North Staffordshire Research Articles

Stoking hate: configuring loss in explanations of racially aggravated crime

Why do some people racially abuse others? In this article, I revisit fieldwork conducted in the early 2000s in Stoke-on-Trent in North Staffordshire with people implicated in racially harassment and racially aggravated crimes. I consider how Keval’s (2024) concept of a ‘haunting melody of loss’ can be used to capture the psychosocial dynamics apparent among people who directed their animosity towards migrant and minority ethnic groups in the midst of their own experiences of loss of face, reputation, health, financial security, control and a sense of community. The article contemplates how such dynamics subsequently became more pervasive features of the British political land, capitalised on by parties of the political right and far-right in the decade that followed. It also invites psychosocial reflections on the harms caused to migrant and minority ethnic populations demonised, misleadingly, as to blame for the losses of encountered by large sections of the ethnic majority white population and notes the enduring dangers cultivated by misdirecting the grief of loss posed by populist politics.

CSP2023: 437 - An evaluation of the North Staffordshire ACLR guidelines. Measuring usability and clinical confidence amongst independent charity sector Physiotherapists (Nuffield Health).

CSP2023: 437 - An evaluation of the North Staffordshire ACLR guidelines. Measuring usability and clinical confidence amongst independent charity sector Physiotherapists (Nuffield Health).

P185 Anatomical patterns of pain in primary care patients with polymyalgia rheumatica compared to the general population

Abstract Background/Aims Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. A tapered course of glucocorticoids is recommended, but not always straightforward, with frequent symptom recurrence. Reasons are unclear, but partial masking of painful comorbidities (e.g., osteoarthritis) may play a part. Methods 652 people with incident PMR were recruited from English general practice (2012-2014) to a postal survey study (questionnaires at diagnosis, 1, 4, 8, 12, 18, 24, [mean] 61 months). Surveys included a body manikin (front and back views). Participants were asked to shade anywhere they experienced pain >1 day in the last month. 44 mutually exclusive areas were defined as painful or not. For comparison, an age-gender matched random sample of 652 people was selected from a general population survey in North Staffordshire that used the same manikins. Pain prevalence was compared between the 2 studies. Results In the PMR study, surveys were completed by 244 participants at 24 months and 197 at 61 months. Pain was reported in a mean of 17.1 areas at diagnosis (Table). Bilateral shoulder and hip pain were present in the majority at diagnosis (shoulder 81%; hips 59%) and in around a third and a fifth of patients respectively throughout the study. The prevalence of bilateral shoulder and hip pain remained higher than in the general population sample, while unilateral pain in these areas was less common. Bilateral hand (27%) and knee (45%) pain were also common at diagnosis. After 1 month, the mean number of pain areas was 7 - similar to the general population. However, prevalence of bilateral shoulder and hip pain remained higher than the general population throughout follow-up. Unilateral hip and knee pain were persistently less common in those with PMR, whilst unilateral hip pain was more common. Conclusion Bilateral pain was reported more commonly across the disease course in people with PMR than the general population. Causes of pain cannot be accurately attributed, but are likely multifactorial, including PMR disease activity, treatment and painful comorbidities. However, the persistence of bilateral pain suggests untreated PMR symptoms, requiring further research. Disclosure N. Hammad: None. R. Partington: None. S. Hider: None. H. Butt: None. T. Helliwell: None. C. Mallen: None. S. Muller: None.

E006 Providing information on arthritis medication: a service evaluation

Abstract Background/Aims Traditionally patients commencing disease modifying anti-rheumatic medications (DMARDs) attended a face to face consultation with a rheumatology nurse or pharmacist, to discuss benefits, concerns and safety monitoring. The pandemic has led to an increase in the use of remote methods of information sharing including telephone consultations. The aim of this service evaluation was to elicit patients preferences on receiving information on arthritis medications to help inform service development. Methods A service evaluation with contributions from patients and stakeholders was designed and registered with the trust. Patients who were commencing or taking DMARDs attending, one of two hospital sites, in North Staffordshire were asked to complete a short questionnaire from November 2022-April 2023. Some patients completed the questionnaire at the end of their telephone drug counselling appointment with the assistance of the nurse whilst others completed the questionnaire whilst attending in person for their appointment. The questionnaire focused on the preferred format for receiving information on arthritis medications including a face to face appointment with a health professional (even if this meant a wait), telephone consultation, attending a group counselling session, having a drug information leaflet with the option to contact a health professional to answer any questions or watching a video on a device with internet access (computer, smart phone or tablet). The importance of receiving information on the same day as commencing treatment was also explored. Results 64 patients took part in the survey. No demographic data was collected. The most popular method for receiving information on arthritis medications was a face to face appointment, even if it meant a delay in starting medication (n = 32,50%). The second most popular method was an information leaflet with the option to discuss any concerns via the telephone (n = 12,19 %). The third preference to receive information were via a video, again with the option to discuss concerns remotely (n = 10, 16%) or a telephone appointment, even if it meant a delay in starting medication (n 10,16%) Surprisingly although no patients expressed a preference to attend a group counselling session, 36 (56%) would attend if offered. When presented with the option of having information on the same day as the decision was made to commence medication, or, having to wait to discuss the mediation with a health professional, there was a strong preference to see a health professional (n = 46, 72%) Conclusion Patients clearly value discussing commencing DMARDs with a health professional even if this means a delay in treatment. Having just one approach to information giving does not equate with individual needs and a range of options regarding information delivery that the patient can select from is required. Disclosure S. Ryan: None. S. Hider: None. Z. Paskins: None.

The Family of Aethelwig, Abbot of Evesham 1058–78 and Acting Justiciar of the Mercian Province

ABSTRACT This article arises from research into people named in the Worcestershire Domesday Book. Counties were administrative units rather than limits on landholding, and estates could stretch across many counties. A greater understanding of each person can come from the Domesday evidence of their estate’s geographical arrangement and who, if anyone, shared their manors and townships. The family of Abbot Aethelwig of Evesham shows what can be achieved through this approach. After the Norman conquest Aethelwig was said, by Hemming, to be second only in judicial power in the Mercian province to William the Conqueror. Documents tell us that Ordwy was Aethelwig’s father. This is enough to reconstruct his immediate family and its pre-conquest estate. It was a family of thegns whose estate was organized to facilitate communication between family members in north Staffordshire, at Evesham and Leominster Abbeys and beyond. There is evidence of a strong link with Evesham Abbey.

Where does it hurt? Small area estimates and inequality in the prevalence of chronic pain.

Chronic pain affects up to half of UK adults, impacting quality of life and demand on local health services. Whilst local health planning is currently based on subnational prevalence estimates, associations between pain and sociodemographic characteristics suggest that inequalities in the prevalence of chronic and high-impact chronic pain between neighbourhoods within local authorities are likely. We aimed to derive lower super output area (LSOA) estimates of the prevalence of chronic and high-impact chronic pain. Presence of self-reported chronic and high-impact chronic pain were measured in adults aged 35+ in North Staffordshire and modelled using multilevel regression as a function of demographic and geographic predictors. Multilevel model predictions were post-stratified using the North Staffordshire age-sex population structure and LSOA demographic characteristics to estimate the prevalence of chronic and high-impact chronic pain in 298 LSOAs, corrected for ethnic diversity underrepresented in the data. Confidence intervals were generated for high-impact chronic pain using bootstrapping. Data were analysed from 4162 survey respondents (2358 women, 1804 men). The estimated prevalence of chronic and high-impact chronic pain in North Staffordshire LSOAs ranged from 18.6% to 50.1% and 6.18 [1.71, 16.0]% to 33.09 [13.3, 44.7]%, respectively. Prevalence of chronic and high-impact chronic pain in adults aged 35+ varies substantially between neighbourhoods within local authorities. Further insight into small-area level variation will help target resources to improve the management and prevention of chronic and high-impact chronic pain to reduce the impact on individuals, communities, workplaces, services and the economy. Post-stratified multilevel model predictions can produce small-area estimates of pain prevalence and impact. The evidence of substantial variation indicates a need to collect local-level data on pain and its impact to understand health needs and to guide interventions.

Identifying Long-Term Trajectories of Foot Pain Severity and Potential Prognostic Factors: A Population-Based Cohort Study.

To identify distinct foot pain trajectories over 7 years and examine their associations with potential prognostic factors. 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. 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. 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.

Early football, governance and cup competitions: the formative years of the Staffordshire Football Association, c. 1877–1887

ABSTRACT The adoption of the half-holiday in North Staffordshire during the mid-1870s facilitateda dramatic increase in association football activity throughout the region. However,the game wasundoubtedly still in its formative stages, with various sets of contrastingrules being applied simultaneously by clubs and players, which created a significant amount of confusion and, at times,conflict. In 1877, the Staffordshire Football Association was established toprovide association football in North Staffordshire with greater governance,including establishing a cup competition and adopting Sheffield Rules. Regionalfootball associations played a central role in the growth of the game in England duringthe final decades of the nineteenth century, yet few scholars have sought toinvestigate their functions, activities and impact. This paper begins toaddress this gap in the literature by examining the formative years of theStaffordshire FA and exploring how it influenced the development of the game inNorth Staffordshire.

Incidence and Progression of Hallux Valgus: A Prospective Cohort Study.

Hallux valgus is a common and disabling condition. The objective of the present study was to identify factors associated with hallux valgus incidence and progression. Participants were from a population-based prospective cohort study, the Clinical Assessment Study of the Foot. All adults ages ≥50 years who were registered at 4 general practices in North Staffordshire, UK, were invited to take part in a postal survey at baseline and at 7-year follow-up, which included health questionnaires and self-assessment of hallux valgus using line drawings. Complete baseline and follow-up data were available for 1,482 participants (739 women and 743 men, mean ± SD age 62.9 ± 8.1 years), of whom 450 (30.4%) had hallux valgus in at least 1 foot at baseline. Incident hallux valgus was identified in 207 (20.1%) participants (349 [15.4%] feet) and was associated with baseline age, poorer physical health, foot pain, and wearing shoes with a very narrow toe-box shape between the ages of 20 and 29 years. Hallux valgus progression was identified in 497 (33.6%) participants (719 [24.3%] feet) but was not associated with any baseline factors. Incident hallux valgus develops in 1 in 5 adults ages ≥50 years over a 7-year period and is related to age, poorer physical health, foot pain, and previous use of constrictive footwear. Progression occurs in 1 in 3 adults. These findings suggest that changes in first metatarsophalangeal joint alignment may still occur beyond the age of 50 years.

Actors, knowledge and path transformations in a declining cluster

We contribute to the literature on cluster dynamics to show that the outcome for declining industrial clusters are not necessarily restricted to death or renewal or replacement. We do so by considering upward and downward causation pressures in the evolution of the North Staffordshire’s ceramics cluster and the role of actors, their visions and the modification of their assets as influenced by both local knowledge sharing and exposure to ‘global buzz’ at international trade fairs. Efforts by cluster-level actors to reinvigorate the cluster appear to be having an effect, and we highlight the types of knowledge being infused into the cluster through these activities. We find the cluster is experiencing two different pathways simultaneously: the first is one of renewal, where traditional ceramicware firms have been supported by cluster-level actors to find new knowledge and make incremental innovations to support the aesthetic appeal of their product offerings and market reach; the second is a form of cluster exaptation where technical ceramics firms have moved onto a pathway with radical innovative potential associated with the properties of ceramics as advanced materials. We conclude with some policy suggestions for the revival of declining clusters.

CO6 Clinical and Economic Outcomes of Adult Limb Spasticity Treatment with Botulinum Toxin-a (BONT-A) Products: A Single-Center Non-Interventional Retrospective Study

Effective limb spasticity (LS) treatment combines physiotherapy and BoNT-A. The North Staffordshire Rehabilitation Centre (UK) initiated LS patients on onabotulinumtoxinA (onaBoNT-A) prior to 2017; after, patients were initiated on abobotulinumtoxinA (aboBoNT-A). This study describes real-world outcomes of BoNT-A treatment, pre- and post-2017.

HPV vaccination and cervical screening: the knowledge and attitudes of mothers of adolescent girls

Objective Mothers play a significant role in decision making about human papillomavirus (HPV) vaccination for their daughters and about cervical screening attendance for themselves. This study had three objectives, to explore: (1) mothers’ knowledge and attitudes about HPV and HPV vaccination, (2) their knowledge and attitudes about cervical cancer and screening, and (3) whether their daughter’s HPV vaccination invitation was an opportunity to nudge mothers to attend screening. Design 138 women from North Staffordshire completed a cross-sectional survey and 15 took part in follow-up focus groups. Results Despite high self-reported engagement with both the cervical screening and HPV vaccination programmes, relatively low levels of knowledge and some uncertainty were evident. There was mixed opinion about the potential of using the vaccination invite as an opportunity to nudge mothers to attend cervical screening. Conclusion Even amongst women who do engage positively with the programmes, knowledge is not as complete and certain as it could be. Further research is needed with women who are less likely to accept the vaccination for their daughters. Women need to be better informed, which may go some way to reversing the decline in screening and maintaining high levels of vaccination.

P149 Prescription for consultations with gout flare in primary care: an observational study

Abstract Background/Aims Gout flares are severely painful and managed with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. NSAIDs are used most commonly, yet many patients with gout have contraindications such as chronic kidney disease (CKD). We investigated the medications prescribed for gout flares in primary care, how these differed according to CKD, colchicine dosing, and prescription trends over time between 2005 and 2015. Methods Using the Consultations in Primary Care Archive, an electronic health record database from thirteen general practices in North Staffordshire, we identified all consultations for a gout flare. Prescriptions for NSAIDs, colchicine and prednisolone were identified. We calculated the proportion of consultations resulting in a prescription for NSAIDs, colchicine and corticosteroids, overall and stratified by eGFR (≥60, <60 ml/min/1.73m2). We examined which NSAIDs and which colchicine doses were prescribed. The trends in prescriptions of NSAID, colchicine or oral prednisolone prescriptions from 2005 to 2015 were described. Results We identified 2641 people with a diagnosis of gout and 1308 consultations for gout flares. The mean (SD) age at flare consultation was 62.6 (14.9) years, and 1025 (78.4%) were male. Flare consultations resulted in 408 (31.2%) NSAID, 294 (22.5%) colchicine, 9 (0.7%) prednisolone prescriptions. We found that 619 (47.3%) did not have a prescription. 21 (1.6%) received a prescription for more than one drug class (colchicine and either NSAID or prednisolone). eGFR was recorded as < 60ml/min/1.73m2 in 224 (17.1%) of the sample. Colchicine doses prescribed were 500mcg 1-2 times/day in 84 (28.6%), 500mcg 3-4 times/day in 112 (38.1%), 500mcg 6-8 times/day in 49 (16.7%) and as directed in 49 (16.7%) consultations. Diclofenac was the most commonly prescribed NSAID (n = 143, 35.1%), followed by naproxen (n = 106, 26.0%) and indomethacin (n = 93, 22.8%). Colchicine (n = 65, 29.0%) was the most common treatment choice in individuals with eGFR<60 and NSAIDs (n = 372, 34.3%) in those with ≥60ml/min/1.73m2. Over time, the proportion of patients prescribed colchicine rose from 15.5% in 2005 to 31.2% in 2015, whereas NSAID prescriptions declined from 38.1% in 2005 to 15.0% in 2015. Conclusion Gout flares were most commonly treated with NSAIDs, except in individuals with CKD, where colchicine was most common. Over time, colchicine prescriptions have become more common, whereas NSAID prescriptions have declined. Disclosure N. Padmanabhan: Grants/research support; N.P. is an NIHR Academic Clinical Fellow. S. Muller: Grants/research support; S.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM). C. Mallen: Grants/research support; C.D.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM), C.D.M. is funded by the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice. E. Roddy: None.

P008 Fracture liaison service management of patients aged 85 and older who sustain fragility fractures: audit and quality improvement

Background/AimsOsteoporosis is a burdensome disease internationally, that is commonly diagnosed following fragility fracture. In line with national guidance, in 2018 the North Staffordshire Fracture Liaison Service (FLS) changed their management policy of patients aged ≥85 years who sustain fragility fractures. Instead of calling these patients for a dual-energy X-ray absorptiometry (DXA) scan, a letter was sent to the patient’s General Practitioner, advising the empirical commencement of oral bisphosphonates. This audit aimed to evaluate whether the recommendations in this letter were enacted by GPs. Following audit, the text of the letter was changed, and a re-audit conducted to evaluate changes in practice.MethodsPatients aged ≥85 years sustaining a fragility fracture between December 2018 and October 2020 were identified from FLS records. Summary Care Records (SCRs) were used to identify whether each patient was receiving a bisphosphonate prescription at time of audit (October 2020). Analysis was descriptive, to report the proportion of patients prescribed a bisphosphonate. Quality improvement methodology informed changes to the standard letter, using GP feedback. Re-audit of fragility fractures occurring between December 2020 and May 2021 was undertaken in July 2021 to assess possible impact.Results408 eligible patients were identified in the initial audit, of which 79% were female. SCR data was available for 396 patients; median time between fracture and data collection was 9 months. 160 patients (40%) had a bisphosphonate prescribed as an acute or repeat prescription, of which >90% were alendronic acid. Following the first audit cycle, the letter was changed to address barriers to clinical decision-making including advice on relative contraindications and referral. 74 patient SCRs were reviewed in the 2nd audit cycle (85% female) and 38 (51%) were recorded as prescribed a bisphosphonate (median time between fracture and assessment 5-months).ConclusionRates of bisphosphonate prescribing, in people aged ≥85 following a recommendation letter sent to the GP, have increased from 40% to 51% following quality improvement initiative. Furthermore, the proportion of patients prescribed a bisphosphonate is similar to previous national data in patients post-DXA. This is of interest, particularly given the de-prioritisation of non-communicable diseases during the COVID-19 pandemic, and demonstrates that an intervention which requires little time, can result in changes in practice. Limitations of this work include that the SCR only includes contemporaneous prescribing data so the period of time between drug recommendation and audit was different in 1st and 2nd cycles, meaning that adherence may be expected to be higher in the 2nd cycle, because the period of time between letter and data collection was shorter, and not because of a change in our intervention.Disclosure T. Appleyard: None. K. Bethwaite: None. N. Dale: None. F. Manning: None. Z. Paskins: None.

Healthy working life expectancy at age 50 for people with and without osteoarthritis in local and national English populations

Retirement ages are rising in many countries to offset the challenges of population ageing, but osteoarthritis is an age-associated disease that is becoming more prevalent and may limit capacity to work until older ages. We aimed to assess the impact of osteoarthritis on healthy working life expectancy (HWLE) by comparing HWLE for people with and without osteoarthritis from ages 50 and 65 nationally and in a local area in England. Mortality-linked data for adults aged ≥ 50 years were used from six waves (2002–13) of the English Longitudinal Study of Ageing and from three time points of the North Staffordshire Osteoarthritis Project. HWLE was defined as the average number of years expected to be spent healthy (no limiting long-standing illness) and in paid work (employment or self-employment), and was estimated for people with and without osteoarthritis and by sex and occupation type using interpolated Markov chain multi-state modelling. HWLE from age 50 years was a third lower for people with osteoarthritis compared to people without osteoarthritis both nationally (5.68 95% CI [5.29, 6.07] years compared to 10.00 [9.74, 10.26]) and in North Staffordshire (4.31 [3.68, 4.94] years compared to 6.90 [6.57, 7.24]). HWLE from age 65 years for self-employed people with osteoarthritis exceeded HWLE for people without osteoarthritis in manual or non-manual occupations. Osteoarthritis was associated with a significantly shorter HWLE. People with osteoarthritis are likely to have significantly impaired working ability and capacity to work until older ages, especially in regions with poorer health and work outcomes.

Surveillance of strangles in UK horses between 2015 and 2019 based on laboratory detection of Streptococcus equi

Previously national surveillance data for monitoring strangles (Streptococcus equi infection) in UK horses was limited. Improved awareness and knowledge of positive diagnoses would permit the optimisation of biosecurity protocols, decreasing the prevalence of strangles. Seven UK laboratories reported positive strangles diagnoses between 1 January 2015 and 31 December 2019 based on identifying Streptococcus equi via agent detection assays from field-based practitioner-submitted samples. Associated clinical history and animal signalment were collected where provided, and descriptive analysis undertaken. Within the study period, 1617 laboratory-confirmed diagnoses occurred from samples submitted by 315 veterinary practices. Of these, 51.6% were swabs and 44.0% guttural pouch lavages. Diagnoses were primarily based on qPCR alone (59.6%), qPCR and culture (35.8%), or culture alone (4.6%). A total of 1791 clinical signs were reported for 713 diagnoses, where nasal discharge (31.3%) and pyrexia (20.5%) were most frequently reported. Regions with the highest number of diagnoses included North Yorkshire (n=75, 4.6%), Staffordshire (n=71, 4.4%) and West Sussex (North East) (n=63, 3.9%). This study presents important insights into the diagnosis and clinical features of strangles in UK horses, even though limited and/or missing clinical history and signalment on laboratory submission forms restricts the completeness of the data.

338Modelling the population distribution of patient-reported outcomes using electronic health records: a UK study

Abstract Background Patient Reported Outcome Measures (PROM) collected in surveys allow understanding of the health at the population-level. We aimed to test the feasibility of estimating health status as measured by PROMs through ecological prediction models which use local linked survey and primary care electronic health records (EHR) and applying the models to national EHR. Methods 3,710 musculoskeletal consulters registered in 11 general practiced in North Staffordshire, UK and consented the linkage of their survey PROM (high impact pain, (HICP)) with EHR were included in this study. HICP was modelled by EHR predictors covering demographic, lifestyle risk factors, musculoskeletal diagnostic/problems, analgesic prescriptions, comorbidities, and deprivation. Final set of predictors were selected through backward elimination (p > 0.1). Individual-level prediction models (binary logistic regression) were fitted and evaluated in terms of model fit statistics (AIC, BIC, R-square), discrimination (C-statistics) and calibration-slope with internal validation. The final model was cross-mapped to a national UK primary EHR database (Clinical Practice Research Database) to obtain national population estimates of high impact pain. Results The C-statistics and calibration-slope of the final model was 0.77 (95% confidence interval: 0.70-0.79) and 1.00 (0.92-1.08), respectively. The estimated HICP was 51.2% overall among 49,788 UK musculoskeletal consulters and matched hypothesised variation by gender, age, deprivation and geographical regions. Conclusions Estimation of population-level health status as measured by PROM using EHR appears feasible and has potential application in assessing health inequalities. Further independent external validation studies are warranted. Key messages Primary care EHR data could be modelled to predict population-level PROMs.

The development of early reservoirs to supply water to arterial canals in England and Wales

ABSTRACT Reservoirs change and control how water moves through the landscape. This article explores a key period in the development of reservoir technology at the turn of the nineteenth century which involved the construction of large reservoirs, such as Rudyard in north Staffordshire, which pre-date similar-size reservoirs for potable water. The creation of larger reservoirs in this period played an important role in the implementation of a resilient stable water supply to the canals, replacing a chaotic system of diverse water supplies to the earliest canals, which left them vulnerable to extreme weather. The development of larger reservoirs took place against a backdrop of changing dynamics in water ownership and entitlement to water, which had implications for the role and legacy of large reservoirs through to the present. Previous studies have concentrated on the economic or technological aspects of this period, with rapid expansion of the canal network. By examining the actions of established canal companies and unpicking the documentary evidence concerning the construction of Rudyard Reservoir, it will be argued that a complex combination of dry weather, competition for water and traffic, technological developments, and changing patterns of water management all contributed in creating a demand for large reservoirs to supply water to arterial canals in England and Wales.

Correia, Diamond and the Chester Exception: Vindicating Patient Autonomy?

In Chester v Afshar [2004], the House of Lords stated they were departing from the traditional rules of causation in order to vindicate the patient’s right of autonomy. Subsequent judgments in the Court of Appeal expressed concerns over the lack of clarity of the legal principles to be derived from that judgment. In Correia v University Hospital of North Staffordshire NHS Trust [2017] and Diamond v Royal Devon and Exeter NHS Foundation Trust [2019], however, the Court of Appeal sought to clarify the scope and limits of Chester. This commentary sets out the scope and limits of Chester in light of those judgments and considers the extent to which they can be said to be vindicating patient autonomy. Drawing upon Coggon’s typology of autonomy, it concludes that future judgments should utilise that typology to explicate which understanding of autonomy they are seeking to protect.

The Development of Sport in the Potteries during the Nineteenth Century: An Initial Survey

ABSTRACT Throughout the nineteenth and twentieth centuries, the pottery and ceramic industry in Britain became synonymous with a collection of six towns located in North Staffordshire. These towns would later amalgamate and become the modern city of Stoke-on-Trent, with the area commonly referred to as The Potteries. However, whilst the industrial history of The Potteries has received considerable scholarly attention, few researchers have sought to examine the development of sport in the area. During the nineteenth century, Britain underwent a ‘sporting revolution’ where modern forms of sport began to emerge, be codified and grow significantly in popularity. This paper provides an initial survey of the development of sport in The Potteries and considers the four most prominent activities that became established in the area – athletics, association football, cricket and horse racing – whilst also considering the importance of ‘the wakes’ in facilitating the popularization of sport.