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Background and purpose -- The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs. Patients and methods -- The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/ reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and highvolume (≥ 30 UKRs/year). Results -- 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87--93), 93% (CI 91--95), and 96% (CI 94--97). 8-year reoperation survivals were 76% (CI 71--80), 81% (CI 78--85), and 84% (CI 82--86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95--97) and 81% (CI 80--83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3--2.9), 2.0 (CI 1.6--2.7), and 1.0 (CI 0.8--1.3) and for reoperation were 1.2 (CI 1.0--1.4), 0.9 (CI 0.8--1.0), and 0.6 (CI 0.5--0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR. Interpretation -- Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for midvolume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs. [ABSTRACT FROM AUTHOR]

In this paper, it is argued that the industrial revolution in eighteenth century Great Britain had its origins in the arrival of 100,000–140,000 Protestant refugees in England and Ireland in the sixteenth, seventeenth and eighteenth centuries. Specifically, it is argued that their arrival prompted both Schmooklerian pull and push factors. The pull factor was the thousands of refugee merchants and ship owners/captains to England and Ireland resulting in the creation of the Protestant International (1550-1750). This increased the demand for tradables which in turn spurred invention and innovation among refugees (push factor) and their descendants as well as in the local population. These factors were self-reinforcing, leading in time to the industrial revolution. The result is a novel account of the origins of the industrial revolution, one that is consistent with competing explanations. [ABSTRACT FROM AUTHOR]

Background: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. Methods: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. Results: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. Conclusions: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service. [ABSTRACT FROM AUTHOR]

Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS. [ABSTRACT FROM AUTHOR]

Background: Achieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death.Methods: We recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months. All services offered consultation on hospital wards, support for existing clinical teams, outpatient services and received funding from their National Health Service and/or relevant Insurance reimbursements. The New York service additionally had 10 inpatient beds. All worked with and referred patients to local hospices. Face-to-face interviews recorded most and least preferred place of death, treatment goal priorities, demographic and clinical information using validated questionnaires. Multivariable and multilevel analyses assessed associated factors.Results: One hundred and thirty eight older adults (64 London, 59 Dublin, 15 New York) were recruited, 110 died during follow-up. Home was the most preferred place of death (77/138, 56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (35/138, 25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between countries. Main associates with home preference were: cancer diagnosis (OR 3.72, 95% CI 1.40-9.90) and living with someone (OR 2.19, 1.33-3.62). Adults with non-cancer diagnoses were more likely to prefer palliative care units (OR 2.39, 1.14-5.03). Conversely, functional independence (OR 1.05, 1.04-1.06) and valuing quality of life (OR 3.11, 2.89-3.36) were associated with dying at home. There was a mismatch between preferences and achievements - of 85 people who preferred home or a palliative care unit, 19 (25%) achieved their first preference.Conclusion: Although home is the most common first preference, it is polarising and for 16% it is the least preferred. Inpatient palliative care unit emerges as the second most preferred place, is rarely least preferred, and yet was often not achieved for those who wanted to die there. Factors affecting stated preferences and met preferences differ. Available services, notably community support and palliative care units, require expansion. Contrasting actual place of death with capacity for meeting patient and family needs may be a better quality indicator than simply 'achieved preferences'. [ABSTRACT FROM AUTHOR]

The degree of mutual intelligibility of British Sign Language (BSL) regional varieties has been a subject of some debate. Recent research in which dyads of signers from contrasting regional backgrounds engaged in a conversational task showed no problems understanding one another. The present study investigated signers' knowledge of different BSL regional varieties. Twenty-five participants from Belfast, Glasgow, Manchester, and Newcastle took part in a computer-based lexical recognition task in which they had to identify the meaning of 47 color signs from various regions in the United Kingdom. The results indicate that overall signers have a poor knowledge of regional signs for colors when signs are presented in isolation and without mouthing. Furthermore, signers with deaf parents performed better in the recognition task than signers with hearing parents and varieties from London and Birmingham were easiest to recognize. This article discusses how signers cope with regional differences and considers the features that facilitate in the recognition of regional varieties in BSL. [ABSTRACT FROM AUTHOR]

Short-term linguistic accommodation has been observed in a number of spoken language studies. The first of its kind in sign language research, this study aims to investigate the effects of regional varieties in contact and lexical accommodation in British Sign Language (BSL). Twenty-five participants were recruited from Belfast, Glasgow, Manchester, and Newcastle and paired with the same conversational partner. Participants completed a "spot-the-difference" task which elicited a considerable amount of contrasting regionally specific sign data in the participant-confederate dyads. Accommodation was observed during the task with younger signers accommodating more than older signers. The results are interpreted with reference to the relationship between language contact and lexical accommodation in BSL, and address how further studies could help us better understand how contact and accommodation contribute to language change more generally. [ABSTRACT FROM AUTHOR]

This article argues for the blending of local, national, and transnational perspectives to explore comparative issues relating to asylum developments and provisions in New Zealand. It also aims to highlight some issues preoccupying authorities of the time and in doing so focuses on three key areas that generated comparative comment among medical officials in the nineteenth and twentieth centuries: asylum provision and funding, statistics, and forms of committal. These areas were of concern due to claims that insane patients were deliberately being shipped to New Zealand: that the colony had high admission and recovery rates; and that asylums in the colony were overcrowded. The findings presented here suggest that not only were certain aspects of New Zealand's asylum provision and population distinctive from the homelands, but there were also differences between asylums in the colony. [ABSTRACT FROM AUTHOR]

The UK has long experienced a shortage of social workers and has recruited internationally to meet demand. There have been few specific data quantifying the scale of social work mobility to the UK through which such experiences can be set in context. The analysis reported in this article uses data from October 2008, relating to registered social workers working in England. As part of a wider study of migrant social care workers in England, the article reports analysis of data records of over 7,000 non-UK social workers registered to work in England and compares their characteristics to UK-qualified social workers. These analyses are supplemented by analysis of more recent application and registration data from the General Social Care Council pertaining to social workers qualified within and outside the European Union during 2008 and 2009. The findings highlight several important observations in terms of non-UK-qualified social workers' profile as well as some possible trends in migration and variations in rates of qualification verification. Over half of all international social workers in England were trained in four countries: Australia, South Africa, India and the USA. Findings are contextualised with qualitative data obtained from the wider study and policy debates. [ABSTRACT FROM PUBLISHER]

The article discusses the debate over whether Ireland was a colony of the British Empire. The author discusses "Captain Colson," an Irish ballad which provides clues regarding the relationship between Ireland and the British Empire and notes revisionist and postcolonial divisions in historical views regarding British imperialism in Ireland. The article addresses the politicisation of the debate, examines author Tom Dunne's post-colonial analysis of Ireland and Great Britain's relationship and the contemporary implications of their earlier relationship.

This article reconsiders Thomas Carlyle's views on the crisis facing Ireland in the 1840s and British responses to it. It argues that while Carlyle saw this crisis as being related to difficulties facing contemporary 'English' society, he treated it as a distinctive manifestation of a malaise that afflicted all European societies. Carlyle's views on Ireland reflected the illiberal and authoritarian attitudes which underwrote his social and political thought, but they were not, as has sometimes been suggested, premised on anti-Irish prejudices derived from racial stereotypes. An examination of Carlyle's writings on Ireland demonstrate that he attributed the parlous state of that country in the 1840s to widespread failures in leadership and social morality that were not unique to the inhabitants of Ireland and were also to be found in England. Carlyle's works were not only admired by leading members of 'Young Ireland', but also generated ideas that framed their response to the economic, social, and political challenges facing Ireland. [ABSTRACT FROM AUTHOR]

The article examines the economic implications of cleaning in response to the flow of visitors through historic houses. The section reflects on work carried out in properties of the National Trust for England, Wales, and Northern Ireland, which is the largest accredited museum authority in the U.K., with 175 furnished properties open to visitors for seven months each year, on average five days per week and four to five hours a day. According to the study, although it describes how control of dust influences property management and housekeeping policies in the National Trust, the outcomes are applicable to historic properties in general and to museums and galleries where significant interiors and collections are exposed to dust.