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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]

Background: Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged >50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures. Aim: To explore if bone health assessment (BHA) rates differ between women and men aged =50 years with fragility fracture risk factors. Design & setting: A primary care-based cohort study in North Staffordshire, UK. Method: Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls, and prolonged steroid use). Evaluation of BHA within 12 months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX and QFracture), bone density measurement, specialist service referral, or if bone-protection medication was started. Results: A total of 15 581 patients with risk factors were identified; men represented 40.4% of the cohort. The study found 1172 (7.5%) had BHA performed within 1 year of presentation, and 8.9% of women and 5.5% of men had BHAs, which was found with strong statistical evidence (χ2 = 59.88, P = 1 × 10-14). This relationship prevailed after adjusting for other covariates, such as comorbidity and number of consultations, with an odds ratio of 1.25 (95% confidence interval [CI] = 1.08 to 1.43). Conclusion: This study has shown that rates of BHA were generally low and even lower in men compared with women. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss. Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis. Methods: Informed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases: 1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain. 2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care. 3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools). 4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams. 5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation. Discussion: This novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies. [ABSTRACT FROM AUTHOR]

Introduction: The National Institute for Health and Care Excellence (NICE) suggest there is no role for routine radiography in the diagnosis of osteoarthritis (OA). It is not known how consistent this recommendation is across international guidelines, or the impact of UK guidance on domestic OA X‐ray request rates. Methods: A systematic search identified guideline recommendations on the role of radiography in OA diagnosis. Full texts underwent dual screening and appraisal using the AGREE II tool. A narrative synthesis was performed. Consultation data were extracted from a UK primary care database: the Consultations in Primary Care Archives (CiPCA). The annual proportion of X‐ray requests per 100 OA consulters from 2000 to 2012 were calculated. Joinpoint regression analysis examined if there were changes in the trend of X‐ray request rates and compared these with the publication dates of UK guidelines. Results: Eighteen evidence‐based OA guidelines were included in the review. Eleven recommended a clinical diagnosis of OA without radiographic confirmation. Seven recommended routine radiography; these guidelines were predominantly for radiologists. A mean of 17.3 X‐rays per 100 patients were requested in patients consulting for OA per year between 2000 and 2012. A statistically significant reduction in X‐ray request rates was seen in 2003. Conclusion: Recommendations on the role of radiography in OA vary between medical specialty and countries. UK guidelines appear to have had a limited impact on X‐ray request rates in OA. [ABSTRACT FROM AUTHOR]

Objectives: To identify distinct foot pain trajectories over 7 years and examine their associations with potential prognostic factors. Methods: Adults ages ≥50 years and registered with 4 general practices in North Staffordshire, UK were mailed a baseline health survey. Those reporting current or recent foot pain were invited to attend a research assessment clinic. Follow‐up was by repeated postal surveys at 18, 36, 54, and 84 months. Distinct trajectories of foot pain were explored using latent class growth analysis (LCGA). Subsequently, identified trajectories were combined into most and least progressive groups, and covariate‐adjusted associations with a range of prognostic factors were examined. Results: Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and 2 or more follow‐up time points. LCGA for foot pain severity (0–10 numerical rating scale) identified a 4‐trajectory model: "mild, improving" (37%); "moderate, improving" (33%); "moderate‐severe, persistent" (24%); and "severe, persistent" (6%). Compared with individuals in more favorable (improving) pain trajectories, those in less favorable (persistent) pain trajectories were more likely to be obese, have routine/manual and intermediate occupations, have poorer physical and mental health, have catastrophizing beliefs, have greater foot‐specific functional limitation, and have self‐assessed hallux valgus at baseline. Conclusions: Four distinct trajectories of foot pain were identified over a 7‐year period, with one‐third of individuals classified as having pain that is persistently moderate‐severe and severe in intensity. The effect of intervening to target modifiable prognostic factors such as obesity and hallux valgus on long‐term outcomes in people with foot pain requires investigation. [ABSTRACT FROM AUTHOR]

John Henry Guy worked in Britain and the United States throughout the first half of the twentieth century. He became the financial vice president of the M. Rumely Company of Indiana at just 31 years of age and, on his return to Britain, made a major contribution to the war effort while working as an accountant at the British Ministry of Munitions. It is also revealed that Guy took a broad view of accounting as a mechanism capable of achieving the more efficient use of resources by demonstrating its potential role within the domestic sphere. Throughout his career, Guy's religious convictions caused him great anxiety as he believed that the objectives of capitalism were fundamentally irreconcilable with the Christian principles that defined the legitimate conduct of daily life. Indeed, his own story demonstrates how easy it is for businesspeople to become associated with the shady side of commercial affairs. [ABSTRACT FROM AUTHOR]

Accurate modelling of air–sea surface exchanges is crucial for reliable extreme surface wind-speed forecasts. While atmosphere-only weather forecast models represent ocean and wave effects through sea-state independent parametrizations, coupled multi-model systems capture sea-state dynamics by integrating feedbacks between the atmosphere, ocean and wave model components. Here, we investigate the sensitivity of extreme surface wind speeds to air–sea exchanges at the kilometre scale using coupled and uncoupled configurations of the Met Office's UK Regional Coupled Environmental Prediction system. The case period includes the passage of extra-tropical cyclones Helen, Ali, and Bronagh, which brought maximum gusts of 36 m s - 1 over the UK. Compared with the atmosphere-only results, coupling to the ocean decreases the domain-average sea-surface temperature by up to 0.5 K. Inclusion of coupling to waves reduce the 98th percentile 10-m wind speed by up to 2 m s - 1 as young, growing wind waves reduce the wind speed by increasing the sea-surface aerodynamic roughness. Impacts on gusts are more modest, with local reductions of up to 1 m s - 1 , due to enhanced boundary-layer turbulence which partially offsets air–sea momentum transfer. Using a new drag parametrization based on the Coupled Ocean–Atmosphere Response Experiment 4.0 parametrization, with a cap on the neutral drag coefficient and reduction for wind speeds exceeding 27 m s - 1 , the atmosphere-only model achieves equivalent impacts on 10-m wind speeds and gusts as from coupling to waves. Overall, the new drag parametrization achieves the same 20% improvement in forecast 10-m wind-speed skill as coupling to waves, with the advantage of saving the computational cost of the ocean and wave models. [ABSTRACT FROM AUTHOR]

The key document directing the way in which homes of all types and ages in the UK are retrofitted is PAS 2035. This document provides a major step forward in the way the retrofit of homes is conducted and while many great efforts have been made to ensure that traditional buildings are properly understood and retrofitted, there are some improvements in the way in which this could be approached. By comparing PAS 2035 with other guidance and standards which have been specifically developed for traditional and historic buildings, we can see where improvements in the next version of PAS 2035 can be made. PAS 2035 covers a broad range of areas with the process and risk analysis being a key part as well as roles with specific responsibilities and stipulated competency, qualification and membership requirements. [ABSTRACT FROM AUTHOR]

We present the latest global land configuration of the Joint UK Land Environment Simulator (JULES) model as used in the latest international coupled model intercomparison project (CMIP6). The configuration is defined by the combination of switches, parameter values and ancillary data, which we provide alongside a set of historical forcing data that defines the experimental setup. In addition, we provide a standardised modelling system that runs on the NERC JASMIN cluster accessible to all with links to JULES. This is provided so that users can test and evaluate their own science against the standard configuration to promote community engagement in the development of land surface modelling capability through JULES. It is intended that JULES configurations should be independent of the underlying code base and thus they will be available at the latest release of the JULES code. This means that different code releases will produce scientifically comparable results for a given configuration version. Versioning is therefore determined by the configuration as opposed to the underlying code base. [ABSTRACT FROM AUTHOR]

This paper describes an updated configuration of the regional coupled research system, termed UKC3, developed and evaluated under the UK Environmental Prediction collaboration. This represents a further step towards a vision of simulating the numerous interactions and feedbacks between different physical and biogeochemical components of the environment across sky, sea and land using more integrated regional coupled prediction systems at kilometre-scale resolution. The UKC3 coupled system incorporates models of the atmosphere (Met Office Unified Model), land surface with river routing (JULES), shelf-sea ocean (NEMO) and ocean surface waves (WAVEWATCH III®), coupled together using OASIS3-MCT libraries. The major update introduced since the UKC2 configuration is an explicit representation of wave–ocean feedbacks through introduction of wave-to-ocean coupling. Ocean model results demonstrate that wave coupling, in particular representing the wave-modified surface drag, has a small but positive improvement on the agreement between simulated sea surface temperatures and in situ observations, relative to simulations without wave feedbacks. Other incremental developments to the coupled modelling capability introduced since the UKC2 configuration are also detailed. Coupled regional prediction systems are of interest for applications across a range of timescales, from hours to decades ahead. The first results from four simulation experiments, each of the order of 1 month in duration, are analysed and discussed in the context of characterizing the potential benefits of coupled prediction on forecast skill. Results across atmosphere, ocean and wave components are shown to be stable over time periods of weeks. The coupled approach shows notable improvements in surface temperature, wave state (in near-coastal regions) and wind speed over the sea, whereas the prediction quality of other quantities shows no significant improvement or degradation relative to the equivalent uncoupled control simulations. [ABSTRACT FROM AUTHOR]

We describe Global Atmosphere 7.0 and Global Land 7.0 (GA7.0/GL7.0), the latest science configurations of the Met Office Unified Model (UM) and the Joint UK Land Environment Simulator (JULES) land surface model developed for use across weather and climate timescales. GA7.0 and GL7.0 include incremental developments and targeted improvements that, between them, address four critical errors identified in previous configurations: excessive precipitation biases over India, warm and moist biases in the tropical tropopause layer (TTL), a source of energy non-conservation in the advection scheme and excessive surface radiation biases over the Southern Ocean. They also include two new parametrisations, namely the UK Chemistry and Aerosol (UKCA) GLOMAP-mode (Global Model of Aerosol Processes) aerosol scheme and the JULES multi-layer snow scheme, which improve the fidelity of the simulation and were required for inclusion in the Global Atmosphere/Global Land configurations ahead of the 6th Coupled Model Intercomparison Project (CMIP6). In addition, we describe the GA7.1 branch configuration, which reduces an overly negative anthropogenic aerosol effective radiative forcing (ERF) in GA7.0 whilst maintaining the quality of simulations of the present-day climate. GA7.1/GL7.0 will form the physical atmosphere/land component in the HadGEM3–GC3.1 and UKESM1 climate model submissions to the CMIP6. [ABSTRACT FROM AUTHOR]

Atmospheric forcing applied as ocean model boundary conditions can have a critical impact on the quality of ocean forecasts. This paper assesses the sensitivity of an eddy-resolving (1.5 km resolution) regional ocean model of the north-west European Shelf (NWS) to the choice of atmospheric forcing and atmosphere–ocean coupling. The analysis is focused on a month-long simulation experiment for July 2014 and evaluation of simulated sea surface temperature (SST) in a shallow near-coastal region to the south-west of the UK (Celtic Sea and western English Channel). Observations of the ocean and atmosphere are used to evaluate model results, with a particular focus on the L4 ocean buoy from the Western Channel Observatory as a rare example of co-located data above and below the sea surface. The impacts of differences in the atmospheric forcing are illustrated by comparing results from an ocean model run in forcing mode using operational global-scale numerical weather prediction (NWP) data with an ocean model run forced by a convective-scale regional atmosphere model. The value of dynamically representing feedbacks between the atmosphere and ocean state is assessed via the use of these model components within a fully coupled ocean–wave–atmosphere system. Simulated SSTs show considerable sensitivity to atmospheric forcing and to the impact of model coupling in near-coastal areas. A warm ocean bias relative to in situ observations in the simulation forced by global-scale NWP (0.7 K in the model domain) is shown to be reduced (to 0.4 K) via the use of the 1.5 km resolution regional atmospheric forcing. When simulated in coupled mode, this bias is further reduced (by 0.2 K). Results demonstrate much greater variability of both the surface heat budget terms and the near-surface winds in the convective-scale atmosphere model data, as might be expected. Assessment of the surface heat budget and wind forcing over the ocean is challenging due to a scarcity of observations. However, it can be demonstrated that the wind speed over the ocean simulated by the convective-scale atmosphere did not agree as well with the limited number of observations as the global-scale NWP data did. Further partially coupled experiments are discussed to better understand why the degraded wind forcing does not detrimentally impact on SST results. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. Methods: A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven‐item [GAD‐7] scale) and guideline‐recommended treatments used to manage pain. Clinical anxiety was defined by a GAD‐7 score of 10 or more. Results: A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The number of pain sites was also positively associated with clinical anxiety (four versus one site; OR 3.64, 95% CI 3.09 to 4.30). Those with clinical anxiety were less likely to undertake general fitness exercises (OR 0.60, 95% CI 0.52 to 0.70), but more likely to diet (OR 1.43, 95% CI 1.21 to 1.69), use walking aids (OR 1.53, 95% CI 1.32 to 1.77) and assistive devices (OR 1.24, 95% CI 1.04 to 1.49), and more likely to use opioids (OR 1.34, 95% CI 1.18 to1.52). Conclusions: Anxiety is common among patients presenting to primary care with joint pain. Patients with anxiety are likely to manage their joint pain differently to those without. Case‐finding to identify and treat anxiety would be appropriate in this population, with caution about opioid prescribing and consideration of exercise as an intervention. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. Methods. An incremental cost-utility analysis using patient responses to the three-level EuroQoL-5D (EQ- 5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Results. Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09 to 54.85) and an incremental quality adjusted life year (QALY) of -0.003 (95% CI: -0.03 to 0.02), with a 44% chance of being cost-effective at a threshold of £20 000 per QALY gained. The percentage of participants who took time off and the associated productivity cost were lower in the model OA consultation arm. Conclusion. Implementing National Institute for Health and Care Excellence guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective. [ABSTRACT FROM AUTHOR]

The episode narrated in this paper is situated in late-Victorian Britain when leading chartered accountants, Frederick Whinney and Edwin Waterhouse, were engaged by a British parliamentary committee to examine the costing and accountability practices of the government's military manufacturing establishments (GMMEs). The contributions of this study to accounting's historiography are twofold. First, the significance of Whinney and Waterhouse's appointment for the status of chartered accountants in late-Victorian Britain is assessed. Second, Whinney and Waterhouse's criticisms of existing accounting routines are examined and evaluated as is the impact of their findings on the subsequent course of accounting practices within GMMEs. [ABSTRACT FROM AUTHOR]

This article studies the careers of Henry William Sharp Whiffin and James Charles Hurst who served as agents of accounting change in Victorian Britain. Whiffin and Hurst were civil servants who worked together, at the War Office, to improve the accounting and accountability of the military establishments that manufactured weaponry used by the army and the navy to expand Britain's power and influence worldwide. It also explores their other workplace activities to add to our knowledge of how accountants traversed the separate spheres of business and government in the pursuit of successful careers as accountants. [ABSTRACT FROM AUTHOR]

A multitude of factors can influence the uptake and implementation of complex interventions in health care. A plethora of theories and frameworks recognize the need to establish relationships, understand organizational dynamics, address context and contingency, and engage key decision makers. Less attention is paid to how theories that emphasize relational contexts can actually be deployed to guide the implementation of an intervention. The purpose of the article is to demonstrate the potential role of qualitative research aligned with theory to inform complex interventions. We detail a study underpinned by theory and qualitative research that (a) ensured key actors made sense of the complex intervention at the earliest stage of adoption and (b) aided initial engagement with the intervention. We conclude that using theoretical approaches aligned with qualitative research can provide insights into the context and dynamics of health care settings that in turn can be used to aid intervention implementation. [ABSTRACT FROM AUTHOR]

Objective. The aims of this study were to determine the feasibility of introducing a computerized template for identifying quality of care during an OA consultation, describe quality of OA care in practices in which the template was introduced and assess the effect of the template on routinely recorded clinician behaviour in those practices. Methods. A computerized template to assist the recording of care in consultations for patients with OA was installed in eight general practices. Eligible patients were those ⩾45 years of age consulting for clinical OA during a 6 month period. The main outcomes were frequency of template triggering, achievement of quality indicators during the consultation (assessment of pain and function, assessment for first-line analgesics, provision of information, exercise advice, consideration of physiotherapy referral, weight loss advice) and change in routinely recorded clinician behaviour (diagnostic coding, prescribing, referral, use of radiography, weight records) compared with the 12 months prior to template installation. Results. The template was triggered for 1730 patients. Achievement of indicators ranged from 36% (for consideration of physiotherapy referral) to 63% (for pain assessment), with substantial variability between clinicians. There was an increase in prescription of recommended first-line analgesics following the template installation: paracetamol [odds ratio (OR) 1.49 (95% CI 1.22, 1.82) compared with pre-template] and topical NSAIDs [OR 1.95 (95% CI 1.61, 2.35)]. Conclusion. This new template is a feasible tool for capturing data during OA consultations to aid assessment of quality of care. It was associated with significant improvements in recommended care processes. However, strategies are needed to ensure consistent approaches between clinicians. Trial registration. http://www.controlled-trials.com/ISRCTN06984617/mosaics. [ABSTRACT FROM AUTHOR]

Tables are presented depicting the International Systems of Units for basic instrument measurement adpoted a partial metrication policy in Great Britain.

This article discusses the importance of collaboration with suppliers and partners during research and development (R&D) technology projects. It details how this can be accomplished using the collaborative enterprise governance (CEG) concept to manage a technology project. CEG is based on the premise that parts of companies work with parts of other companies, which are reconfigured on dynamic bases according to a variety of different internal and external factors. This article presents an overview of the founding literature, the CEG and its methodology, and examples based at Jaguar Land Rover in the UK. CEG has been used here to explain why some technology projects have succeeded while others have done less well. This article concludes by offering new propositions, inducted through grounded theory, relating to the successful management of R&D projects, which should be picked up by future research studies in the area. [ABSTRACT FROM PUBLISHER]

Background: Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate. Methods: Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. Results: Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. Conclusions: The primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence. [ABSTRACT FROM AUTHOR]

The agricultural revolution has been portrayed as the time when landowners began to display a capitalist mentality. This paper seeks to add to our knowledge of the use of accounting for managerial purposes during this period by exploring the content of treatises advocating different ways of accounting on landed estates. Two research questions are addressed. The first is the degree of inter-relationship between accounting methods - charge-and-discharge accounting (CDA) and double-entry bookkeeping - that have been presented in the literature as distinct in terms of their objectives and operation. The second objective is to assess the extent to which CDA could be used by management and landowners for performance assessment purposes and, following on from that, to reflect on whether the demise of CDA was an inevitable consequence of demands for more useful management information. [ABSTRACT FROM AUTHOR]

Presented here is the first English and annotated translation of the Spanish sermon on congregational participation in the Mass delivered by the Dominican Friar, Bartolomé Carranza. It was originally preached at Whitehall, in the first week of Lent, 1555, before King Philip I and Queen Mary I of England. The text was subsequently written down by the preacher at the request of one of those present, the Duke of Medinaceli, and published in Salamanca and Antwerp. After a lengthy historical introduction, bolstered by quotations from Scripture, papal and conciliar documents, as well as from the writings of patristic and medieval theologians, the text is divided into three parts, which reflect the phases of the liturgy. The first covers the service from the entrance of the celebrating priest to the Preface of the Canon of the Mass; the second continues up to the recitation of the Lord's Prayer, and the third discusses the conclusion of the Mass. Then follows a short guide to help worshippers unfamiliar with Latin to participate as fully as possible in the service. Carranza rejects the medieval practice of bringing private prayer books to church for use during Mass, and instead urges full participation, as far as the rubrics of the liturgy permit, in the activity of the priest and his assistants at the altar. He also expresses a preference for frequent communion by the laity, which some Catholic reformers were advocating in the mid-sixteenth century. Although first preached in England, the published text was evidently as much directed at the Spanish market, where the writer evidently hoped that a reform of Catholic practice would help stave off Protestantism as well. [ABSTRACT FROM AUTHOR]

This paper examines the difficulty of achieving representative and effective governance of a professional body. The collective studied for this purpose is the Institute of Chartered Accountants in England and Wales (formed 1880) which, throughout its existence, has possessed the largest membership among British accounting associations. Drawing on the political theory of organization, we will explain why, despite a series of measures taken to make the constitution of its Council more representative between formation date and 1970, the failure of the 1970 scheme for integrating the entire U.K. accountancy profession remained attributable to the "detachment of office bearers from their constituents" [Shackleton and Walker, 2001, p. 277]. We also trace the failure of attempts to restore the Council's authority over a period approaching four decades since that "disaster" occurred [Accountancy, September 1970, p. 637]. [ABSTRACT FROM AUTHOR]

Published reports on censuses of population and the surviving enumeration books on which they were based are key sources for accounting historians. The increasing availability of electronic versions of census enumeration books (CEBs) for Canada, the U.K., and the U.S. offers opportunities for better understanding the history of occupations concerned with the performance of accounting functions. However, census reports and original census documents must be interpreted critically. The paper reports on a study of accountants appearing in the transcribed version of the British CEBs for 1881. It is shown how" the published census underreported the number of accountants in Britain and suggests that there are potential inconsistencies in the manner in which accountants were counted. While accounting historians may rely on the high level of accuracy in transcribed versions of the CEBs, transcription errors have been discovered in relation to female accountants, those pursuing occupations spelt in ways closely resembling "accountant," and individuals possessing complex occupational titles. Caution in respect of entries relating to accountant clerks is also suggested. [ABSTRACT FROM AUTHOR]

Paracetamol (acetaminophen) is the most common drug taken in overdose in the UK, accounting for 48% of poisoning admissions to hospital and being involved in an estimated 100-200 deaths per year. In 1998, the UK government introduced legislation that reduced the maximum pack size of all non-effervescent tablets and capsules containing aspirin (acetylsalicylic acid) or paracetamol that can be sold or supplied from outlets other than registered pharmacies from 25 to 16 tablets or capsules. This article reviews the literature to determine the effectiveness of the legislation, focusing specifically on paracetamol poisoning. Seventeen studies on this subject were identified. Three studies found reductions in mortality rates; one study found an increase in mortality rates, while one found an initial reduction followed by an eventual increase; three found no significant difference in mortality rates before and after introduction of the legislation. Five studies found reductions in admissions to liver units, three of these finding a reduction in liver transplantation rates; two further studies found no change in liver function tests and rates of paracetamol-induced acute liver injury or failure. Four studies found a sustained decrease in hospital admissions, while two found an initial decrease followed by an eventual increase. One study found a decline in admissions for paracetamol poisoning and an increase in admissions for non-paracetamol poisoning. Sales data are conflicting, with two studies finding no significant difference in paracetamol sales before and after the introduction of the legislation and one reporting a decline. The severity of overdose appears to have decreased since the maximum permitted packet size was reduced, with five studies reporting a reduction in the number of severe overdoses (measured by numbers of tablets ingested, serum paracetamol concentrations and usage of antidotes). Only two studies reported an increase in the number of severe overdoses.Paracetamol-associated mortality rates, admissions to liver units/liver transplants, hospital admissions and the severity of paracetamol overdose appear to have been decreasing since 1998. However, one study showed that the reductions in mortality and hospital admissions began in 1997; therefore, the contribution of the 1998 legislation to the observed changes is unclear. Most of the studies are based on short-term follow-up so it is difficult to draw any conclusions regarding long-term trends. Many of the studies were also restricted to relatively small areas of the UK; this, combined with a variety of outcome measures, makes it difficult to distinguish any conclusive trends. The studies also suffer from a lack of comparison and control groups. Some studies do not clearly differentiate between the paracetamol preparations covered by the legislation and those not. The limited number of studies to date, combined with a variety of outcome measures, make it difficult to determine with accuracy whether or not the legislation has been a success. More long-term studies are needed to fully assess the impact of the legislation. [ABSTRACT FROM AUTHOR]

This article explores the idea that in order to improve the ways we teach children to write creatively it is worth exploring how we, as teachers and writers, do that ourselves. It describes some of the stages of a curriculum development project undertaken in the Portsmouth and Southampton Postgraduate Certificate in Education (PGCE) English teams, begun in 2004. The project was supported by funding from the Esmee Eairbairn Foundation and was designed to foster a range of learning activities for trainee teachers in the area of teaching creative writing to pupils in schools. The project that was developed had multiple aims: subject knowledge development in trainee English teachers; pedagogic exploration amongst all teachers involved looking at how the difficult area of teaching creative writing might be better addressed. This article evaluates the aims of the project and some of the outcomes and argues for recognition of the training year as a vital area for exploring issues in teaching, beyond competence. The article draws on a variety of sources, including participant observation notes made in writing workshops, responses to a questionnaire completed by project participants and excerpts from writing collected across the project produced by teachers and pupils. [ABSTRACT FROM AUTHOR]

Using archival evidence relating to Albright & Wilson (A&W), this article 'challenges the validity of Chandler's view, based mainly on the study of secondary sources, that personal capitalism retarded the development of more advanced forms of managerial organisation in Britain in the late nineteenth and early twentieth centuries. While Chandler has criticised A&W for abrogating control of its North American subsidiaries to American managers, the archival evidence reveals an effective control mechanism based around an accounting information system in which there is evidence of the use of standards for purposes of monitoring and control, and a recognition of the relevance of marginal costs for purposes of decision making. The article also throws light on the relationship between family ownership, firm size, strategy, investment and innovation. [ABSTRACT FROM AUTHOR]

Friendly societies date from the seventeenth century and have been the subject of statutory recognition and regulation since 1793. These societies developed rapidly in the nineteenth century as a mechanism of self-help for the emerging industrial working class. This article embraces an historical examination of the social, economic and political contexts within which a discourse on the issue of their regulation took place and reveals the ideologies underpinning the disciplinary framework that was constructed. Ideas of the philosophical radicals were influential in making friendly societies the subject of closer regulation. This development came at a time when laissez-faire as a guide to government action gave ground to the acceptance of the need for state control in the endeavour to enhance the common good. The concepts of paternalism and financial safety are found to have influenced the decision to regulate friendly societies, and the disciplinary framework constructed is located within the range of provisions applying to organizational entities operating in nineteenth-century Britain. [ABSTRACT FROM AUTHOR]

Focuses on the formulation of British urban policy. Competition for resources in urban policy; Role of urban development corporations in policymaking; Partnerships among the private and public sectors and the voluntary sector; Community empowerment; Benefits and drawbacks of competition as policy.

This article presents an account of the rise of professional accountants in Great Britain. Accountants are by far the most prominent professionals active in British management today. The first accountancy' society in the world was formed in Scotland in 1853. Societies south of the border date from 1870 and, after combining, a Royal Charter was won in 1880. As part of the process of establishing accountancy as a profession, these chartered accountants admitted to membership only those able to meet stringent entry requirements including, in most cases, a costly five-year period of articles in a chartered accountant's office and written examinations. It could be suggested that the increased scale of companies, the particular travails of the British economy, and its financial environment meant that the presence of an accountant in top management was more useful to a British company than is the case in other countries. Undoubtedly, one of the reasons for the British accountant's success in management was that the sector creamed off some, of the brightest "middle-class" public, and grammar schoolboys.

The article examines the development of accounting in Great Britain during the nineteenth century. Dowlais was a large, vertically integrated, multi-unit private sector organization. Prior to 1840 the exact organizational structure at Dowlais is unclear but it can be reconstructed for the 1840s and 1850s from surviving salary lists of agents and sub-agents and other information. The Dowlais management system in the mid-nineteenth century was "based on a division of labor, with each department working individually, and reporting to a higher level". The key problems facing the management during the industrial revolution period and beyond that was that of the emergence of industrial labor force into a reliable factor of production. Overall control of production in mid-nineteenth century ironworks, therefore, was affected through a mix of formal and informal methods, which from a disciplinary point of view had certain limitations. The potential of accounting for labor disciplinary control was recognized, but there were rational reasons why the management at Dowlais and other Great British iron companies did not utilize accounting systems in this manner.

Explores the evolution of capital expenditure accounting practice within municipal corporations in Great Britain from 1884 to 1914. Provisions of the Municipal Corporation Act of 1835; Accountability and organization of municipal corporations; Accounting treatment of capital expenditure in private sector; Amortization of capital expenditure.

The use of secret reserves by British companies, both to manipulate the content of published reports and to influence investor perceptions of corporate progress during the late nineteenth and early twentieth century, has been an important focus] of historical enquiry. By way of contrast, relatively little attention has been devoted to the possible exploitation of fixed asset accounting practices to achieve similar financial reporting objectives. It is the aim of the present paper to help to redress this imbalance. The principal basis for the study is the archival records of four major iron and coal companies. Identified features of prudent financial policy include: a determination to restrict distributions and the level of activity to what the company could comfortably afford; and a reluctance to use loan finance. The selection of accounting practices was subordinated to the pursuit of these, and related, policy objectives. The identified use of prudent financial policies may be contrasted with Briefs (1976, p. 184) conclusion that nineteenth century companies consistently overestimated profitability, with a consequential stimulation of business investment and economic growth. [ABSTRACT FROM AUTHOR]

This article focuses on the cost accounting systems in Great Britain in the 1900s. The article addresses the following two interrelated matters, namely the nature of the costing practices employed by industrial companies in the pre-1900 period, and the relationship between the cost accounting literature and actual practice. The analysis is based on research undertaken into the accounting archives of 15 companies engaged in coal mining, iron production and, in some cases, steel-making in various parts of Great Britain. The results of this research, taken in conjunction with those of other historians over the last 20 or so years, are found to have important consequences for previous assessments of the contribution of accounting to British managerial development in the nineteenth century. The traditional view of the development of cost accounting theory in Britain, from the perspective of accountants, was laid down by Ronald S. Edwards and David Solomons. Collins demonstrates the application of double-entry bookkeeping to the internal transfer of raw materials employed in dyeing from a stock account to a process account.

The relative merits of market forces compared with regulations as the more efficient mechanism for ensuring adequate accountability from business (and non-business) organizations is a subject of keen debate. Britain in the second half of the nineteenth century is regularly cited as an example of how the market will ensure adequate accountability in the absence of regulatory requirements. There is a great deal of speculation but very little hard evidence concerning the precise levels of accountability during this period. This study is designed to penetrate contemporary attitudes and actions by using primary sources to determine the audit arrangements made by quoted companies in the year 1886. It is discovered that professionally qualified accountants generally, and chartered accountants in particular, had achieved a dominant position by 1886, and possibly rather earlier; a finding which is also used to illuminate the question of the nature of the professional accountants' work in the late nineteenth century. [ABSTRACT FROM AUTHOR]

The popular view that market forces controlled the development of financial reporting practices among nineteenth-century British companies has recently been shown, by Parker (1990), to be an oversimplification. Large companies engaged in the provision of public utilities, transportation and financial services were the subject of close regulation, though not necessarily or only for the purpose of shareholder protection. The nineteenth century also saw the creation of municipal corporations, and their development is marked by a further variation in the process of accounting change. A regulatory structure, including requirements for accountability, was established when the modern municipal corporation was created in 1834, and this broad framework remained in force without major amendment until 1930. The accounting practices employed by municipal corporations underwent fundamental change, however, to accommodate major alterations in the nature of their activities. The process of 'voluntary' change in response to market pressure received reinforcement from recommendations made by the highly active local-authority-oriented professional accounting body. [ABSTRACT FROM AUTHOR]

The distinguishing characteristic of the double account system is the subdivision of the conventional balance sheet into a capital account and a revenue account, and it is the purpose of this paper to explain why it became the practice of railway companies to publish accounts in this form. [ABSTRACT FROM AUTHOR]

The objective was to determine the relative association of social class and neighbourhood deprivation with primary care consultation for eight morbidities. In 18 047 survey responders aged ≥50 years, living in more deprived neighbourhoods was independently associated with new consultation for chronic obstructive pulmonary disease, ischaemic heart disease, diabetes, asthma and depression. Lower social class was associated with diabetes and chronic obstructive pulmonary disease. No such associations were found with otitis media, osteoarthritis or upper respiratory tract infection. These findings suggest a role of social environment in certain morbidities and indicate the importance of identifying and acting on neighbourhood deprivation to reduce health inequalities. [ABSTRACT FROM AUTHOR]

The article presents evidence regarding the birthday of Lady Jane Grey, who ruled England briefly in the 16th century. It is reported that Grey's date of birth has been widely speculated to lie somewhere in early October 1537, but that a lack of documentary evidence makes the exact date uncertain. Evidence from various sources that places Grey's birthday somewhere between late summer and November of 1537 is outlined.

The article focuses on the participation of students in school management, policy development, and initial teacher training. It is mentioned that the student voice movement is associated with children's rights discussed in the 1992 United Nations Convention. The modest level of student voice in the United Kingdom schools is also cited.

The article discusses the quality of educational supervisor reports for all General Practitioner (GP) trainees going through the American Realty Capital Properties (ARCP) panels. It states that most of the supervisors uses the skills to maintain portfolio evidence to assess trainees progress. Also presents the table showing percentage of reports falling down at each criteria from ST1 to ST3.