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This thesis principally studies the determination of UK export performance between the wars. Several improvements to the measurement of sterling's nominal and real effective exchange rate in the period are implemented, and the path of the exchange rate is related to UK and foreign exchange rate policies. The nature of competitiveness and the demand and supply mechanisms by which it may influence exports are discussed. In the light of this, and the commodity and geographical breakdown of UK exports, we suggest alternative measures of competitiveness which may appropriately be tested in econometric work. Aggregate UK export volume and price equations for the inter- war period are then estimated. Competitiveness, which is in turn influenced by the exchange rate, and the economic position of primary producing countries, are found to have had significant effects on UK export performance. Similarly specified equations are estimated for UK exports in eight industrial sectors. Distinctive characteristics of sectors may lead to substantial divergences between sectoral and aggregate behaviour. This is confirmed in further work on UK coal exports. Nevertheless, measures of the price of UK exports relative to the price of exports of other industrial countries generally give explanations of UK export performance which are superior to other competitiveness measures. A substantial statistical appendix containing data on, inter alia, UK and foreign exchange rates, trade volumes and values (with geographcial and commodity breakdown), labour costs and prices, together with the sources and methods used in their construction, is provided both for historical interest and to facilitate replication of results and further research.

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) collectively referred to as venous thromboembolism (VTE) are associated with significant morbidity and mortality worldwide.DVT is common in hospitalized patients with acute medical illness. Routine use of thromboprophylaxis has been shown to reduce prevalence of DVT in hospitalized patients with acute medical illness. Thromboprophylaxis is not routinely given to hospitalized medical patients in most hospitals in Zambia.Objectives: The objectives of this study were: todetermine the prevalence and anatomical distribution of DVT in medical patients admitted to the UTH for at least 7 days; establish demographic and clinical characteristics of medical patients with DVT and finally determine the accuracy of the Well's score for DVT.Methods: This was a descriptive, cross sectional analytical study. The sample size comprised 296 medical patients admitted for at least 7 days. A questionnaire was used to obtain demographic characteristics and relevant clinical history. A focused detailed physical examination was conducted to screen for DVT of the lower limbs and Well's score for DVT computed. Laboratory tests including HIV test and full blood count were done. Biochemical and genetic studies to evaluate for inherited and acquired thrombophilias could not be done due limited financial resources. Compression ultrasound scans (USS) were done on lower limbs of recruited patients to determine the presence of DVT. Variables of interest were compared by chi-square, Kruskal-wallis and t-tests. Multivariate and univariate logistic regression analysis were used to assess for associations between DVT and independent variables of interest.Results: The Prevalence of DVT of the lower limbs was 11.1 % (33/296). Prevalence of proximal lower limb DVT was 9.1%. Eighty two percent (27/33) of all patients with DVT had proximal lower limb DVT. Asymptomatic lower limb DVT was noted in 85 % (28/33) of all patients with DVT.The Mean age of patients with DVT was 42.12 years (SD 12.71).The mean duration of hospital admission was 11.91 (SD 7.77) days. Seventy six percent (25/33) of all patients with DVT had an infectious disease as a primary diagnosis. Tuberculosis was the most common infectious disease among patients with DVT accounting for 60.6 % (20/33) of all infections. Up to 70 % (23/33) of all patients with DVT were HIV positive.The specificity for the Wells score specificity for DVT was 73.4% while the sensitivity was 100%. The accuracy was 76.3%.The positive and negative predictive values were 32% and 100% respectively.Conclusion: Proximal Lower limb DVT is common among HIV positive medical patients admitted for at least 7 days at the UTH. In our study, lower extremity proximal DVT was more common in patients with Tuberculosis and a low BMI. Up to 85% of lower limb DVT was asymptomatic. Without a high index of suspicion, lower limb DVT is likely to be missed. The pretest Wells score correlated well with the USS findings and could be used as a rule out test for those with suspected DVT.A follow up study to evaluate for genetic and biochemical factors that predispose to DVT need to be undertaken in the near future. There is need to advocate for thromboprophylaxis in medical patients with acute illness and prolonged hospital stay.

Background: Sepsis due to respiratory disease is one of the main complications of HIV/AIDS. Audit data from the Department of Internal Medicine at the University Teaching Hospital in Lusaka, Zambia indicate that pneumonia and tuberculosis in HIV represent two of the four leading causes of death. The mortality rate has remained high despite the advances made in antimicrobial spectrum. Limited ventilatory support options for patients with respiratory complications contribute to the high mortality rate. It is envisaged that non-invasive ventilation (NIV) will help reduce the mortality rate in this patient sub-population. Since Zambia has limited ICU capacity, less complex interventions such as NIV, might be lifesaving.Method: We conducted an observational prospective cohort study for the NIV arm (in the first half of 2016) with a retrospective chart review for the controls that focused on HIV positive patients with sepsis and hypoxaemic respiratory failure. 77 consecutive HIV positive patients with sepsis and respiratory distress meeting the inclusion criteria constituted the study population. Using the same clinical criteria 77 historical comparator patients were added from available charts reviewed from January 2014 to January 2016. After initial review of 385 folders, every 5th file was selected as comparator group. All patients meeting the inclusion criteria were offered NIV unless they opted out or refused to give consent. Clinical details were obtained and NIV initiated and clinical follow up recorded at 1, 24, 48 hours and daily assessment for 72 hours. Primary outcomes were patient tolerability on NIV. Secondary outcomes were survival to hospital discharge of participants on NIV. Clinical outcomes from the NIV arm were compared with the historical group.Results: 18 out of 77 patients receiving NIV (23.3%) died and the rest had a hospital survival to discharge. One patient in the NIV group left against medical advice after 48 hours, but his 24 and 48 hour clinical assessments showed marked improvement. In the historical group 64 out of 77 patients died by day 3, mortality rate of 83%. In both the historical and NIV groups, the main attributed cause of death was tuberculosis (89% vs 72% for the controls and NIV respectively). 4 patients developed complications of NIV (5.2%) leading to its discontinuation (3 patients had mask intolerance and worsening respiratory failure while one patient had gastric distension).Conclusion: Patients on NIV had a 72% relative risk reduction and a 60% absolute risk reduction of mortality compared to conventional group by day 3 at UTH. Only 5.2% developed intolerance or complication to NIV. Therefore, NIV could be a much needed arsenal in boosting survival outcomes in this patient subgroup.