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Background: Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. Aims: This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian et al. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. Methods & Procedures: Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post‐recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. Outcomes & Results: Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. Conclusions & Implications: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long‐term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined. WHAT THIS PAPER ADDS: What is already known on the subject: The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge: A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work?: Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. [ABSTRACT FROM AUTHOR]

Genuine engagement about how best to achieve liveable urban futures should be part of planning's raison-d'etre but it has a chequered history of delivery. Exhibitions harnessing the communicative power of mixed media and linked to a progressive and responsive programme of focused discussion and debate remain relevant to community consultation and civic engagement. Terry Farrell's concept of the 'urban room' to involve citizens in engaging with the past, present, and future of towns and cities offers a contemporary refreshment of the approach propounded by Patrick Geddes from the early 1900s. The possibilities of creating novel and compelling opportunities for civic discourse in this guise are explored in this review article though the Newcastle City Futures pop-up exhibition and events held in Newcastle upon Tyne, UK in 2014. This event carries lessons for imagining how planners, developers, governments, and community groups may come together to critically and creatively forge future propositions for the urban condition. [ABSTRACT FROM AUTHOR]

Successive attempts to reform planning practice in England have given rise to an impression that planning is “under attack”. Various academic commentaries have performed the valuable service of cataloguing aspects of this reform agenda, often within the context of the analytical framework offered by neoliberalization. In this paper, we seek to chronicle the cumulative effects of the sustained programme of neoliberalization to which urban and environmental planning has been subjected in England over a period spanning approximately the last 15 years. In doing so, we hope to show why planning has been such an intractable issue for all governments that have sought its reform irrespective of the particularities of their political agenda. [ABSTRACT FROM AUTHOR]

Of all the Reformation theologians, John Calvin exerted arguably the most influence on the English Puritans. at did not mean, however, that his theology was uncritically accepted. is chapter considers the reception of Calvin's theology at the Westminster Assembly on two doctrines that were debated among the Westminster divines, namely, the eternal generation of the Son of God and the so-called descent of Christ into Hell. Calvin's somewhat unique position on the Son's aseity and his interpretation of Christ's descent were considered by the Assembly, but ultimately rejected by the majority, though not all, of the Westminster divines. Nevertheless, the Westminster documents are not quite detailed enough to contradict Calvin's position on the Son's aseity, but the Larger Catechism definitely departs from Calvin's teaching on Christ's descent into Hell. Moreover, the relation of the Apostles' Creed and Nicene Creed to Reformed theology in the sixteenth and seventeenth centuries also comes under consideration in this chapter. [ABSTRACT FROM AUTHOR]

This paper offers a critical examination of London's governmental and planning structures and its commitments to creating a sustainable city. Governing a world city like London has always been a difficult process. Legislative commitments to address London's sustainable future have sometimes been undermined by different policy interpretations by different key players over different time periods. This has created a fluid and diverse structure of governance that enables short-term policy shifts but which threatens longer term strategic sustainability policy commitments. These interpretations have occurred against an ongoing and contentious political debate over powers and responsibilities between different scales of the state, and the rights to make key decisions affecting London's future. This has resulted in a policy and governmental structure that is highly dependent on negotiation and compromise and one that employs a variety of policy tools, information and persuasion, financial incentives, and collaboration, to achieve a balanced form of governance. This flexible arrangement enables divergent public attitudes towards sustainability and climate change to be harnessed but may not deliver long term urban sustainability. [ABSTRACT FROM AUTHOR]

Community-led parish planning - both process and product - can play an important part in rural spatial planning, acting as a focus for community capacity-building and ultimately helping broader spatial strategies to reflect the goals and aspirations of local communities, whilst ensuring that these same strategies have a clear spatial dimension. Drawing on research that explores the nature of the spatial planning approach in England, and on a case study in the borough of Tonbridge and Malling, we consider how successfully parish plans are being aligned with broader statutory planning processes at a more strategic (district or borough-wide) level, given that they inevitably deal with very local issues and goals, and are not necessarily framed within the limits of planning intervention. In particular, and drawing on the work of other researchers in this area, we consider the extent to which parish plans should be formally integrated with spatial plans (i.e. LDF), as opposed to being put into these plans - and other strategies - through more flexible 'bridging' approaches. [ABSTRACT FROM AUTHOR]

The current round of local government modernisation in England, which commenced in 1997, has focused primarily on three main areas-new council constitutions, e-government, and performance. However, a fourth strand of initiatives relates to the power of well-being and the duty to prepare a community strategy, in partnership with a local strategic partnership. Academic commentators and planners, who have been focusing on the proposed UK planning reforms as contained within the Planning and Compulsory Purchase Act (passed in 2004), have largely ignored the development of this strand. In this paper we explore these aspects of the local government modernisation agenda for planners and pull out some of the key issues for comparison in the ownership, role, and development of the new plans: community strategies and development plans. Opportunities and difficulties of ensuring that new development plans become the spatial expression of community strategies is assessed through an illustration of the relationship between the London Borough of Camden's community strategy and its unitary development plan. Following a review of the content of both documents, wider assessments are drawn out and we conclude by debating the implications of and challenges for a future reformed planning system at the local level. [ABSTRACT FROM AUTHOR]

The impacts of second homes in the English countryside have concerned academics and policy makers since at least the 1960s. Often they are thought of as one of the numerous drivers of social exclusion in the countryside, and this has prompted periodic assessments of how changing policy frameworks might be used to address the 'second home problem'. Mark Shucksmith's 1983 paper — 'Second homes: a framework for policy' — was the first comprehensive attempt to link the repercussions of second home concentrations with potential policy responses. This current paper updates Shucksmith's framework, drawing on recent work for the Countryside Agency in England, and argues that both planning powers and fiscal controls should be directed at assisting communities affected by second home concentrations. [ABSTRACT FROM AUTHOR]

Examines the implementation of housing policy in rural England and Wales, and the willingness and capacity of local authorities to use the policies to deliver affordable housing. Critical differences in the way planning authorities use existing mechanisms; Policy context in England and Wales; Barriers common to all rural authorities and how these barriers may be overcome.

Studies the role of advice and training support agencies in the development of small businesses in West Yorkshire, England. Magnitude of use of support services by small firms; Small business owners' perception and satisfaction with support services; Training requirements of small firms.

Focuses on the effect of monetarist experiment to the economic condition of England. Indication of extreme deflation; Increase in unemployment rate; Decline in national and manufacturing output.

Background: In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim of understanding awareness and support of the change. This paper analyses the free-text responses from the survey., Methods: The #options survey was registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992] 14 February 2020, and was completed between July and December 2020 across NHS organisations in the North-East and North Cumbria, and North Thames. The survey contained 16 questions of which three were free-text, covering reasons against, additional information required and family discussions. The responses to these questions were thematically analysed., Results: The #options survey received 5789 responses from NHS staff with 1404 individuals leaving 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses (66%), followed by those against the legislation (19%), and those requiring more information (15%). Analysis revealed six main themes with 22 sub-themes., Conclusions: The overall #options survey indicated NHS staff are supportive of the legislative change. Analysis of the free-text responses indicates that the views of the NHS staff who are against the change reflect the reasons, misconceptions, and misunderstandings of the public. Additional concerns included the rationale for the change, informed decision making, easy access to information and information regarding organ donation processes. Educational materials and interventions need to be developed for NHS staff to address the concepts of autonomy and consent, organ donation processes, and promote family conversations. Wider public awareness campaigns should continue to promote the positives and refute the negatives thus reducing misconceptions and misunderstandings., Trial Registration: National Institute of Health Research (NIHR) [IRAS 275992]., (© 2024. The Author(s).)

Background: Since 2013, badger culling has been part of the UK Government's strategy for controlling bovine tuberculosis (bTB) within a high-risk area (HRA) in England. Government surveillance data now enables an examination of bTB herd incidence and prevalence, its headline indicators, within and outside cull areas over the period 2009-2020., Methods: Analysis compared herd incidence and prevalence data from within and outside badger culling areas. A range of models (GLMs, GLMMs, GAMs and GAMMs) were used to analyse incidence and prevalence in culled and unculled areas using frequentist and Bayesian approaches. Change in incidence across ten county areas within the HRA for the period 2010-2020 was also compared., Results: Analyses based on Defra published data using a variety of statistical methodologies did not suggest that badger culling affected herd bTB incidence or prevalence over the study period. In 9 of 10 counties, bTB incidence peaked and began to fall before badger culling commenced., Limitations: There are limitations around the data available on culling location, temporal information and other confounding factors. As such, further analysis of any future datasets that may be released on bTB levels in areas where badger culling has been implemented is warranted., Conclusion: This examination of government data obtained over a wide area and a long time period failed to identify a meaningful effect of badger culling on bTB in English cattle herds. These findings may have implications for the use of badger culling in current and future bTB control policy., (Veterinary Record© 2022 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

This paper reports findings from online, continuous monitoring of dissolved and gaseous nitrous oxide (N₂O), combined with dissolved oxygen (DO) and ammonia loading, in a full-scale nitrifying activated sludge plant. The study was conducted over eight weeks, at a 210,000 population equivalent sewage treatment works in the UK. Results showed diurnal variability in the gaseous and dissolved N₂O emissions, with hourly averages ranging from 0 to 0.00009 kgN₂O-N/h for dissolved and 0.00077-0.0027 kgN₂O-N/h for gaseous nitrous oxide emissions respectively, per ammonia loading, depending on the time of day. Similarly, the spatial variability was high, with the highest emissions recorded immediately after the anoxic zone and in the final pass of the aeration lane, where ammonia concentrations were typically below 0.5 mg/L. Emissions were shown to be negatively correlated to dissolved oxygen, which fluctuated between 0.5 and 2.5 mgO₂/L, at the control set point of 1.5 mgO₂/L. The resulting dynamic DO conditions are known to favour N₂O production, both by autotrophic and heterotrophic processes in mixed cultures. Average mass emissions from the lane were greater in the gaseous (0.036% of the influent total nitrogen) than in the dissolved (0.01% of the influent total nitrogen) phase, and followed the same diurnal and spatial patterns. Nitrous oxide emissions corresponded to over 34,000 carbon dioxide equivalents/year, adding 13% to the carbon footprint associated with the energy requirements of the monitored lane. A clearer understanding of emissions obtained from real-time data can help towards finding the right balance between improving operational efficiency and saving energy, without increasing N₂O emissions., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: The use of an open vein harvesting (OVH) technique for saphenous vein harvesting (SVH) is associated with wound complications and delayed patient mobilization. This has led to the development of minimally invasive vein harvesting (MIVH) techniques, such as standard bridging and endoscopic SVH (EVH). This randomized trial was established to assess immediate clinical outcome and patient satisfaction in our centre., Methods: A total of 150 consecutive patients were prospectively randomized into three groups. Group 1 consisted of 50 patients who underwent OVH, Group 2 consisted of 50 patients who underwent a standard bridging technique (SBT) and Group 3 consisted of 50 patients who underwent EVH. Each group was assessed for the incidence of wound infection, postoperative pain and satisfaction and the number of vein repairs using previously validated scoring systems., Results: The MIVH techniques reduced the pain at hospital (P < 0.001) and at 6 weeks (P < 0.001), and improved cosmesis (P < 0.001), compared with the OVH group. Patient satisfaction was greatest in the EVH group followed by the SBT and then the OVH group. The clinical markers of inflammation were reduced with an MIVHt. There were more vein repairs in the EVH compared with the OVH (P < 0.001) and the SBT (P = 0.04) groups., Conclusions: This study demonstrates that MIVH reduces wound morbidity. We believe that each technique has advantages and disadvantages, which should be considered during the selection of a harvesting procedure by both the patient and the surgeon.

The UK has been reported to have the lowest resection and survival rates for lung cancer patients. These reports were based largely on retrospective data from the cancer registry and are now outdated. To monitor the present day surgical resection rate at our institution all newly diagnosed cases of lung cancer presenting to us were enrolled into a prospective tracking study. From September 2003 to March 2005 all suspected primary lung cancer referrals to the North West Lung Centre were tracked to identify patients with newly diagnosed lung cancer. The histology of 247 patients confirmed to be new lung cancer cases were small cell (SCLC), non-small cell (NSCLC) and mixed cancers in 33 (16%), 170 (83.5%) and 1 (0.5%) patients, respectively, while 43 patients had no histological confirmation. Overall, 43 patients (17%) underwent surgery while chemotherapy and radiotherapy were used in 91 (38%) and 43 (17%), respectively. Out of 170 confirmed NSCLC patients, 43 (25%), 65 (38%) and 27 (16%) patients underwent surgery, chemotherapy and radiotherapy, respectively. The remaining 35 (20%) did not receive any treatment because of patient wishes or poor condition. The surgical resection rates were 17% for all lung cancers and 25% for NSCLC. Current surgical resection rates at the South Manchester University Hospital are comparable to international standards. Similar data from the rest of the UK are required to determine the national resection rate, which may not be as low as once thought to be.

Objectives: To study changes in coronary artery surgery practice in the years spanning publication of cardiac surgery mortality data in the UK., Methods: A retrospective analysis of prospectively collected data from all National Health Service centres undertaking adult cardiac surgery in northwest England was carried out. Patients undergoing coronary artery surgery for the first time between April 1997 and March 2005 were included. Changes in observed, predicted and risk adjusted mortality (EuroSCORE) were studied. Evidence of risk-averse behaviour was looked for by examining the number of patients at low risk (EuroSCORE 0-5), high risk (6-10), and very high risk (11 or more), before and after public disclosure., Results: 25,730 patients underwent coronary artery surgery during the study period. The observed mortality decreased from 2.4% in 1997-8 to 1.8% in 2004-5 (p = 0.014). The expected mortality (EuroSCORE) increased from 3.0 to 3.5 (p<0.001). The observed to expected mortality ratio decreased from 0.8 to 0.51 (p<0.05). The total number and percentage of patients who were at low risk, high risk and very high risk was 2694 (84.6%), 449 (14.1%) and 41 (1.3%) before and 2654 (81.7%), 547 (16.8%) and 47 (1.4%) after public disclosure, respectively, demonstrating a significant increase in the number and proportion of high risk patients undergoing surgery (p<0.001)., Conclusions: Publication of cardiac surgery mortality data in the UK has been associated with decreased risk adjusted mortality on retrospective analysis of a large patient database. There is no evidence that fewer high risk patients are undergoing surgery because mortality rates are published.

Objective: As little is known about the impact of non-dialysis-dependent renal dysfunction on short- and mid-term outcomes following coronary surgery we have conducted a large multi-centre study comparing patients with no history of renal dysfunction to those with preoperative renal dysfunction., Methods: Data was prospectively collected on 19,625 consecutive patients undergoing isolated coronary surgery between 1997 and 2003 from four institutions. Sixty-seven patients had a history of dialysis support prior to coronary surgery, and were excluded from the main analysis of the study. The remaining 19,558 patients were divided into two groups based on preoperative serum creatinine level, patients with preoperative renal dysfunction with serum creatinine levels >200 micromol/L without dialysis support and control patients with preoperative serum creatinine levels <200 micromol/L. Case-mix was accounted for by developing a propensity score, which was the probability of belonging to the non-dialysis-dependent renal dysfunction group, and included in the multivariable analyses., Results: There were 19,172 patients with preoperative serum creatinine levels <200 micromol/L and 386 patients with serum creatinine levels >200 micromol/L without dialysis support. The propensity score included sex, body mass index, co-morbidity factors (respiratory disease, diabetes, cerebrovascular disease, hypertension, and hypercholesterolemia), ejection fraction, left main stem stenosis, emergency status, prior cardiac surgery, off-pump surgery, and the logistic EuroSCORE. After adjusting for the propensity score, patients with preoperative non-dialysis-dependent renal dysfunction had significantly higher in-hospital mortality (adjusted odds ratio 3.0, p < 0.001), stroke (adjusted odds ratio 2.0, p = 0.033), atrial arrhythmia (adjusted odds ratio 1.5, p = 0.003), prolonged ventilation (adjusted odds ratio 2.1, p < 0.001), and post-op stay > 6 days (adjusted odds ratio 2.6, p < 0.001). One thousand one hundred and eighty-three (6.1%) deaths occurred during 58,062 patient-years follow-up. After adjusting for the propensity score, the adjusted hazard ratio of mid-term mortality for non-dialysis-dependent renal dysfunction was 2.7 (p < 0.001)., Conclusions: Patients undergoing coronary surgery with non-dialysis-dependent renal dysfunction have significantly increased perioperative morbidity and mortality. Mid-term survival is also significantly reduced at 5-years.

Despite a high incidence of renal failure, disproportionately fewer Indo-Asians in the United Kingdom receive a renal transplant, in part because of the high prevalence of blood group B. It is now clear that it is possible to safely transplant kidneys from donors with blood group A of the subtype A2 into recipients with blood group B if the latter have low titers of anti-A antibodies. We measured the anti-A titers in 25 Indo-Asian patients on dialysis being considered for transplantation and found stably low titers in all. Titers were comparable to those found in a control white population with blood group B. In addition, in a complement-dependent cytotoxicity crossmatch against group A lymphocytes, the only positive results were obtained in those with high preexisting panel reactivity (i.e., because of the presence of preformed anti-human leukocyte antigen antibodies). We conclude that there are grounds for investigating this approach further to solve the ethnic disparity in rates of transplantation.

Objective: As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons' mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk., Design: Retrospective analysis of prospectively collected data., Setting: All NHS centres in the geographical north west of England that undertake cardiac surgery in adults., Participants: All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002., Main Outcome Measures: Surgeon specific postoperative mortality and predicted mortality by EuroSCORE., Results: 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients., Conclusions: It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.