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The U.K. economy experienced significant macroeconomic adjustments following the 2016 referendum on its withdrawal from the European Union. To understand these adjustments, this paper presents empirical facts using novel U.K. macroeconomic data and estimates a small open economy model with tradable and non-tradable sectors. We demonstrate that the referendum outcome can be interpreted as news about a future decline in productivity growth in the tradable sector. An immediate fall in the relative price of non-tradable goods induces a temporary "sweet spot" for tradable producers. Economic activity in the tradable sector expands in the short run, while the non-tradable sector contracts. Aggregate output, consumption, and investment growth decelerate. [ABSTRACT FROM AUTHOR]

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March–July 2020). Analysis was informed by the conceptual framework of service and learning. 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures. Practice points There was a benefit for most students who provided clinical support compared to those who did not during Covid-19. Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team. Not every student's experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity. The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service. There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations. [ABSTRACT FROM AUTHOR]

The article offers information on the lessons learned from the COVID-19 pandemic regarding infection prevention and control (IPC). Topics discussed include the challenges faced during the pandemic, the importance of IPC education, and the need for improved planning and preparedness for future pandemics.

Analysis of Gildas, Anglo-Saxon Chronicle, Historia Brittonum and the Harleian chronicle suggests that all originally recorded the same series of post-Roman British events. Moreover, the three annals used an apparatus distinct from those in continental or Irish works: a unique placeholder standing for each year. These 'Britannic annals' originally provided a simple yet effective means of dating past events. The prime reason these four sources now seem inconsistent is due to Gildas' providential bias. His misdating of a single event in his De excidio Britanniae made it impossible for later historians to create a unified chronology for events in fifth-century Britain. However, once Gildas' providential error is corrected, all these early sources provide consistent dates for post-Roman events in Britain. [ABSTRACT FROM AUTHOR]

The extent to which immune responses to natural infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and immunization with vaccines protect against variants of concern (VOC) is of increasing importance. Accordingly, here we analyse antibodies and T cells of a recently vaccinated, UK cohort, alongside those recovering from natural infection in early 2020. We show that neutralization of the VOC compared to a reference isolate of the original circulating lineage, B, is reduced: more profoundly against B.1.351 than for B.1.1.7, and in responses to infection or a single dose of vaccine than to a second dose of vaccine. Importantly, high magnitude T cell responses are generated after two vaccine doses, with the majority of the T cell response directed against epitopes that are conserved between the prototype isolate B and the VOC. Vaccination is required to generate high potency immune responses to protect against these and other emergent variants. Understanding the effect of vaccination on emerging SARS-CoV-2 variants of concern is of increasing importance. Here, James et al. report that two doses of vaccination with the Pfizer-BioNTech vaccine induce more robust immune responses to the B.1.1.7 and B.1.351 SARS-CoV-2 lineages than does natural infection. [ABSTRACT FROM AUTHOR]

Background: A quarter of people with intellectual disability (ID) have epilepsy, compared to approximately one in a hundred across the general population. Evidence for the safe and effective prescribing of antiepileptic drugs (AEDs) for those with ID is, however, limited. Aims of Study: This study seeks to strengthen the research evidence around Eslicarbazepine Acetate (ESL), a new AED, by comparing response of individuals with ID to those from the general population who do not have ID. Methods: A single data set was created through retrospective data collection from English and Welsh NHS Trusts. The UK‐based Epilepsy Database Research Register (Ep‐ID) data collection and analysis method were used. Results: Data were collected for 93 people (36 ID and 57 'no ID'). Seizure improvement of '>50%' was higher at 12 months for 'no ID' participants (56%), compared to ID participants (35%). Retention rates were slightly higher for those with ID (56% compared to 53%). Neither difference was significant. Conclusions: Tolerance and Efficacy for ID and 'no ID' people in our data set were similar. Seizure improvement and retention rates were slightly lower than that found in other European data sets, but findings strengthen the evidence for the use of ESL in the ID population. [ABSTRACT FROM AUTHOR]

The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal‐type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99–200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal‐type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation. [ABSTRACT FROM AUTHOR]

John Croft's article 'Composition is not Research' challenges a conception and ideal of compositional work in academia which has grown in prominence over several decades in the UK. As a performer-scholar, who also writes non-performancerelated scholarship, I welcome this challenge, share some of Croft's reservations about the ways in which these conceptions often manifest themselves, and also have concerns about the rushed integration of practitioners into academia and the implications for more traditional forms of scholarship. However, I find many of Croft's formulations and assumptions too narrow, and instead argue that a good deal of the process of composition and performance does constitute research - grappling with difficult questions, exploring solutions, and producing creative work which embodies these solutions and from which others can draw much of value. [ABSTRACT FROM AUTHOR]

Assessing attachment is essential yet challenging. The Adult Attachment Interview (AAI) provides the best appraisal of adult attachment but is time-intensive and costly. Likewise, concerns have been raised regarding the Berkeley-AAI coding and classification method. Meanwhile, self-report measures of adult attachment are time-efficient and low-cost, but their validity is questionable. The Dynamic-Maturational Model approach to the AAI (DMM-AAI) and a novel self-report measure - the Attachment Relationship Questionaire (ARQ) - may offer a solution. However, additional investigations regarding the validity of DMM-AAI are needed and the ARQ's psychometric properties have not be tested. The validity of the DMM approach to the AAI and the predictive relationship between the ARQ and DMM-AAI classification were examined for 212 participants living the UK. Results indicated a strong positive relationship between high numbered attachment classification on the DMM-AAI and psychological treatment status, X²(6) = 56.07, p < .001; Cramer's V = .371, p < .001. Binomial logistic regressions between the ARQ and DMM-AAI found both single-statement and multi-statement predictive models were statistically significant. However, the ARQ accounted for only a small amount of the variance (R² = 0.15). In conclusion, the DMM-AAI demonstrated strong construct validity, whereas the ARQ is not useful for assessment of adult attachment. Further investigation with a revised version of the ARQ that addresses psychometric concerns is suggested. [ABSTRACT FROM AUTHOR]

A few months ago I took part in a gloomy debate about the housing crisis with the celebrated modernist architect Kate Macintosh. All the speakers had referred despairingly to the demolition of dozens upon dozens of London's housing estates—the ‘London clearances’ written about so cogently by Simon Elmer and Geraldine Dening in this Special Feature. When Kate got up to speak she talked about her experience of designing South London's landmark Dawson's Heights in the 1960s and the success of recent community projects in bringing North London's once troubled Broadwater Farm Estate together. ‘Does she not know it's also under threat of demolition?’, I wondered to myself. It turns out she did, with her voice cracking as she continued, breaking down in tears at the thought of what the community now had to face, despite all their efforts. Then she composed herself and continued. But as she returned to her seat she was tripped up by a misplaced lead and fell, breaking her arm. It was an upsetting incident and felt to me like a disturbing metaphor for London's housing crisis. [ABSTRACT FROM PUBLISHER]

Purpose: Major pelvic injuries resulting from high-energy trauma require emergency hospital treatment, and part of the initial management includes mechanical stabilisation of the pelvis. Controversies include binder position, use in lateral compression injuries and application during radiological assessment. We present the results of a survey of both emergency department and orthopaedic specialties. Methods: A telephone survey of all 144 trauma units in the UK accepting adult pelvic trauma patients was carried out in July 2012. The duty registrar for the emergency and orthopaedic departments was contacted and asked to complete a questionnaire. Results: A response rate of 100 % was achieved. Pelvic binders were available for use in approximately three quarters of the trauma units surveyed. Eight-five emergency department (59 %) and 79 orthopaedic (54.9 %) registrars had been given training on pelvic binder application. Fifty-six emergency department (38.9 %) and 114 orthopaedic (79.1 %) registrars identified the level of the greater trochanters as the most suitable position for the binder. Forty-five emergency department (31.3 %) and 58 orthopaedic (40.3 %) registrars used pelvic binders in suspected lateral compression injuries. One hundred and twenty-six emergency department (87.5 %) and 113 orthopaedic (78.5 %) registrars would not release the binder during radiological assessment of the pelvis in a haemodynamically stable patient. Conclusion: There is great variability in practice amongst trauma units in the UK. Training must be formalised and provided as a mandatory part of departmental induction. The use of standardised treatment algorithms in trauma units and the Advanced Trauma and Life Support (ATLS) framework may help decision making and improve patient survival rates. [ABSTRACT FROM AUTHOR]

In this debate, we explore the dilemmas between the law, the ethical issues, the good clinical practice, and the wishes of the family. In the scenario chosen, the issues center around not only the senior family members but also of an older child with some rights to self-determination. There are no absolute rights or wrongs to this case, which is based on a synthesis of other actual clinical scenarios. The maze of considerations are not easy to negotiate, and in the final analysis, the surgeon and the anesthetist must also be comfortable with the decisions as they are the active elements that have to practically manage a clinical crisis should it occur. The participants in this debate are all UK based, and as such the legal standpoint reflects UK legislation, and the ethical and clinical reviews are strongly influenced by current attitudes within UK and Europe that may not be exactly mirrored in different cultural frameworks. However, in this article, it is the broad principles behind the differing responses that are important, which it is hoped will stimulate reflection of attitudes and management in different cultural frameworks. [ABSTRACT FROM AUTHOR]

The St. Christopher's Hospice Palliative Care in Dementia Project, funded for 3 years by the King's Fund, aims to investigate the palliative care needs of patients with advanced dementia and their families; to clarify the role of specialist palliative care for this patient group; and to examine the usefulness of one model of working. This interim report outlines findings from the first 50 patients taken on by the project. Early results indicate that both patients and their carers have a high level of unmet need. The model of care chosen for this project appears to meet many of these needs, and appears to be both cost efficient and effective in terms of improving end of life care for dementia patients and their carers. [ABSTRACT FROM AUTHOR]

Provides information on teaching mechanical design principles on engineering foundation courses at universities in Great Britain. Nature of problem solving in mechanical design; Details on the problem solving method for mechanical product analysis; Externalization of concepts with the aid of drawing and sketching; Significance of the ability of students to combine mechanical principles and creativity.

Elderly residents in nursing homes are at very high risk of life-threatening COVID-19-related outcomes. In this report, an epidemiological and serological investigation of a SARS-CoV-2 outbreak in an Italian nursing home is described. Among the residents, all but one (19/20) were regularly vaccinated against SARS-CoV-2. In mid-February 2021, a non-vaccinated staff member of the nursing home was diagnosed with the SARS-CoV-2 infection. Following the outbreak investigation, a total of 70% (14/20) of residents aged 77–100 years were found positive. The phylogenetic analysis showed that the outbreak was caused by the SARS-CoV-2 variant of concern 202012/01 (the so-called "UK variant"). However, all but one positive subjects (13/14) were fully asymptomatic. The only symptomatic patient was a vaccinated 86-year-old female with a highly compromised health background and deceased approximately two weeks later. The subsequent serological investigation showed that the deceased patient was the only vaccinated subject that did not develop the anti-spike protein antibody response, therefore being likely a vaccine non-responder. Although the available mRNA SARS-CoV-2 vaccine was not able to prevent several asymptomatic infections, it was able to avert most symptomatic disease cases caused by the SARS-CoV-2 variant of concern 202012/01 in nursing home residents. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (Covid-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents a global health emergency that needs urgent intervention. Viruses constantly change through mutation, and new variants of a virus are expected to occur over time. In the United Kingdom (UK), a new variant called B.1.1.7 has emerged with an unusually large number of mutations. The aim of this study is to evaluate the level of protection of sera from 12 patients infected and later healed in Apulia Region (Italy) with Covid-19 between March and November 2020, when the English variant was not circulating in this territory yet, against the new VOC 202012/01 variant by seroneutralization assay. The sera of patients had already been tested before, using a virus belonging to the lineage B.1 and showed an antibody neutralizing titer ranging between 1:160 and 1:320. All the 12 sera donors confirmed the same titers of neutralizing antibodies obtained with a strain belonging to the lineage B.1.1.7 (VOC 202012/01). These data indicate that antibodies produced in subjects infected with variants of Sars-CoV-2 strain before the appearance of the English one, seem to have a neutralizing power also against this variant. [ABSTRACT FROM AUTHOR]

In the article, the authors present their opinion on the use of remote-access open-book examinations (OBE) by medical schools in Great Britain during the Covid-19 pandemic. Topics include the equity issues on the use of OBE like the socioeconomic status achievement gap and quality and accessibility of Internet connection and the need for additional research on the use of OBE before its acceptance as educational performance measure.

Background: Antiretroviral therapy (ART) cannot cure HIV infection because of a persistent reservoir of latently infected cells. Approaches that force HIV transcription from these cells, making them susceptible to killing-termed kick and kill regimens-have been explored as a strategy towards an HIV cure. RIVER is the first randomised trial to determine the effect of ART-only versus ART plus kick and kill on markers of the HIV reservoir.Methods: This phase 2, open-label, multicentre, randomised, controlled trial was undertaken at six clinical sites in the UK. Patients aged 18-60 years who were confirmed as HIV-positive within a maximum of the past 6 months and started ART within 1 month from confirmed diagnosis were randomly assigned by a computer generated randomisation list to receive ART-only (control) or ART plus the histone deacetylase inhibitor vorinostat (the kick) and replication-deficient viral vector T-cell inducing vaccines encoding conserved HIV sequences ChAdV63. HIVconsv-prime and MVA.HIVconsv-boost (the kill; ART + V + V; intervention). The primary endpoint was total HIV DNA isolated from peripheral blood CD4+ T-cells at weeks 16 and 18 after randomisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02336074.Findings: Between June 14, 2015 and Jul 11, 2017, 60 men with HIV were randomly assigned to receive either an ART-only (n=30) or an ART + V + V (n=30) regimen; all 60 participants completed the study, with no loss-to-follow-up. Mean total HIV DNA at weeks 16 and 18 after randomisation was 3·02 log10 copies HIV DNA per 106 CD4+ T-cells in the ART-only group versus 3·06 log10 copies HIV DNA per 106 CD4+ T-cells in ART + V + V group, with no statistically significant difference between the two groups (mean difference of 0·04 log10 copies HIV DNA per 106 CD4+ T-cells [95% CI -0·03 to 0·11; p=0·26]). There were no intervention-related serious adverse events.Interpretation: This kick and kill approach conferred no significant benefit compared with ART alone on measures of the HIV reservoir. Although this does not disprove the efficacy kick and kill strategy, for future trials enhancement of both kick and kill agents will be required.Funding: Medical Research Council (MR/L00528X/1). [ABSTRACT FROM AUTHOR]

The article presents a phase IV open label randomised controlled trial to determine whether one priming dose of serogroup C meningococcal (MenC) conjugate vaccine is comparable to two doses when followed by a booster of Haemophilus influenzae type B (Hib)-MenC-Tetanus Toxoid (TT) conjugate vaccine at 12 months in infants. The study results show that the immunogenicity of one priming dose of MenC-CRM conjugate vaccine at 3 months was superior to the two dose regimen.

Both musculoskeletal pain and sleep disturbances are major health problems worldwide. Literature suggests that the two are reciprocally related and both may be associated with changes in C-reactive protein (CRP) levels. However, the relationships among musculoskeletal pain, sleep duration, and CRP remain unclear. In this cross-sectional study, we investigated the relationship between acute and chronic musculoskeletal pain, sleep, and inflammation using the data from the initial visit of the UK Biobank. 17,642 individuals with chronic musculoskeletal pain, 11,962 individuals with acute musculoskeletal pain, and 29,604 pain-free controls were included in the analysis. In addition, we validated the findings using data from the second visit assessment of the UK Biobank. We found that 1) chronic pain was associated with higher CRP levels compared to both acute pain and the pain-free controls; 2) chronic pain was associated with a lower sleep score (a measurement of sleep patterns), compared to acute pain and the pain-free controls; and acute pain was associated with lower sleep scores compared to the controls; 3) there was a significant negative association between the sleep score and CRP; 4) CRP may partially mediate the association between chronic pain and decreased sleep score. However, the effect size of the mediation was rather small, and the pathophysiological significance remains uncertain. Further validation is needed. These findings were partly replicated in the UK Biobank second visit assessment cohort with a smaller sample size. Our findings, which are based on the large UK Biobank dataset, support the interplay between musculoskeletal pain, sleep patterns, and the potential mediating role of CRP on this reciprocal relationship. • We investigated the association among acute and chronic musculoskeletal pain, sleep, and inflammation. • Chronic pain was associated with higher CRP levels compared to both acute pain and the pain-free controls. • Both acute and chronic pain was associated with a lower sleep score. • CRP may partially mediate the association between chronic pain and decreased sleep score. [ABSTRACT FROM AUTHOR]

Reprints an article from the October 3, 1896 issue of `Journal of the American Medical Association' which deals with the issue of smallpox vaccination.

Whole-genome sequencing (WGS) is the gold standard for fully characterizing genetic variation but is still prohibitively expensive for large samples. To reduce costs, many studies sequence only a subset of individuals or genomic regions, and genotype imputation is used to infer genotypes for the remaining individuals or regions without sequencing data. However, not all variants can be well imputed, and the current state-of-the-art imputation quality metric, denoted as standard Rsq, is poorly calibrated for lower-frequency variants. Here, we propose MagicalRsq, a machine-learning-based method that integrates variant-level imputation and population genetics statistics, to provide a better calibrated imputation quality metric. Leveraging WGS data from the Cystic Fibrosis Genome Project (CFGP), and whole-exome sequence data from UK BioBank (UKB), we performed comprehensive experiments to evaluate the performance of MagicalRsq compared to standard Rsq for partially sequenced studies. We found that MagicalRsq aligns better with true R2 than standard Rsq in almost every situation evaluated, for both European and African ancestry samples. For example, when applying models trained from 1,992 CFGP sequenced samples to an independent 3,103 samples with no sequencing but TOPMed imputation from array genotypes, MagicalRsq, compared to standard Rsq, achieved net gains of 1.4 million rare, 117k low-frequency, and 18k common variants, where net gains were gained numbers of correctly distinguished variants by MagicalRsq over standard Rsq. MagicalRsq can serve as an improved post-imputation quality metric and will benefit downstream analysis by better distinguishing well-imputed variants from those poorly imputed. MagicalRsq is freely available on GitHub. [Display omitted] Ever-growing reference panels allow imputation of huge number (∼108) of lower-frequency variants. However, not all variants can be well imputed and standard imputation quality metric poorly reflects true imputation quality, particularly for uncommon variants. We present MagicalRsq, a machine-learning-based and better calibrated post-imputation quality metric, that can rescue 105–106 variants. [ABSTRACT FROM AUTHOR]

• PCR assays to detect key mutations of SARS-CoV-2 spike protein are described • Discrimination of Variants of Concern (VOCs) and other variants is achieved • The assays detected key mutations of 20I/501Y.V1 and 20 J/501Y.V3 in sewage in Italy • The method allows rapid and cost-effective detection of VOCs in sewage for WBE • The described approach can be used for rapid screening in clinical samples New SARS-CoV-2 mutations are constantly emerging, raising concerns of increased transmissibility, virulence or escape from host immune response. We describe a nested RT-PCR assay (~1500 bps) to detect multiple nucleotide changes resulting in key spike protein mutations distinctive of the major known circulating SARS-CoV-2 variants, including the three Variants of Concern (VOCs) 20I/501Y.V1 (United Kingdom), 20H/501Y.V2 (South Africa), and 20 J/501Y.V3 (Brazil), as well as the 20E.EU1 variant (Spain), the CAL.20C recently identified in California, and the mink-associated variant (GR, lineage B.1.1.298). Prior to application to field samples, the discriminatory potential of this PCR assay was explored using GISAID and Nextclade. To extend variant detection to challenging matrices such as sewage, where the amplification of long fragments is problematic, two short nested RT-PCR assays (~300 bps) were also designed, targeting portions of the region spanned by the long nested assay. The three newly-designed assays were then tested on field samples, including 31 clinical samples (7 fully-sequenced swab samples, and 24 uncharacterized ones) and 34 urban wastewater samples, some of which collected in areas where circulation of VOCs had been reported. The long assay successfully amplified 29 of the 31 swabs (93%), allowing the correct identification of variants 20I/501Y.V1 and 20E.EU1 present in the panel of previously characterized samples. The Spanish variant was detected in 14/24 of the uncharacterized samples as well. The sequences obtained using the short assays were consistent with those obtained with the long assay. Mutations characteristic of VOCs (UK and Brazilian variant) and of other variant (Spanish) were detected in sewage samples. To our knowledge, this is the first evidence of the presence of sequences harboring key mutations of 20I/501Y.V1 and 20 J/501Y.V3 in urban wastewaters, highlighting the potential contribution of wastewater surveillance to explore SARS-CoV-2 diversity. The developed nested RT-PCR assays can be used as an initial rapid screening test to select clinical samples containing mutations of interest. This can speed up diagnosis and optimize resources since it allows full genome sequencing to be done only on clinically relevant specimens. The assays can be also employed for a rapid and cost-effective detection of VOCs or other variants in sewage for the purposes of wastewater-based epidemiology. The approach proposed here can be used to better understand SARS-CoV-2 variant diversity, geographic distribution and impact worldwide. [Display omitted] [ABSTRACT FROM AUTHOR]

One hundred and twenty-four patients with knee osteoarthritis were reviewed at three stages over a mean of 24 months (range: 9-32 months) at the time of referral by the general practitioner, by the orthopedic consultant, and before surgery. At each visit, patients were examined and the American Knee Society score and Oxford Knee Society score were obtained. The functional element of the American Knee Score deteriorated significantly from the time of referral until the time of first orthopedic consultation (P=.005) and from the time of referral to the time of surgery (P=.006). The pain element of the American Knee Society score improved from the time of referral till the time of orthopedic assessment (P=.011). The change in Oxford Knee Society score between the time the patient was put on the waiting list to the time of surgery was not statistically significant (P=.30). This article questions the emphasis on surgical waiting times instead of symptoms and physical function in determining timing of surgery.

Background: The risk of coronary heart disease (CHD) is increased in rheumatoid arthritis (RA). The reasons for this remain unknown, but traditional risk factors for CHD identified in the general population may be important contributors., Objective: To assess comparatively the prevalence of traditional CHD risk factors and the absolute 10-year CHD risk in patients with RA or osteoarthritis (OA) without known cardiovascular co-morbidity., Methods: Consecutive Caucasian hospital outpatients with RA (n = 150) or OA (n = 100) aged 40-75 years were assessed for known cardiovascular co-morbidity, age, sex, smoking status, presence of diabetes mellitus (DM), height, weight, systolic blood pressure (BP), total cholesterol (TC) and HDL cholesterol. Absolute 10-year CHD risk for each individual was calculated using the Joint British Societies CHD risk calculator., Results: Prevalence and distribution of known cardiovascular co-morbid conditions were similar in RA (56/150, 37%) and OA (34/100, 34%). The resulting subgroups of patients without known co-morbidity (RA: n = 94; OA: n = 66) were not significantly different for age, sex, DM, smoking, systolic BP or TC: HDL cholesterol ratio. There was no significant difference in the absolute 10-year CHD risk between RA and OA (15.6+/-11.0 versus 14.8+/-9.3, p = 0.63). However, a significant proportion of patients without known cardiovascular disease in both the RA and OA subgroups had a 10-year CHD risk above the 15% or 30% risk levels, indicating the need for possible or definite intervention respectively. Over 80% of RA patients had at least 1 CHD risk factor that could be modified., Conclusion: Absolute 10-year CHD risk was not different between RA and OA patients in this study. Substantial numbers of RA and OA patients have potentially modifiable CHD risk factors present. We suggest that CHD risk should be assessed and modifiable risk factors addressed in the routine rheumatology clinic setting.