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Despite its practical and symbolic importance, the role of space in higher education remains under-researched. This study develops an understanding of student experience of the campus as a learning landscape. It is based on 28 participatory walking interviews with students, including the hand drawing of a campus map. Participants tended to see learning as about individual study or working alongside others, and rarely mentioned lectures. The choice of space to study was often shaped by convenience, and appeared to be somewhat static and habitual. There was a lack of exploration and only a limited sense of the benefit of fitting the learning task to the space. Yet students felt a sense of ownership and safety on campus. They actively used the characteristics of space to manage their own attention through studying where there were visible cues to study and controlling distraction.

This guideline was developed according to the British Society for Rheumatology Guidelines Protocol by a Guideline Development Group comprising healthcare professionals with expertise in SSc and people with lived experience, as well as patient organization representatives. It is an update of the previous 2015 SSc guideline. The recommendations were developed and agreed by the group and are underpinned by published evidence, assessed by systematic literature review and reinforced by collective expert opinion of the group. It considers all aspects of SSc including general management, treatment of organ-based complications, including cardiopulmonary, renal and gastrointestinal tract manifestations, as well as broader impact of disease. Whilst it is focused on adults with SSc we expect that the guideline will be relevant to people of all ages and expert input and review by paediatric rheumatologists and other relevant specialists considered where the guideline was, or may not be, applicable to young people with SSc and juvenile-onset disease. In addition to providing guidance on disease assessment and management the full guideline also considers service organization within the National Health Service and future approaches to audit of the guideline. The lay summary that accompanies this abstract can be found in Supplemental information 1. [ABSTRACT FROM AUTHOR]

Objective: To develop, refine, and score a novel patient‐reported outcome instrument to assess the severity and impact of Raynaud's phenomenon (RP) in systemic sclerosis (SSc). Methods: The Assessment of Systemic Sclerosis–Associated Raynaud's Phenomenon (ASRAP) questionnaire items were developed with patient insight partner support and grounded in the lived patient experience of SSc‐RP. ASRAP items underwent formal qualitative assessment and linguistic testing. An international multicenter study was undertaken to field test the preliminary ASRAP questionnaire. Results: A preliminary 37‐item ASRAP questionnaire was supplemented with 2 additional items following expert review to enhance content coverage before undergoing formal linguistic testing to optimize readability. Patient cognitive debriefing interviews were undertaken to enhance comprehension, ambiguity, cognitive difficulty, relevance, and content coverage of both the ASRAP items and instructions. We enrolled 420 SSc patients from scleroderma centers in the UK and US over 2 consecutive winters. Factor analysis with item response theory was undertaken to remove redundant and poorly fitting items. The retained 27‐item long‐form ASRAP questionnaire was calibrated and scored using the graded response model. A fixed 10‐item short‐form ASRAP questionnaire was developed using computerized adaptive testing simulations. Conclusion: The ASRAP questionnaire has been developed with extensive SSc patient input, with items grounded in the lived experience of SSc‐RP to ensure strong content validity, with a focus on how patients feel and function. An advanced psychometric approach with expert input has removed redundant and/or poorly fitting items without eroding content validity. Long‐ and short‐form ASRAP questionnaires have been calibrated and scored to permit formal validation. [ABSTRACT FROM AUTHOR]

The alcohol policy debate demands greater critical reflection on the complex and disaggregated nature of the alcohol industries in contrast to their frequent characterization as a coherent, monolithic and singular entity with a common goal. Such reflection is necessary in order to rethink the linked assumption that drinkers are vulnerable victims of the activities of industry and, in so doing, to start moving beyond the UK's current policy development impasse in creative and plausible ways.

As "health" climbs academic, policy, commercial, non-profit and societal agendas, it has become increasingly subject to scrutiny by geographers. Yet, while health geographers may explore the discursive production, operationalization, deployment and management of health; the role of pedagogical practices has been repeatedly overlooked despite the clear intersections between the discipline's ongoing debate over its criticality and critical pedagogical aspirations. This paper explores this omission and its significance for teaching health geography by drawing upon the example and experience of two exercises undertaken with Masters students in a new health geography module--concept mapping and a simple definition exercise. (Contains 9 figures and 3 notes.)

The aim of the UK National Literacy Strategy is to raise standards in literacy. Strong evidence for its success has, however, been lacking: most of the available data comes from performance on tests administered in schools or from Office for Standards in Education reports and is vulnerable to suggestions of bias. An opportunistic analysis of data from a population cohort study extending over three school years compares school-based scores at school entry and at age 7-8 with independently administered scores on similar tests. The results show a small but statistically significant rise between 1998 and 1999 and between 1998 and 2000 in scores on both Key Stage 1 Reading Standard Assessment Tasks taken in schools and the reading component of the WORD test taken independently. This is clear evidence for a real rise in reading attainment over this period, which may be attributable to the children's experience of the National Literacy Strategy. (Contains 7 tables.)

The UK response to Covid-19 has been unusually complex in its ever-shifting classifications of clinical vulnerability. By May 2020, 2.2 million people had been identified as 'clinically extremely vulnerable' (CEV) and were asked to 'shield' at home for over four months. To adhere to this strict guidance, they were enfolded within the patchy infrastructure of the 'shielding programme'. However, membership of the 'shielded list' has changed—often without warning or explanation—through time and across space. Drawing on policy and evidentiary documents, government speeches, reports, press conferences and media analysis of Covid-19 coverage between March 2020 and April 1, 2021, this paper traces the shifting delineations of clinical vulnerability in the UK response across three lockdowns. It argues that the complexities and confusions generated by the transience of the CEV category have fed into forms of biosociality that have been as much about making practical sense of government guidance as a form of mutual support amid crisis. This uncertainty has not eased as restrictions have been relaxed and vaccines rolled out. Instead, tracing individual immune response has become a burgeoning industry as 'the shielded' navigate the uneasy demands of taking 'personal responsibility' rather than being protected by 'the rules'. [ABSTRACT FROM AUTHOR]

Objectives To identify barriers to the use of nailfold capillaroscopy as a diagnostic tool for patients presenting with Raynaud's phenomenon in UK rheumatology centres and to obtain rheumatologists' views on a proposed internet-based standardized system for clinical reporting of nailfold capillaroscopy images. Methods An online survey was developed using expert opinion from clinicians, scientists and health service researchers. The survey was piloted and sent to UK-based rheumatologists using established electronic mailing lists between October 2020 and March 2021. Survey data were analysed using descriptive statistics. Results A total of 104 rheumatologists representing rheumatology centres across the UK responded to the survey. Wide variations in terms of workloads and practices were described. Thirty-four (33%) respondents reported using nailfold capillaroscopy only at their own centre, 33 (32%) referred to other centres, 9 (9%) did both and 28 (27%) did not use capillaroscopy at all. Of the 43 respondents using capillaroscopy on site, 25 (58%) used either a dermatoscope or universal serial bus microscope and 9 (21%) used videocapillaroscopy. Among the 61 respondents not undertaking capillaroscopy on site, barriers included lack of equipment (85%), lack of experience in acquiring images (69%) and lack of expertise in interpreting images (67%). Sixty-six respondents (63%) expressed interest in an internet-based, standardized automated system for reporting images. Conclusion Most UK rheumatologists currently do not perform nailfold capillaroscopy on site. An internet-based nailfold capillaroscopy system for use with low-cost microscopes as well as with videocapillaroscopy could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of SSc across the UK. [ABSTRACT FROM AUTHOR]

Reflection is an essential tool for postgraduate medical training, yet fear of exposing incompetence is a known barrier for engagement with reflection. In the UK, this fear may have been amplified by the case of Dr Bawa-Garba, whose reflective e-portfolio entries informed a General Medical Council investigation resulting in the loss of her licence to practice. To identify themes GP trainees commonly explore in e-portfolio entries, and whether their reflective e-portfolio entries have changed following the Bawa-Garba case. A phenomenological approach was applied. Semi-structured interviews continued to data saturation in a purposive sample of trainees (7) and trainers (4) recruited from a South Yorkshire GP training scheme. Transcript data were assigned to a coding framework with iterative thematic analysis. Dominant emergent themes were 'difficulty' and 'challenge'. All trainees described reluctance to submit significant event analyses (SEAs) on mistakes and near misses for fear of jeopardising their careers. International medical graduates were disproportionately affected by the challenges reflection posed. Following the Bawa-Garba case, trainees are disengaging with SEAs to reduce the risk of self-incrimination. Further guidance with which trainees can navigate their reflective e-portfolios is required to retain the value of reflection as a tool for professional development. [ABSTRACT FROM AUTHOR]

The article discusses a survey which aimed to gauge the thoughts and opinions of calcinosis patients regarding the clinical burden of the disease and of the treatment of their calcinosis. Topics covered include questions included in the survey, the impact of calcinosis on the daily life of patients, and the widespread distribution of calcinosis in terms of body sites affected confirmed by the survey results.

The article discusses research which examined link between tumor necrosis factor ligand superfamily member 4 gene (TNFSF4) rs844648 polymorphism and systemic sclerosis (SS)-related calcinosis. Topics explored include the prevalence of calcinosis in patients with SS, the observed increase in OX40L serum levels in early-onset SS patients, and brief details about the genotyping and meta-analysis of data performed.

Digital ulcers (DUs) are a common visible manifestation of the progressive vascular disease that characterizes the SSc disease process. DUs not only impact significantly on patients' quality of life and hand function, but are also a biomarker of internal organ involvement and of disease severity. The aetiology of (digital) vascular disease in SSc is multifactorial, and many of these factors are potentially amenable to therapeutic intervention. The management of DU disease in SSc is multifaceted. Patient education and non-pharmacological interventions (e.g. smoking cessation) should not be neglected. There are a number of drug therapies available to prevent (e.g. phosphodiesterase type-5 inhibitors and ET receptor-1 antagonists) and treat (e.g. i.v. iloprost) DUs. DUs are also important for two other reasons: firstly, as a primary end point in SSc-related clinical trials; and secondly, DUs are included in the ACR/EULAR SSc classification criteria. However, the reliability of rheumatologists to grade DUs is poor to moderate at best, and this poses challenges in both clinical practice and research. The purpose of this review is to provide the reader with a description of the spectrum of DU disease in SSc including pathophysiology, epidemiology and clinical burden, all of which inform the multifaceted approach to management. [ABSTRACT FROM AUTHOR]

The article presents systemic sclerosis (SSc) management procedures issued by the British Society of Rheumatology and British Health Professionals in Rheumatology. Topics discussed include general tips on SSc management, recommended treatment options for SSc-linked diseases like digital ulcers, lung fibrosis and renal complications, and service organization and delivery recommendations for National Health Service (NHS) England.

Objective. Digital vasculopathy (comprising RP, digital ulceration and critical digital ischaemia) is responsible for much of the pain and disability experienced by patients with SSc. However, there is a limited evidence base to guide clinicians in the management of SSc-related digital vasculopathy. Our aim was to produce recommendations that would be helpful for clinicians, especially for those managing patients outside specialist centres. Methods. The UK Scleroderma Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including digital vasculopathy. Results. This overview presents the background and best practice consensus pathways for SSc-related RP, digital ulceration and critical ischaemia. Examples of drug therapies, including doses, are suggested in order to inform prescribing practice. Conclusion. A number of treatment algorithms are provided that are intended to provide the clinician with accessible reference tools for use in daily management. [ABSTRACT FROM AUTHOR]

Objective. To evaluate whether patients can predict attacks of RP (if so, this would have implications for developing new treatments) and to evaluate the impact of RP attacks on quality of life (QoL). Methods. Individuals with RP were invited through international patient associations to participate in an online survey. Results. Responses from 443 subjects with self-reported RP from 15 countries were evaluable. The mean age of subjects was 41 years (91% female). Fifty-eight per cent of subjects reported they could predict at least 51 % of RP attacks, and 57% could predict attack severity either fairly well or better [with 43% predicting severity only poorly (30%) or very poorly (13%)]. Sixty-four per cent of subjects reported a poor or very poor current ability to prevent/control RP attacks. One hundred and eighty-two subjects (41 %) reported current or previous use of medications for RP: 82% reported at least one currently used medication being tolerated, but only 16% reported at least one current medication being effective. Most subjects (78%) reported making at least one life adjustment due to RP, with more in subjects with secondary RP compared with primary RP (87% vs 71%, P = 0.001). Current QoL with RP was impaired [mean = 6/10 (10 best imaginable)] and secondary RP subjects reported a greater absolute improvement when asked to imagine their QoL without RP (2.3 vs 3.3 P = 0.0002). Conclusion. Subjects' ability to predict RP attacks is limited. Treatments were generally considered tolerable but seldom fully effective. Our results confirm an unmet need for new treatments. RP significantly impacts on QoL in all subjects. [ABSTRACT FROM AUTHOR]

Objectives. Nailfold videocapillaroscopy (NVC), the current gold standard for detection of capillary abnormalities suggestive of an SSc-spectrum disorder, is not widely available: a key question is whether lower-magnification, easy-to-use dermoscopy compares favourably. This is especially relevant given the inclusion of capillaroscopic abnormality within the 2013 classification criteria for SSc. Our objectives were to examine the ability to classify capillaries and to evaluate abnormality (severity), by both NVC and dermoscopy, to determine whether these differ between general and specialist rheumatologists, and to compare intra- and interrater reliability of both techniques. Methods. NVC and dermoscopy images were acquired from all 10 nailbeds of 32 subjects with a range of capillary abnormalities. Images were graded (using a web-based interface) on a 0-3 scale of severity: normal (0), mildly (1), definitely (2) and grossly abnormal (3), and an unclassifiable category. Raters graded images from four subjects (40 nailbeds) using each technique, with five repeated images to estimate intrarater reliability. Results. Forty-eight rheumatologists from 12 countries participated in the study (22 generalists, 26 specialists). While most images could be graded by both techniques, more were graded by NVC (84% vs 70%) and were systematically scored higher by NVC (mean difference 0.43 between the ratings). Agreement between the techniques was moderate. Intra- and interrater reliability were comparable for the two techniques in the classifiability of images and the grading of severity. Conclusion. Our results suggest that dermoscopy is comparable to NVC, although NVC images were more likely to be classifiable and were graded more severely. [ABSTRACT FROM AUTHOR]

Objectives. Digital ischaemia, often progressing beyond RP to digital ulceration and sometimes even gangrene, is the most common vascular manifestation of SSc. Both microvascular and macrovascular disease can contribute and coexistence of microvascular and macrovascular (proximal vessel) disease in patients with SSc is potentially limb threatening. The aims of this study were to examine the change over time in the ankle brachial pressure index (ABPI) in a cohort of patients with SSc and to examine whether age, gender, smoking status, disease duration, disease subtype and ACA are associated with ABPI.Methods. The clinical and laboratory data of 217 patients attending the SSc clinic at a tertiary referral centre and who had their ABPIs checked between 1996 and 2011 were reviewed retrospectively. Data were analysed to see how the ABPI changed with time and linear mixed effects modelling was used to determine which factors were associated with ABPI.Results. In most patients with SSc, the ABPI remained constant over time [median rate of change 0 units/year, interquartile range (IQR) −0.01–0.01]. There was a significant association between lower ABPI and increasing age (P = 0.04), the limited cutaneous subtype of SSc (P = 0.01) and ACA positivity (P = 0.03). Additionally there was an association between ABPI and smoking status of borderline statistical significance (P = 0.08).Conclusion. This study provides further evidence for associations between the severity of vascular disease in patients with SSc and increasing age, smoking, limited cutaneous disease and positive ACA. Reassuringly, in most patients ABPI remains stable over time. [ABSTRACT FROM PUBLISHER]

Objective. Cutaneous telangiectases are a characteristic and psychologically distressing feature of SSc. Our aim was to assess the efficacy of two light-based treatments: pulsed dye laser (PDL) and intense pulsed light (IPL).Methods. Nineteen patients with facial or upper limb telangiectases underwent three treatments with PDL and IPL (randomly assigned to left- and right-sided lesions). Outcome measures were clinical photography (assessed by two clinicians), dermoscopy (assessed by two observers), laser Doppler imaging (LDI) and observer and patient opinion, including patient self-assessment psychological questionnaires [Hospital Anxiety and Depression Scale (HADS), Adapted Satisfaction with Appearance Scale (ASWAP)].Results. Comparison between 16-week follow-up and baseline photography scores (from −2 to +2 on a Likert scale, with >0 being improvement) were a mean score for PDL of 1.7 (95% CI 1.4, 2.0) and for IPL 1.4 (0.9, 1.8), with a mean difference between PDL and IPL of −0.3 (−0.5, −0.1) (P = 0.01). Dermoscopy scores also improved with both therapies: PDL 1.3 (1.1, 1.5) and IPL 0.8 (0.5, 1.1), again greater with PDL (P = 0.01). LDI showed decreases in blood flow at 16 weeks, indicating a response to both therapies. All patients reported benefit from treatment (more preferred PDL at 16 weeks). Psychological questionnaires also indicated improvement after therapy with mean change in ASWAP of −13.9 (95% CI −20.5, −7.4). No side effects were reported for IPL; PDL caused transient bruising in most cases.Conclusion. Both PDL and IPL are effective treatments for SSc-related telangiectases. Outcome measures indicate that PDL has better outcomes in terms of appearance, although IPL had fewer side effects. [ABSTRACT FROM PUBLISHER]

Objectives. Nailfold videocapillaroscopy is being increasingly used as a marker of SSc-related microvascular disease, including in response to treatment. However, it requires further validation. Our aim was to assess the inter-observer, intra-observer and test–retest variability of semi-automated measurement of capillary features as well as of a manual density measurement.Methods. All capillary apexes in images from 58 patients with SSc were marked up independently by two trained observers (inter-observer variability). The first observer then re-marked the images (intra-observer variability), and finally, the first observer marked up a second image of the same nailfold (test–retest). Mark-up of capillaries was carried out on cropped mosaic images (cropped independently by the observers to a fixed width, to allow the same length of nail bed to be studied for each patient) and on whole mosaic images (examining the whole nail bed).Results. Reproducibility of independently cropped mosaic images was poor and was due to the variation in the positioning of the cropped area. However, quantification of whole mosaic images was highly reproducible, e.g. for inter-capillary distance, the intra-class correlation coefficient for inter-observer, intra-observer and test–retest reliability was 0.95, 0.98 and 0.90 (compared with 0.88, 0.79 and 0.89 for cropped mosaic images), respectively. Intra-observer limits of agreement for whole mosaic images were better than inter-observer reproducibility.Conclusion. Quantitative assessment of SSc-related change in nailfold capillaries is unreliable if examination of the same set of capillaries cannot be guaranteed. Conversely a wide-field, high-magnification system that allows visualization of the whole nail bed offers a highly reproducible approach for quantitative assessment and therefore has potential as an outcome measure. [ABSTRACT FROM PUBLISHER]

Objectives. Our aim was to describe clinical features and pattern of care in children with localized scleroderma presenting to secondary care during a 25-month incidence study.Methods. Eighty-seven patients were identified, and clinical features, serum autoantibodies, current treatment and outcome at 12 months were documented.Results. Fifty-eight (67%) had linear scleroderma, 25 (29%) non-linear morphoea and 4 (4%) a mixed pattern. Of the 58 patients with linear scleroderma, 29 (50%) presented with lesions of the trunk and/or limbs only, 26 (45%) with face–head localization only and 3 (5%) with both. Thirteen (15%) had extracutaneous features and 16 (43%) out of 37 were ANA positive. At 12 months, 59% were on MTX. At 12 months, 51 (65%) were improved/resolved, 14 (18%) were unchanged and 13 (17%) had deteriorated.Conclusion. Key findings included the high prevalence of face–head involvement in those with linear disease, and the high prevalence of extracutaneous disease and of ANA positivity. After 12 months, most patients improved according to clinician's opinion. [ABSTRACT FROM PUBLISHER]

The relationship between the built environment, physical activity, and well-being is currently attracting concerted government attention in the UK which has been formalized through new sets of urban planning and design guidelines. In light of this, the author argues that the domains of intersection between the physical environment and governmental health and social agendas need further exploration. Furthermore, she asserts that urban geographers are theoretically and empirically well placed to undertake valuable and much needed research agendas within these domains. To explore these assertions, the author first sets out the recent turn to physical activity as an explicit policy concern. She then critically interrogates two recent sets of design guidelines, Active Design (Sport England) and the 2008 NICE guidance within the context of current UK policy thinking, before exploring the problematic nature of the instrumental readings of space they present. It is argued that this instrumental rationale may sanction the neglect of the intrinsic value and importance of active lives themselves to urban spaces, which, it is asserted, can have marked impacts on wellbeing. An appreciation of this opens up new geographical research agendas with respect to the built form, public health, and governance. [ABSTRACT FROM AUTHOR]

Background: Breast-feeding rates in the UK are known to vary by maternal socio-economic status but the latter function is imperfectly defined. We test if CTVB (Council Tax Valuation Band -- a categorical assessment of UK property values and amenities governing local tax levies) of maternal address predicts, in a large UK regional sample of births, (a) breast-feeding (b) personal and socio-economic attributes of the mothers. Methods: Retrospective study of a subset (n.1390 selected at random) of the ALSPAC sample (Avon Longitudinal Study of Parents and Children), a large, geographically defined cohort of mothers followed from early pregnancy to 8 weeks post-delivery. Outcome measures are attitudes to breast-feeding prior to delivery, breast-feeding intention and uptake, demographic and socioeconomic attributes of the mothers, CTVB of maternal home address at the time of each birth. Logistic regression analysis, categorical tests. Results: Study sample: 1360 women divided across the CTVBs -- at least 155 in any band or band aggregation. CTVB predicted only one belief or attitude - that bottle-feeding was more convenient for the mother. However only 31% of 'CTVB A infants' are fully breast fed at 4 weeks of life whereas for 'CTVB E+ infants' the rate is 57%. CTVB is also strongly associated with maternal social class, home conditions, parental educational attainment, family income and smoking habit. Conclusion: CTVB predicts breast-feeding rates and links them with social circumstances. CTVB could be used as the basis for accurate resource allocation for community paediatric services: UK breast-feeding rates are low and merit targeted promotion. [ABSTRACT FROM AUTHOR]

1. Phratora vulgatissima is the most serious pest of willow grown as short-rotation coppice in Britain. The effects of genetically diverse plantations of willow on beetle density, damage and oviposition were studied in a field trial containing monocultures of willow varieties with different willow beetle susceptibility, and mixtures which differed in number and spatial configuration of varieties. In addition, P. vulgatissima adults were introduced to potted willows in cages in a glasshouse as either a monoculture or a mixture of three varieties, and damage and oviposition were recorded. 2. Beetle density, damage and oviposition in the field were generally lower in mixtures than in monocultures, especially with five varieties rather than three and random structural composition rather than regular. In the caged experiment, where beetles could not migrate, there were no significant differences between the monoculture and the mixture for mean damage or oviposition on the two susceptible varieties. 3. Over time, the average beetle density per tree in the field increased in the monocultures of susceptible varieties, yet decreased in the mixtures. The behavioural response of P. vulgatissima to vegetational diversity was consistent with the resource concentration hypothesis, with lower colonization in, and increased emigration from, mixtures compared with monocultures. 4. Genetically and spatially diverse willow mixtures provide a sound basis for pest management due to the propensity for movement by the beetles. As each movement necessitates the location of a new host plant, it is more difficult for beetles to find favourable varieties in a genetically diverse mixture than in a monoculture. 5. Adult P. vulgatissima occur in mobile aggregations, so pest and damage surveys must be intensive and cover a wide time interval. An option for pest management is a mixture of five willow varieties, at least one of which has low susceptibility to the willow beetle, grown in a... [ABSTRACT FROM AUTHOR]

Summary1 Phratora vulgatissima (Chrysomelidae) is the major pest of short-rotation coppice willows in the U.K., capable of causing severe defoliation in monoculture plantations. As this beetle shows feeding preferences between willow clones, knowledge of the spatio-temporal dynamics of P. vulgatissima is needed in order to assess the effects of mixed clonal plantings on the management of this pest. 2 Distribution patterns of adult P. vulgatissima were monitored over a season at a spatial scale of every tree or every other tree in single clone plantings (monocultures) of three willow clones and in a regular row mixture of these clones. 3 Distribution indices (deviation from Complete Spatial Randomness) demonstrated that P. vulgatissima adults were spatially aggregated on favourable clones in the monocultures and the mixture. The degree of aggregation (measured by the k-parameter of the negative binomial) differed between willow clones. Beetles were highly aggregated at the start of the season, but less so later. 4 Dispersal studies of P. vulgatissima adults over time showed a pattern of beetle infestation along rows of the preferred clones in a regularly structured mixture. In the monocultures, movement was less directional. 5 Plantation design offers some potential for more effective non-chemical pest management for P. vulgatissima. Monitoring of the pest must take account of our findings that adults occur in mobile aggregations. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to hypomagnesaemia causing symptomatic hypocalcaemia in the November 5, 2013 issue.

The article focuses on the role of social reforms as the best remedy to prevent social revolution. Yet one can hardly escape admitting the validity of such an axiom in the light of the recent history of Europe. Countries which endured the greatest strains during the great war- namely Great Britain, France, and Germany, were also those in which pre-war legislation had done the most to insure the average man against ignorance, unemployment, and a destitute old age. dictatorship. The case of Germany is especially striking. The new republic, immediately after the revolution which brought it into being, was forced to accept the humiliation, the territorial losses, and the economic burdens embodied in the treaty of Versailles; then came the period of inflation resulting in the complete collapse of the mark; finally, with stabilization, unemployment appeared to add its share to the sufferings of the people. Yet Germany escaped social revolution. While, the illiterate countries, the countries which never embarked on programs of social reform have suffered from attempts to impose new schemes of society which range from Communism to Fascism.

The article discusses Great Britain's Liberalism and the idea of social justice. The influence of theory on Great Britain's politics was particularly significant in the early years of the twentieth century, when the great social reforms of the Liberal party laid the foundations of a new social unity, the strength of which was tested in World War I, and in the great depression, and won universal admiration after the military collapse of Dunkirk. Between 1906 and 1911 as much important legislation was placed upon the statute books as in the six years from 1832 to 1837. Among the more significant laws were the Trade Disputes Act and the Workman's Compensation Act of 1906, the Old Age Pensions Act of 1908, the Labor Exchange Act, the Children's Act and the Housing and Town Planning Act of 1909, and the National Insurance Act of 1911, Although this mass of detailed social legislation was put into effect piece-meal, it was the coherent result of years of discussion and agitation. It was based on a considered view of the State and society.

Presents information related to several articles on economics. Economic growth and productivity in the United States, Canada, Great Britain, Germany and Japan in the post war period; Dividend policies of electric utility firms; Relationship between the quantity of materials imported by the United States and the level of industrial production and prices of imports.

A letter to the editor is presented in response to the article "Scleroderma (systemic sclerosis): classification, subsets and pathogenesis," by E.C. LeRoy and colleagues in the February 1998 issue.

A letter to the editor is presented regarding a study that described children's and parents beliefs about childhood scleroderma using the Revised Illness Perceptions Questionnaire (IPQ-R).

A letter to the editor is presented which confirmed the predictability of digital ulcers (DU) through severe abnormality on nailfold videocapillaroscopy (NVC) patterns.

The article focuses on the association of educational institutions with religion. Humanists and atheists have a dilemma in dealing with religion in schools. It asks whether worship and religious education (RE) should be a part of school activities and curricula. In Great Britain, religion has long played a part in the state schools. The ideal is to abolish RE and put teaching about religion into philosophy, history, literature and music. Schools need more teaching about philosophy and more teaching about the process of scientific discovery.

The article examines whether copper homeostasis is aberrant in systemic sclerosis (SSc) patients. Topics discussed include the implication of abnormalities in copper homeostasis in the pathogenesis of diabetes mellitus and other illnesses and the therapeutic potential for selective copper chelation given encouraging results in the amelioration of tissue fibrosis. The significant reduction of serum selenium in SSc patients is then mentioned.

This article presents the views of two scholars on secularism. The article analyses the question of why secularism hasn't triumphed completely over unbelief. One of the authors believe that the irrational aspect of human behavior is just as much a part of oneself as the rational part. This is why one will never be able to convince all people that secularism is the best solution to society's problems. The other author compares the secularism prevalent in Great Britain with that of the U.S. Secularism, in the author's view, includes reason and science for solving problems, action to try and bring greater equality and democracy in the world.

The article states that the point at which politics and prayer touch is a dangerous one. It has been seen in the recent British election, in the workings of the European Union, and in the policies of the Vatican. The British election was fought among the incumbent Labour Party; the Conservative Party hungry for power after years in the wilderness; and the ever-hopeful Liberal Democrats, who hoped to inject a spice of radicalism into the election and, indeed, Parliament. It looked at the beginning of the campaign as if religion might play a part, that prayer might relieve the boredom.

This paper focuses on the planning of New Towns in the UK in order to explore what the design and planning of urban spaces can tell us about which populations and their health matter and are prioritized, at different points in time. We concentrate on how ageing was conceptualized, and what this tells us about how ageing societies and bodies are accounted for and understood. Through the dynamic evolution of people and place, we can also come to see that what was once viewed as health promoting can become entangled with the causes of ill health. We recommend further multidisciplinary research into the planning of future cities and urban environments. [ABSTRACT FROM AUTHOR]

Objective: The burden of disability associated with systemic sclerosis (SSc) is being increasingly recognized. Our aim was to test the hypothesis that changes in functional ability over time differ between patients with limited (lcSSc) and diffuse cutaneous (dcSSc) subtypes, and that in dcSSc (but not lcSSc) these changes correlate with skin thickening., Method: This was a retrospective analysis of data collected prospectively between 2005 and 2016 at a single centre. Data recorded at annual review visits included modified Rodnan skin score (mRSS) and Health Assessment Questionnaire Disability Index (HAQ-DI). Yearly rates of mRSS and HAQ-DI change were assessed by individual linear regressions, and those gradients were compared between disease groups (lcSSc/dcSSc) for each of early/late disease (less/greater than 5 years' duration)., Results: The study included 402 patients (110 dcSSc, 292 lcSSc), with mean length of follow-up of 5.5 years (sd 3.5). Mean baseline HAQ-DI was 1.4 in dcSSc and 1.2 in lcSSc. In dcSSc, increased mRSS was associated with worsening disability (ρ = 0.36, p = 0.004) during early but not late disease (ρ = 0.12, p = 0.331). In lcSSc, changes in mRSS were not associated with changes in disability for early (ρ = -0.15, p = 0.173) or late disease (ρ = 0.10, p = 0.137)., Conclusion: These findings confirm high disability in patients with SSc. A relationship between HAQ-DI and mRSS (worsening mRSS associated with increasing disability) was found only in patients with early dcSSc, suggesting that in other patient subgroups other factors play the major role.

Introduction: Potassium voltage-gated channel shaker-related subfamily member 5 (KCNA5) is implicated in vascular tone regulation, and its inhibition during hypoxia produces pulmonary vasoconstriction. Recently, a protective association of the KCNA5 locus with systemic sclerosis (SSc) patients with pulmonary arterial hypertension (PAH) was reported. Hence, the aim of this study was to replicate these findings in an independent multicenter Caucasian SSc cohort., Methods: The 2,343 SSc cases (179 PAH positive, confirmed by right-heart catheterization) and 2,690 matched healthy controls from five European countries were included in this study. Rs10744676 single-nucleotide polymorphism (SNP) was genotyped by using a TaqMan SNP genotyping assay., Results: Individual population analyses of the selected KCNA5 genetic variant did not show significant association with SSc or any of the defined subsets (for example, limited cutaneous SSc, diffuse cutaneous SSc, anti-centromere autoantibody positive and anti-topoisomerase autoantibody positive). Furthermore, pooled analyses revealed no significant evidence of association with the disease or any of the subsets, not even the PAH-positive group. The comparison of PAH-positive patients with PAH-negative patients showed no significant differences among patients., Conclusions: Our data do not support an important role of KCNA5 as an SSc-susceptibility factor or as a PAH-development genetic marker for SSc patients.