and, most recently, exploitation of the group ownership system of what mainly began as locally owned and locally operated radio stations, and the appropriateness of the current regulatory regime in the much altered media landscape of today. It uses original data derived from the ownership groups themselves to show the extent to which 'hubs' are routinely being used to increase profitability by making economies of scale, while also taking news journalism out of the editorial areas it is intended to cover. [ABSTRACT FROM AUTHOR]

Transoral laser microsurgery (TLM) represents an important treatment for selected laryngeal cancers. Utilisation of TLM, however, is highly variable between United Kingdom (UK) centres, and published data relating to its use in the UK is scarce. We report outcomes from our tertiary referral centre, and highlight lessons learned. Patients undergoing primary TLM for laryngeal cancer with curative intent (2007-2011) were studied retrospectively. Survival analyses were evaluated using the Kaplan-Meier method and log-rank statistics used to examine the influence of several variables. Overall, 170 cases were included-153 glottic and 17 supraglottic. Median follow-up was 39 months (range 14-79 months). Respective 3-year local control (LC), overall survival (OS), disease-specific survival (DSS), and disease-free survival were 92, 92, 98, and 86 % for glottic carcinomas. Three-year LC and OS were both 88 % for supraglottic carcinomas. For glottic cases, a significant impact of pT stage on DSS was observed, and of age on OS. Median hospital stay was one and 19 days for glottic and supraglottic cases respectively, with respective 3-year laryngeal preservation rates of 97 and 94 %, and tracheostomy rates of 0 and 29 %. One patient in the glottic group and four in the supraglottic group failed to regain swallowing function post-operatively, remaining either PEG dependent or undergoing functional total laryngectomy. Our series confirms the oncological and functional efficacy of TLM, offering a unique large-scale UK perspective. Our experience indicates, however, that treatment of larger supraglottic tumours should be considered carefully, as functional outcomes may be compromised. [ABSTRACT FROM AUTHOR]

Local studies of military service in the First World War have traditionally focused on ‘Pals’ or other units known to be linked to a specific area. However, the availability of new records online has revolutionized the way in which local studies can be carried out. A ‘military history from the street’ approach can now document and analyse service by all those from a local area who served. The article explains how such socio-military methods, as used in the author’s monograph on West Belfast (Belfast Boys, London, Continuum, 2009), can be adapted to other areas, with a particular focus on employment data not included in that study. [ABSTRACT FROM PUBLISHER]

The Times was a mid-nineteenth-century newspaper phenomenon, defeating rival London newspapers through its skilful management, advanced technology, greater editorial resources and access to powerful politicians. Its authority enabled it to make and break governments. However, the uniqueness of The Times limits its usefulness as a historical source. This article begins with a brief history of The Times, before analysing how the newspaper remains centre stage in the historiography of journalism and of nineteenth-century culture more broadly, despite the digitization of provincial and other London papers. Over-dependence on The Times, it argues, has exaggerated the significance of London daily newspapers and underplayed the importance of weekly papers, particularly those published outside London. The Times was unusual because it was a metropolitan rather than provincial paper, with a focus on political news and a dearth of lighter, broader content, or news of events around the UK. Using quantitative analysis of recent scholarship, the article demonstrates that unwarranted conclusions are still drawn from over-use of this source and from a wider view that it was representative of nineteenth-century newspapers in general. The conclusion urges a more geographically and culturally nuanced approach to Victorian newspapers, beyond a metropolitan-focused political and cultural history. [ABSTRACT FROM AUTHOR]

Debates surrounding the decarbonisation of energy systems in developed societies have been overlaid with controversy about the merits of decentralised or “community” energy. These are ambiguous concepts, implicating energy generation or demand reduction activities carried out in buildings or across neighbourhood or urban areas, as well as social and political aspects such as trust and communitarian relations amongst participating actors. This research was based on the criticism that most existing advocacy for, and research into decentralised energy (DE) has neglected the spatiality of such initiatives. In particular, the concept of “local” has been largely presumed to be self-evident and unproblematic. Drawing on the analysis of primary and secondary data from nine UK case studies, this study reveals the different degrees to which DE initiatives are locally embedded, dependent upon the sector of the instigating actors. Findings also reveal the multi-dimensionality of discourses of DE, going beyond purely physical or technical aspects to encompass social, spatial and political issues that are intertwined in complex patterns. In particular, it reveals how aspirations to “roll out” successful DE initiatives, consistent with broader policy goals for carbon reduction, are challenged by discourses of local uniqueness and “bottom-up” engagement. Future research is required to investigate the generalisability of the patterns observed. [ABSTRACT FROM PUBLISHER]

This study challenges the idea that women are less interested in politics than men by arguing that women are not less interested in politics but, rather, are interested in different issues. I decompose the concept of general political interest into interest in local, national and international issues and investigate gender differences in interest in these different issues, as well as in politics in general. Ordinary Least Squares (OLS) regression analyses, based on data collected in 2011 (British Participation Survey) on a representative sample of British citizens ( N = 1,353), reveal no substantial gender difference in interest in local issues. Once political efficacy is controlled for, however, women are more likely than men to be interested in local issues. Furthermore, women are less likely to be interested in national and international issues, as well as politics in general, than men. Further analyses demonstrate that part of the gap in general political interest may be explained by the fact that interest in politics is primarily understood as interest in national politics, an issue in which men are more likely to be interested than women. In summary, the results highlight the need to clarify the concept of 'politics' and to move towards the notion that women and men are interested in different issues, rather than the notion that women are less politically interested than men. [ABSTRACT FROM AUTHOR]

The emergence and organisation of amateur networks of observation in Britain in the period between 1920 and 1940 are addressed in this paper. It examines the geographical, organisational and epistemological associations between networks of ornithological observation (traced through the British Trust for Ornithology), which emerged from the 1920s. and amateur ethnography (traced through Mass-Observation) which emerged in the late 1930s. I approach these 'observational cultures' as spaces which brought together new concepts of the local, of everyday nature and society, as well as the possibilities of changing the everyday. The paper suggests that popular observation during the period partly constituted a refraining of ways of knowing Britain differentiated through the everyday production of natural and social knowledge and the construction of the active citizen and new communities of practice. [ABSTRACT FROM AUTHOR]

National data shows that the social class gap in higher education (HE) participation is narrowing. Local Aimhigher data explores where and how by creating complex statistical neighbourhood profiles that exploit the large amount of data accessible through the partnership. Baskets of data are used, drawn from Higher Education Statistics Agency (HESA) and Universities and Colleges Admissions Service (UCAS) data bought in by Aimhigher, progression tracking data from Connexions, and local authority and school data on attainment and pupil profiles. Through regular data reporting to partners and responding to local data requests, Aimhigher makes previously hidden trends visible to partners. Such data increases cross-sectoral understanding of the structures and issues in widening participation in schools, colleges and universities and enables inclusion of higher education progression in local educational strategies.With examples from the work of Aimhigherin Greater Manchester, this paper demonstrates how Aimhigher statistical research informs practice and institutional strategies. [ABSTRACT FROM AUTHOR]

This essay examines the use of space in Spenser's early pastoral work, The Shepheardes Calender. In a pastoral mode that has often been characterized by its literal stasis, space--and the movement through it--actually figures as a dynamic element of the poem's ecclesiastical and political satire; moreover, space becomes an important context for examining the poet's progression from a pastoral to an epic role. By grounding the characters in spaces that are both heavily allegorized and yet highly resonant with the reality of sixteenth-century England, Spenser creates a regional landscape that evokes the actual world around him. Finally, the essay suggests that we might better understand the development of the Calender's regional (or topographical) landscape as a precursor to Spenser's eventual development of a national (or chorographical) landscape in The Faerie Queene. [ABSTRACT FROM AUTHOR]

Our everyday shopping practices are increasingly marketed as opportunities to ‘make a difference’ via our ethical consumption choices. In response to a growing body of work detailing the ways in which specific alignments of ‘ethics’ and ‘consumption’ are mediated, we explore how ‘ethical’ opportunities such as the consumption of Fairtrade products are recognized, experienced and taken-up in the everyday. The ‘everyday’ is approached here via a specially commissioned Mass Observation directive, a volunteer panel of correspondents in the UK. Our on-going thematic analysis of their autobiographical accounts aims to explore a complex unevenness in the ways ‘ordinary’ people experience and negotiate calls to enact their ethical agency through consumption. Situating ethical consumption, moral obligation and choice in the everyday is, we argue, important if we are to avoid both over-exaggerating the reflexive and self-conscious sensibilities involved in ethical consumption, and, adhering to a reductive understanding of ethical self-expression. [ABSTRACT FROM AUTHOR]

This article summarises what the Department of Health's (2005) Delivering Race Equality (DRE) agenda in mental health services set out to achieve and the background to this. The article then provides commentary on the Central and North West London NHS Foundation Trust's experiences while acting as one of the 18 focused implementation sites (FIS) created as part of the Department of Health's five-year Delivering Race Equality Action Plan and highlights the recommendations that developed out of this work and have national application. [ABSTRACT FROM AUTHOR]

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The article presents a study which examined the spatial variation in species richness of littoral molluscan and algal species around the coast of Great Britain. It states that the study used sources such as the Marine Nature Conservation Review (MNCR) dataset and the British Phycological Society (BPS) dataset. The richness patterns of the species were subdivided using trend surface analysis (TSA). The study found that spatial patterns of molluscan and algal species richness were congruent. The coasts where both mollusks and algae species richness were diverse are along England and Scilly Isles. It adds that local species richness hotspots were identified on all coasts relative to the underlying trend.

This paper explores the relationship between changing forms of the governance of education and the growth and uses of data in the context of England - a context that can be described as the most 'advanced' in Europe in terms of data production and use. The paper links the shifting relations between the central department of education (variously known between the 1980s and the time of writing as the Department of Education and Science [DES], Department for Education and Skills [DfES] and the Department for Children, Schools and Families [DCSF]), the local education authorities and the schools to the growth and development of data-based systems of inspection and performance management, and suggests that the massive growth of data has unbalanced the relations of governing and created highly centralised system steering. Recent attempts to 'rebalance' steering through 'intelligent accountability' invoke network principles and self-regulation through self-evaluation, and thus give the appearance of deregulation, but the centre maintains control through its management and use of data, and local government remains peripheral. [ABSTRACT FROM AUTHOR]

Abstract: The effectiveness of institutional arrangements and policies for governance has become a key question within the sustainability paradigm, not least in coastal areas which have unique issues and jurisdictions across the land–sea interface. In the UK, approximately 60 non-statutory coastal management initiatives have been established at the local/regional level since the 1990s, based on a variety of programmes and projects. Proposals for a UK Marine Bill have raised questions about the role of non-statutory initiatives in the system of governance. The traditional sectoral approach to management and planning is being modified due to the pressure of increased human activities, but doubts exist about what effective contribution local and regional partnerships can make. The paper reports extensive examples of Integrated Coastal Management initiatives engaging institutions and society to produce outputs which have transformed management, promoting long-term, collaborative, participatory and ecologically sustainable approaches. The paper concludes that there are demonstrable benefits in taking a partnership approach to coastal management at a local level, yet these forms of planning and management are not widely accepted or embedded within the current system of governance. [Copyright &y& Elsevier]

Studies of extreme right party support typically eschew detailed local research. This article examines the recent development of the British National Party (BNP), currently the dominant representative of the British extreme right, and focuses specifically on two local case studies. Drawing on research into BNP voters and activists, the article highlights the role of perceived ethnic competition and threat as an important explanatory factor of BNP support. The article also draws attention to local circumstances and cultures that render some areas especially susceptible to exclusionistic forms of mobilization. The article ends by noting some broader implications for the study of contemporary extreme right parties. [ABSTRACT FROM AUTHOR]

An 'activism index', combining data on membership of civil associations and societies and the level of activism suggests that, notwithstanding cultural differences, civil activism in European countries could be a great deal higher than its current level. If higher civic participation is to be achieved, each stakeholder group within local governance can play an 'activation' role in relation to citizens, both as individuals and in relation to the voluntary organizations which represent citizens in their collective activities. In practice, different stakeholder groups play this role in widely differing ways in the contexts of Germany, Spain and the UK. In the future, we can expect the lead role in activating civil society in each country to be taken by different stakeholders, depending on the trust currently placed in them by other stakeholders in the community and by the resources which they command. [ABSTRACT FROM AUTHOR]

Since 1997 UK central government has launched a bewildering array of new initiatives known collectively as the 'local government modernizing agenda' which represent an ambitious attempt to transform the performance and the politics of local authorities in the UK. The aim is to improve local services, enhance community governance and increase public confidence in the institutions of local government. Some of the key elements of this agenda, notably attempts to persuade authorities to make greater use of markets, to encourage strategic management techniques and the reliance on external monitoring, draw heavily upon the New Public Management and build directly upon previous reforms. Others, in particular the emergence of a more diversified approach to regulation of local government, signal a new and distinctive approach to public service improvement. The result is a combination of multiple drivers of change and paradoxical 'operating codes' which reflect both the politics of the modernizing agenda and our current lack of understanding about which approaches will prove most effective in enabling performance improvement in the public sector. [ABSTRACT FROM AUTHOR]

Research studies of political communications at the local or constituency level are scarce. There are few detailed analyses of local newspapers' coverage of the constituency campaign or any systematic account of local journalists' attitudes towards election reporting. This paper seeks to redress this neglect by providing a longitudinal overview and analysis of local newspaper coverage of the local campaign in the 1987, 1992, 1997 and 2001 UK general elections. Drawing on the findings of a unique and extensive analysis of newspapers' election reporting, combined with detailed interviews with journalists, editors, politicians and their agents, the paper argues that while certain aspects of local newspapers' election coverage have declined recently, local journalists' commitments to reporting the election remain strong and coverage continues to be informative and wide ranging: indeed the findings suggest that on some grounds local press reporting of elections compares favourably with national press coverage. But in 2001 three significant changes in local coverage were evident. Reporting was: (1) markedly more locally oriented than in previous elections; (2) notably more disposed towards a "lighter" editorial emphasis preferring to focus on human interest stories about candidates than discussions of policy, and (3) finally, more partisan than previously with newspapers' overall "balance of partisanship" being replaced by a tendency to favour the Conservative Party above Labour - a trend strongly at variance with national newspapers' political sympathies. [ABSTRACT FROM AUTHOR]

AbstractMarketing food directly from producers to consumers, so circumventing the ‘middlemen’ in the food supply chain, has many potential benefits. For consumers, direct marketing initiatives are providing people with locally grown, fresh, healthy and, in many cases, organic food at affordable prices. Through buying locally grown produce, consumers are giving their support to local producers as well as helping to revitalize rural economies. Producers benefit through retaining more of the value of their produce, which can help them survive through the current crisis in UK farming. There are also environmental benefits. Creating markets where people can buy produce from local farmers and growers reduces the distance that food travels between producers and consumers, which in turn decreases global environmental pollution. One direct marketing scheme – the farmers’ market – has proved to be particularly popular with local people, producers and the local councils, organizations and institutions who are involved in setting them up. This paper focuses on one such market, the Stour Valley Farmers' Market, which commenced trading on 20th June 1999. Customers who attended the first three of these monthly markets were interviewed to investigate the reasons for their attendance at the market, and their attitudes towards a number of food issues including organic and genetically modified food, local and seasonal food and concerns they may have over the way their food is produced. The research has shown that most customers visited the markets initially out of curiosity, although some attended specifically to buy healthy fresh foods. The vast majority of interviewees expressed a preference for food which is organically grown and free from genetic modification. Organic foods are generally perceived to be healthier and more flavoursome. When buying fresh foods, interviewees stated the importance of quality and freshness in their choice of produce. [ABSTRACT FROM AUTHOR]

Introduction: Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes., Materials and Methods: A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. A dedicated nasal fracture clinic providing manipulation under local anaesthesia was implemented followed by a prospective study of all patients presenting to the clinic between February and November 2017. Main outcome measures included time from injury to otolaryngology assessment, time from injury to manipulation and incidence of secondary septorhinoplasty., Results: The retrospective series involved 525 patients including 381 males (72.6%) and 144 females (27.4%). Mean time from injury to assessment was 10 days. Mean time from injury to surgery was 14.5 days. Mean time from assessment to surgery was five days. The incidence of septorhinoplasty was 2.3%. The prospective series involved 119 patients including 78 males (65.5%) and 41 females (34.5%). Following implementation of a nasal fracture clinic, mean time from injury to assessment and manipulation was 6.1 days and 5.4% of patients underwent septorhinoplasty for secondary deformity., Discussion: Implementation of a nasal fracture clinic providing reduction under local anaesthesia reduced the time to assessment and manipulation. The incidence of septorhinoplasty is low following reduction under general or local anaesthesia. Assessment earlier than seven days is feasible and advice for referral can be changed accordingly.

This study investigates the substitution and complementary effects for beef mince attributes drawing on data from large choice experiments conducted in the UK and Spain. In both countries, consumers were found to be willing to pay a price premium for the individual use of the labels "Low Fat" (UK: €3.41, Spain: €1.94), "Moderate Fat" (UK: €2.23, Spain: €1.57), "Local" (UK: €1.54, Spain: €1.61), "National" (UK: €1.33, Spain: €1.37), "Organic" (UK: €1.02, Spain: €1.09) and "Low Greenhouse Gas Emissions (GHG)" (UK: €2.05, Spain: €0.96). The results showed that consumers in both countries do not treat desirable food attributes as unrelated. In particular, consumers in Spain are willing to pay a price premium for the use of the labels "Local", "Organic" and "Low GHG" on beef mince that is also labelled as having low or moderate fat content. By contrast, consumers in the UK were found to discount the coexistence of the labels "Low Fat" and "Organic", "Low Fat" and "Low GHG" and "Moderate Fat" and "Low GHG". The results, however, suggest that in the UK the demand for beef mince with moderate (low) fat content can be increased if it is also labelled as "Organic" or "Low GHG" ("Local").

Background: An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors., Methods: A prospective audit was undertaken over a 3-month period. Our practice was compared with evidence-based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti-inflammatory., Results: The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10 months in a row after implementation., Conclusion: Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention., (© 2018 John Wiley & Sons Ltd.)

Question In men with clinically localized prostate cancer, what is the comparative effectiveness of active monitoring, radical prostatectomy, and external-beam radiotherapy in terms of mortality? Methods Design Randomized controlled trial (Prostate Testing for Cancer and Treatment [ProtecT] trial). Current Controlled Trials ISRCTN20141297; ClinicalTrials.gov NCT02044172. Allocation Concealed.* Blinding Blinded* {questionnaire data entry staff and outcome assessors for cause of death}†. Follow-up period Median 10 years. Setting Screening population in the UK. Patients 1643 men 50 to 69 years of age (median age 62 y, median prostate-specific antigen [PSA] level 4.6 ng/mL) who received a diagnosis of localized prostate cancer after PSA screening. Intervention Active monitoring with PSA measurements every 3 months for 1 year, then every 6 to 12 months; patients were reviewed when PSA increased by > 50% in the past 12 months (n = 545); radical prostatectomy (n = 553); or radiotherapy with 3 to 6 months of neoadjuvant androgen-deprivation therapy plus 3-dimensional conformal radiotherapy, total dose 74 Gy in 37 fractions (n = 545). All groups were offered androgen-deprivation therapy at PSA levels > 20 ng/mL, or lower if indicated. Outcomes The primary outcome was prostate cancer mortality (death definitely or probably due to prostate cancer or its treatment). Secondary outcomes included all-cause mortality, metastases, and clinical progression. Patient follow-up 99% (intention-to-treat analysis). Main results 55% of men in the monitoring group received radical treatment by 10 years. The main results are in the Table. Groups did not differ for prostate cancer-related or all-cause mortality. Metastases and disease progression were higher in the monitoring group than in the prostatectomy or radiotherapy group. Compared with monitoring, 27 (95% CI 16 to 73)‡ and 33 (CI 18 to 147)‡ men would need to be treated with prostatectomy or radiotherapy, respectively, to avoid 1 additional patient with metastases, and 9 (7 to 13)‡ would need to be treated with prostatectomy or radiotherapy to avoid 1 additional patient with clinical progression. Conclusion In men with clinically localized prostate cancer, cancer-related mortality at 10 years did not differ with active monitoring, radical prostatectomy, or radiotherapy. Radical prostatectomy and radiotherapy reduced disease progression. [ABSTRACT FROM AUTHOR]

Question In men with clinically localized prostate cancer, what are the effects of active monitoring, radical prostatectomy, and external-beam radiotherapy on patient-reported outcomes? Methods Design Randomized controlled trial (Prostate Testing for Cancer and Treatment [ProtecT] trial). Current Controlled Trials ISRCTN20141297; ClinicalTrials.gov NCT02044172. Allocation Concealed.* Blinding Blinded* {questionnaire data entry staff and outcome assessors for cause of death}†. Follow-up period 6 years. Setting Screening population in the UK. Patients 1643 men 50 to 69 years of age (median age 62 y, median prostate-specific antigen [PSA] level 4.6 ng/mL) who received a diagnosis of localized prostate cancer after PSA screening. Intervention Active monitoring with PSA measurements every 3 months for 1 year, then every 6 to 12 months, with patient review when PSA increased by > 50% in the past 12 months (n = 545); radical prostatectomy (n = 553); or radiotherapy with 3 to 6 months of neoadjuvant androgen-deprivation therapy plus external-beam 3-dimensional conformal radiotherapy (total dose 74 Gy in 37 fractions) (n = 545). All groups were offered androgen-deprivation therapy at PSA levels > 20 ng/mL or lower, if indicated. Outcomes Outcomes were urinary, sexual, and bowel function, and health-related quality of life at baseline, 6 and 12 months, and annually from 2 to 6 years. Patient follow-up 86% (intention-to-treat analysis). Main results The main results are in the Table. Conclusion In men with prostate cancer, urinary function and sexual function over 6 years were worse with prostatectomy than with active monitoring or radiotherapy; bowel function at 6 months was worse with radiotherapy. Health-related quality of life did not differ among groups. [ABSTRACT FROM AUTHOR]

Background: The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM)., Methods: A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics., Results: Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%., Conclusion: To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263-1270, 2016., (© 2016 Wiley Periodicals, Inc.)