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Extended pleurectomy decortication for complete macroscopic resection for pleural mesothelioma has never been evaluated in a randomised trial. The aim of this study was to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. MARS 2 was a phase 3, national, multicentre, open-label, parallel two-group, pragmatic, superiority randomised controlled trial conducted in the UK. The trial took place across 26 hospitals (21 recruiting only, one surgical only, and four recruiting and surgical). Following two cycles of chemotherapy, eligible participants with pleural mesothelioma were randomly assigned (1:1) to surgery and chemotherapy or chemotherapy alone using a secure web-based system. Individuals aged 16 years or older with resectable pleural mesothelioma and adequate organ and lung function were eligible for inclusion. Participants in the chemotherapy only group received two to four further cycles of chemotherapy, and participants in the surgery and chemotherapy group received pleurectomy decortication or extended pleurectomy decortication, followed by two to four further cycles of chemotherapy. It was not possible to mask allocation because the intervention was a major surgical procedure. The primary outcome was overall survival, defined as time from randomisation to death from any cause. Analyses were done on the intention-to-treat population for all outcomes, unless specified. This study is registered with ClinicalTrials.gov , NCT02040272 , and is closed to new participants. Between June 19, 2015, and Jan 21, 2021, of 1030 assessed for eligibility, 335 participants were randomly assigned (169 to surgery and chemotherapy, and 166 to chemotherapy alone). 291 (87%) participants were men and 44 (13%) women, and 288 (86%) were diagnosed with epithelioid mesothelioma. At a median follow-up of 22·4 months (IQR 11·3–30·8), median survival was shorter in the surgery and chemotherapy group (19·3 months [IQR 10·0–33·7]) than in the chemotherapy alone group (24·8 months [IQR 12·6–37·4]), and the difference in restricted mean survival time at 2 years was –1·9 months (95% CI –3·4 to –0·3, p=0·019). There were 318 serious adverse events (grade ≥3) in the surgery group and 169 in the chemotherapy group (incidence rate ratio 3·6 [95% CI 2·3 to 5·5], p<0·0001), with increased incidence of cardiac (30 vs 12; 3·01 [1·13 to 8·02]) and respiratory (84 vs 34; 2·62 [1·58 to 4·33]) disorders, infection (124 vs 53; 2·13 [1·36 to 3·33]), and additional surgical or medical procedures (15 vs eight; 2·41 [1·04 to 5·57]) in the surgery group. Extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable pleural mesothelioma, compared with chemotherapy alone. National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/188/31), Cancer Research UK Feasibility Studies Project Grant (A15895). [ABSTRACT FROM AUTHOR]

This paper underlines the difficulties of working with looked after children and their carers. The author discusses a particular approach to respond to the complexity of looked after children's emotional difficulties, and their impact on the network of professionals making decisions about their life in care. As their own parents are no longer in a position to take responsibility for them, their trauma and past abuse make for a lack of clarity amongst this network when establishing the responsible role in loco parentis. In order to provide effective therapeutic work with these children, it is crucial to consider their disturbance as affecting the network around them. Enabling the network to understand and process powerful feelings around the child enhances its self-reflective function, so crucial for thinking about the child's needs and emotional development.

This article goes into a critical analysis of the concept of employability, its development across historical periods, its components, and different strategic approaches to enhance workers' employability throughout their career. Given the need for a systematic analysis and more empirical research in the field, the authors come up with the so-called employability-link model that is aimed to guide future practitioners and researchers as far as their specific choices as regard core components of the concept that ought to be made. The article concludes with a thorough onset of possible future research questions that are assumed to be of importance given the current labor market situation. The employability-link model has implications for individual and organizational career interventions aimed at increasing life-long employability. (Contains 1 table and 1 figure.)

Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli's claim that 'an affordable basic income would be inadequate, and an adequate basic income would be unaffordable'. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the seasonal training load completed by professional soccer players of the English Premier League. Methods: Thirty players were sampled (using GPS, heart rate, and rating of perceived exertion [RPE]) during the daily training sessions of the 2011-12 preseason and in-season period. Preseason data were analyzed across 6 x 1-wk microcycles. In-season data were analyzed across 6 x 6-wk mesocycle blocks and 3 x 1-wk microcycles at start, midpoint, and end-time points. Data were also analyzed with respect to number of days before a match. Results: Typical daily training load (ie, total distance, high-speed distance, percent maximal heart rate [%HR max], RPE load) did not differ during each week of the preseason phase. However, daily total distance covered was 1304 (95% CI 434-2174) m greater in the 1st mesocycle than in the 6th. %HRmax values were also greater (3.3%, 1.3-5.4%) in the 3rd mesocycle than in the first. Furthermore, training load was lower on the day before match (MD-1) than 2 (MD-2) to 5 (MD-5) d before a match, although no difference was apparent between these latter time points. Conclusions: The authors provide the 1st report of seasonal training load in elite soccer players and observed that periodization of training load was typically confined to MD-1 (regardless of mesocycle), whereas no differences were apparent during MD-2 to MD-5. Future studies should evaluate whether this loading and periodization are facilitative of optimal training adaptations and match-day performance. [ABSTRACT FROM AUTHOR]

Background: Digital retinal imaging is the gold standard technique for diabetic retinopathy (DR) and diabetic macular oedema (DME) assessment during DR screening. Objectives: To evaluate the diagnostic accuracy of digital retinal fundus image (DRFI) analysis in detecting DME using three manual grading systems (MGS) and comparing it with optical coherence tomography (OCT) findings. Method: A total of 287 DRFI of 287 eyes were analysed. Non-stereoscopic 45° images were acquired using a Kowa VX-20 camera and were graded according to three MGS: Early Treatment Diabetic Retinopathy Study (ETDRS), International Clinical Diabetic Retinopathy (ICDR), and United Kingdom National Screening Committee (UKNSC). The two graders were masked to the patient's clinical DR status. DME characteristics were analysed using OCTs. Results: A very good agreement in detecting DME was found with Cohen's κ = 0.83 (ICDR vs. ETDRS), κ = 0.83 (ICDR vs. UKNSC), and κ = 0.82 (ETDRS vs. UKNSC). Sensitivity and specificity of DRFI analysis in DME assessment were 70.0 and 69.6% for UKNSC, 71.9 and 67.4% for ETDRS, and 70.9 and 65.2% for ICDR, respectively. Positive and negative predictive values were 91.7 and 32.7% for UKNSC, 91.4 and 33.3% for ETDRS, and 90.7 and 31.9% for ICDR, respectively. On OCT scans, micro-architectural damages of both inner and outer retinal layers and mean ganglion cell layer thickness showed a significant association with the presence of DME detected with DRFI analysis. Conclusions: Despite the low negative predictive value, the good specificity and sensitivity of DRFI in detecting DME make it a useful tool in a routine clinical setting, and its potential in diabetic eye screening is yet to be realized. [ABSTRACT FROM AUTHOR]

Effect of transcatheter aortic valve implantation vs. surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis: a randomized clinical trial. The primary outcome occurred in 21 patients (4.6%) in the TAVI group and in 30 patients (6.6%) in the SAVR group, with an adjusted absolute risk difference of -2.0% (one-sided 97.5% CI: - to 1.2%, P < 0.001 for noninferiority). [Extracted from the article]

Several commentators have argued that the short-term advantage of vocational versus academic education, which is a smoother school-to-work transition, trades off with long-term disadvantages,which are lower employment and/or lower wages. Using data based on the careers of individuals born in the United Kingdom in 1958, we find evidence of a trade-off, but only for real wages and only for the group with lower vocational education. These results are confirmed when the careers of individuals born in 1970 are examined. The presence of a trade-off does not imply, however, that individuals with vocational education have lower long-term utility. [ABSTRACT FROM AUTHOR]

The article retraces the steps employed by the European Union to mitigate the risk arising across Member States from financial collateral arrangements, especially in a cross-border context. In this respect it draws attention to the rationale of the Financial Collateral Directive (FCD) and, after more than a decade, it analyses the extent to which the FCD has succeeded in achieving its objectives. In particular, the article studies the deadlocks in implementation of the FCD in the UK under the Financial Collateral Arrangements (No 2) Regulations 2003 in order to illustrate the unresolved legal uncertainties. The article draws attention also to the various strategies set forth and partially undertaken by the international community to overcome the lack of full harmonisation by stressing the importance of the flexible “place of the relevant intermediary approach” (PRIMA) rule on conflict of laws. Yet, despite the efforts, most of the legal flaws are far from being fixed at international, EU, and even domestic level. [ABSTRACT FROM PUBLISHER]

This paper addresses the make-up and the limitations of a multi-level governance approach in tackling issues of fuel poverty and energy transition connected to poverty in England. Although the English planning framework offers unparalleled opportunities for innovative governance arrangements, and although much has been done in this area by national and local authorities, there are important limitations to how English cities are tackling fuel poverty and energy transition in a context of energy transition coupled with deprivation. The case analysed is an archetypical formerly industrial city dealing with socio-economic and spatial regeneration issues and transferable lessons can be learned. The questions addressed in this paper are: How does a former industrial city in Northwestern Europe deal with energy transition in the face of relatively high levels of deprivation? What is the governance of energy transition in the case and how does it help deprived citizens achieve energy security, if at all? This paper relies on extensive fieldwork research, interviews with several stakeholders and policy analysis carried out for the 7th Framework PLEEC Project (Planning for Energy Efficient Cities). Preliminary conclusions point at the failing of governance arrangements to include vulnerable actors and the inadequacy of solutions found for deprived or vulnerable households in the renting sector. [ABSTRACT FROM AUTHOR]

This paper investigates the initial market reactions to the February 2022 military escalation. We provide an overview while discriminating for different investment classes, shining light on the intensity of the geopolitical risk and on potential hedging properties of specific assets (such as gold and Bitcoin). Results deliver preliminary evidence supporting a more pronounced effect in the Eurozone and the UK stock markets, while gold and bitcoin showcase their resilience to war-induced negative economic effects. • The initial market reactions to the 2022 military escalation are analyzed. • A more pronounced effect in the Eurozone and the UK stock market is evident. • Gold and cryptocurrencies exhibit hedging properties. • Future research might shine more light on the resilience of cryptocurrencies. [ABSTRACT FROM AUTHOR]

Opioid abuse has become a public health concern among many developed countries, with policymakers searching for strategies to mitigate adverse effects on population health and the wider economy. The United Kingdom has seen dramatic increases in opioid-related mortality following the financial crises in 2008. We examine the impact of spending cuts resulting from government prescribed austerity measures on opioid-related hospitalisations and mortality, thereby expanding on existing evidence suggesting a countercyclical relationship with macroeconomic performance. We take advantage of the variation in spending cuts passed down from central government to local authorities since 2010, with reductions in budgets of up to fifty percent in some areas resulting in the rescaling of vital public services. Longitudinal panel data methods are used to analyse a comprehensive, linked dataset that combines information from spending records, official death registry data and large administrative health care data for 152 local authorities (i.e. , unitary authorities and county councils) in England between April 2010 and March 2017. A total of 280,827 people experienced a hospital admission in the English National Health Service because of an opioid overdose and 14,700 people died from opioids across the study period. Local authorities that experienced largest spending cuts also saw largest increases in opioid abuse. Interactions between changes in unemployment and spending items for welfare programmes show evidence about the importance for governments to protect populations from social-risk effects at times of deteriorating macroeconomic performance. Our study carries important lessons for countries aiming to address high rates of opioid abuse, including the United States, Canada and Sweden. • Opioid abuse is increasing globally with adverse impacts on health and economies. • More people consume opioids when macroeconomic performance declines. • Austerity measures were associated with opioid abuse through social-risk effects. • Policymakers should avoid regressive policies to address opioid epidemics. [ABSTRACT FROM AUTHOR]

Background: An association between social disadvantage and established psychosis is well documented in the literature, but there remains a lack of data on the social circumstances of patients before they became ill. We investigated whether social disadvantage at, and prior to, first contact with psychiatric services, is associated with psychosis. Method: We collected information on social disadvantage in childhood and adulthood from 278 cases presenting with their first episode of psychosis to the South London and Maudsley National Health Service Foundation Trust and from 226 controls recruited from the local population. Three markers of childhood social disadvantage and 3 markers of disadvantage in adulthood were analyzed. Results: Long term separation from, and death of, a parent before the age of 17 years were both strongly associated with a 2- to 3-fold-increased odds of psychosis. Cases were also significantly more likely to report 2 or more markers of adult social disadvantage than healthy controls (OR = 9.03) at the time of the first presentation with psychosis, independent of a number of confounders. When we repeated these analyses for long-standing adult social disadvantage, we found that the strength of the association decreased but still remained significant for 1 year (OR = 5.67) and 5 years (OR = 2.57) prior to the first contact. Conclusions: Social disadvantage indexes exposure to factors operating prior to onset that increase the risk of psychosis, both during childhood and adulthood. [ABSTRACT FROM PUBLISHER]

The article assesses the potential of remplissage repair in prevention of recurrent shoulder instability. A survey was made on the patients suffering from Hill-Sachs and Bankart lesions, who were then evaluated based on remplissage and Bankart repair. It led to significant improvement of active forward elevation and internal rotation compared with baseline assessment. It concludes that remplissage enables the surgeon to address large humeral defects with a low postoperative recurrence.

As the title of the book suggests, Kuo traces the roots of programmatic parties to changes in the organization of the capitalist class. Rather, as Kuo argues, it was shaped by the relative timing of party and business organization. Similarly, a content analysis of party platform planks (e.g., Gerring [2]) could have strengthened the book's claims about the link between business demands and the styling of party positions. [Extracted from the article]

In this article the author looks at the prostates of patients with bladder cancer in Great Britain. He states that prostate and bladder cancer occuring together in the same individual is considered common. In conclusion, it mentions that candidates for prostrate-sparing surgery it is reasonable to include a routine prostate biopsy.

The authors discuss the public service trilemmas associated with the launch of the U.S. Patient Protection and Affordable Care Act or Obamacare and the implementation of the Universal Credit welfare reform in Great Britain. They argue that the mix of increasing demands for public services, austerity and a culture of accountability has made public policy governance increasingly prone to critical system failures. They cites ways to address the issues of capacity and the culture of accountability.

Introduction: Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes., Methods: The US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables., Results: 15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25-75) was significantly associated with a lower survival (OR 4×10 4 , 95% CI 1.61×10 4 to 110.6×10 4 , p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001)., Conclusions: Presence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)