South-central England Research Articles

A 23-year analysis of litigation in orthopedic elbow surgery

BackgroundThe reasons for malpractice litigation in elbow surgery are not well understood. The aim of this study is to report the most frequently litigated surgeries of the elbow and analyze the reasons for litigation and case outcomes. MethodsA retrospective review of the Westlaw legal database was performed, and all federal and state jurisdiction litigation cases involving the elbow from 2000-2023 were queried. Cases were excluded if they did not involve an orthopedic surgeon, nor primary elbow injury or procedure. Cases were reviewed for demographic information, surgical procedure based on reference CPT codes, complications, symptoms, and reasons for litigation. Quantitative information, including settlement and indemnity cost to the defendant orthopedic surgeon, was analyzed. Cases were sub-divided based on United States Census Bureau regions and states to assess regional frequency of litigation with ANOVA tests. ResultsThere were 59 cases meeting inclusion criteria from 2000-2023.The most litigated cases involved were ulnar nerve transposition/release and open reduction and internal fixation of the proximal radius and/or ulna at the elbow. The most litigated complication was claimed nerve damage (46%) and permanent disability (27%). Of the total cases, the most frequently litigated symptoms were nerve damage (46%) and loss of function (37%), while the least frequent was postoperative stiffness (2%). The Pacific region demonstrated the highest litigation rate (20%), while the East South Central, Mountain, and New England regions had the lowest litigation rate (3% each). A favorable verdict was given to the defendant orthopedic surgeon in 59% of the cases. The average loss incurred through settlement was $245,590, while the average indemnity paid through verdict was $523,334. ConclusionOperative fixation of the proximal ulna/radius and ulnar nerve release/transposition are the most litigated procedures of the elbow. Litigation is most associated with nerve injury. Across Census Bureau regions, there is no significant difference in monetary cost incurred through settlements and verdict losses. Although a majority of litigated cases are won by the defending orthopedic surgeon, thorough informed consent and perioperative expectation management may mitigate litigation risk.

WTP4.5 An Evaluation of the Introduction of a Perioperative Care Bundle to Reduce Surgical Site Infections after Bowel Resection Surgery in a DGH Setting

Abstract Background The surgical site infection (SSI) rate for colonic resections at a District General Hospital (DGH) in South-Central England was 25.3%. The UK national average is 8.6%. The aim of this study was to evaluate if the implementation of a perioperative care bundle based on NICE guidance improved SSI rates. Methods Retrospective data was collected prior to the bundle implementation (Group 1) and prospective data following bundle introduction (Group 2). Inclusion criteria were all emergency and elective bowel resections. The primary outcome assessed was the development of an SSI within the 30-day postoperative period. The secondary outcomes were related to confounding variables, such as diabetes and immunosupression. Data was collected from the electronic patient record system and follow-up telephone consultations using a standardised questionnaire. Results The SSI rate in Group 1 (n=55) was 30.9% (95% CI,19.0%-43.1%) as opposed to 19.2% (95 CI, 8.5%-30.0%) in Group 2 (n=52), p=0.16. Interestingly, for patients of a BMI >30 the SSI rate dropped from 45.5% (95% CI, 16.7%-76.6%) to 20.0% (95% CI, 4.3%- 48.1%). Conclusion The 10-step perioperative care bundle did not significantly reduce the SSI rate. However, bundle uptake was moderate (73%), and only 65.4% of prospective cases achieved complete bundle compliance. Further research is required to investigate the effectiveness of this bundle on high-risk groups, as well as implementation barriers.

A climate perturbation at the Middle –Late Jurassic Transition? Evaluating the isotopic evidence from south-central England

The Jurassic greenhouse is punctuated by short cooling intervals. Some published oxygen isotope records of belemnite rostra and fish teeth have been interpreted to reveal a prominent decrease in seawater temperature during the Late Callovian–Early Oxfordian. This is in part the basis for a proposed an ice age at the Middle-Late Jurassic Transition. In contrast relatively constant oxygen isotope records and therefore seawater temperatures as well as carbon isotope values characterized by significant scatter but showing more positive values during the middle and late Callovian have been reported from elsewhere. This research has constructed a stable isotope stratigraphy (from belemnites, Gryphaea and oysters) principally from the Callovian-Oxfordian interval (from southern England) and integrated these data with existing data to assess the pattern of carbon and oxygen isotopic change. Our marine macrofossil record reveals isotopic patterns that are generally comparable with other European basins. Carbon isotopic trends are consistent with bulk carbonate carbon isotope records displaying systematic fluctuations, the largest of which (Middle Callovian, Calloviense/Jason Zones to Early Oxfordian, Mariae Zone) corresponds to previously identified phases of environmental perturbation. Such a trend may have resulted from enhanced burial and preservation of organic matter, leaving the seawater enriched in the heavy carbon isotope. Inferred cooling, derived from our oxygen isotope data from southern England, occurs within the Late Callovian and the Early Oxfordian (Athleta to Mariae zones). Cooling post-dates this positive carbon isotope excursion. Enhanced carbon burial and atmospheric carbon dioxide draw down may have induced cooling. In this study the analysis of a single region (southern England) allows critical factors controlling the oxygen isotopic composition of the carbonates (e.g. temperature and the oxygen isotopic composition of the solution from which the carbonates precipitated) to be more comparable. If Jurassic polar climates were truly warm such a degree of cooling would undoubtedly lead to cooler polar temperatures – but only with seasonal ice.

Applying Outcomes in Community-Based Social Care Practice in England

Context: Social care outcomes (the effect of services on the quality of life of people with support needs and unpaid carers) have been proposed as a way of improving the quality and effectiveness of care. Outcomes have also been proposed as a way of reconceptualising ‘needs’ that have applications in needs assessment, care planning, evaluation and care practice. Objectives: The study aimed to provide insights into social care professionals’ experiences and views on the collection and application of outcomes data in practice and what they believe are the benefits, challenges and barriers to implementation. Methods: Interviews were conducted with 25 social care professionals in England and analysed using a framework approach. Findings: Participants reported perceived benefits of using outcomes data, especially to focus effort on improving the well-being of people with support needs and carers. Perceived challenges include requirements for data collection set by funders/commissioners, the volume of data collected, difficulties in separating non-service-related influences on outcomes and the format of collection. Participants felt a more flexible approach might facilitate more meaningful conversations, rather than a ‘tick-box’ exercise. Limitations: The study sample was purposive, based on established connections. It only included professionals from London and South East and Central England. Implications: Although outcomes are perceived as important in helping to improve people’s lives, social care professionals identified a number of challenges. Further research to understand and address these challenges is needed.

Gender and Geographic Trends Amongst Foot & Ankle Surgeons: Where are We and Where Do We Need to Improve?

Category: Other Introduction/Purpose: Clinical and elective experiences as well as the guidance of mentors are all critical factors in the pursuance of orthopedic residencies and fellowships. Women have historically been underrepresented in orthopedics. Some propose that the root cause lies in the lack of availability in the aforementioned factors. Previous studies demonstrated geographic differences in sex representation in orthopedic residency programs. Studies over geographic distributions of orthopedic foot and ankle (OFA) surgeons showed high variation in geographic density of OFA surgeons throughout the U.S. This study seeks to determine both the gender and geographic distributions of OFA surgeons as well as to determine geographic patterns between their training locations and current practices. Methods: AOFAS data regarding fellowship completion from 1988 through 2021 was analyzed with regards to gender and fellowship location. Internet searches were performed for all those identified within the database for their medical school, residency, and current practice location. This biographical data was obtained from their front-facing biographical webpage or hospital affiliation. States were placed into regions and subsequent divisions as defined according to the US Census Bureau definition: Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central) and West (Mountain and Pacific). Results: 1,088 OFA surgeons were analyzed. 168 (15.3%) were female and 922 (84.7%) were male. Female-held OFA fellowship positions increased over time, currently sitting at 13 (22% of all fellowship positions), with a maximum of 15 (25%) in 2017. Geographically, the Pacific had most females (n=26, 15.6% of females), while East South Central had least (n=10, 6.0%). The South Atlantic had most males (n=193, 20.9% of males) while East South Central had least (n=59, 5.3%). The region with the most OFA surgeons in total was the South Atlantic (n=218, 20.0% of the total) whereas the regions with the least were East South Central and New England (n=59, 5.4% in each). Conclusion: Although the amount of female OFA surgeons has increased, the numbers are still low. Geographically, the East South Central division of the U.S consistently had the least number of OFA surgeons whereas the South Atlantic division had the highest.

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States.

Background and ObjectivesPersons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the US during 2020. This article highlights changes in resources, admissions, and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC).MethodsWe compared data reported in 2019, prior to the COVID-19 pandemic, and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category, and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included.ResultsEMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England US Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing, and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies.DiscussionIn the US, access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care, and many persons in the eastern half of the US were most affected.

Gender and Geographic Trends Amongst Foot & Ankle Surgeons: Where Are We and Where Do We Need to Improve?

Category:OtherIntroduction/Purpose:Clinical and elective experiences as well as the guidance of mentors are all critical factors in the pursuance of orthopedic residencies and fellowships. Women have historically been underrepresented in orthopedics. Some propose that the root cause lies in the lack of availability in the aforementioned factors. Previous studies demonstrated geographic differences in sex representation in orthopedic residency programs. Studies over geographic distributions of orthopedic foot and ankle (OFA) surgeons showed high variation in geographic density of OFA surgeons throughout the U.S. This study seeks to determine both the gender and geographic distributions of OFA surgeons as well as to determine geographic patterns between their training locations and current practices.Methods:AOFAS data regarding fellowship completion from 1988 through 2021 was analyzed with regards to gender and fellowship location. Internet searches were performed for all those identified within the database for their medical school, residency, and current practice location. This biographical data was obtained from their front-facing biographical webpage or hospital affiliation. States were placed into regions and subsequent divisions as defined according to the US Census Bureau definition: Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central) and West (Mountain and Pacific).Results:1,088 OFA surgeons were analyzed. 168 (15.3%) were female and 922 (84.7%) were male. Female-held OFA fellowship positions increased over time, currently sitting at 13 (22% of all fellowship positions), with a maximum of 15 (25%) in 2017. Geographically, the Pacific had most females (n=26, 15.6% of females), while East South Central had least (n=10, 6.0%). The South Atlantic had most males (n=193, 20.9% of males) while East South Central had least (n=59, 5.3%). The region with the most OFA surgeons in total was the South Atlantic (n=218, 20.0% of the total) whereas the regions with the least were East South Central and New England (n=59, 5.4% in each).Conclusion:Although the amount of female OFA surgeons has increased, the numbers are still low. Geographically, the East South Central division of the U.S consistently had the least number of OFA surgeons whereas the South Atlantic division had the highest.

Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States.

Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs during the early months of the pandemic in the US.Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020 through phased removal of interventions) were obtained. County-level cases, doubling times, and death rates were compared to four increasingly restrictive NPI levels. Socio-demographic, climate and mobility factors were analyzed to explain and evaluate NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were conducted separately for the US and for each Census regions (Pacific, Mountain, east/West North Central, East/West South Central, South Atlantic, Middle Atlantic and New England). A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased implementation of policies.Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly in high compliance counties. Longer duration of level 4 NPIs was associated with lower case rates (log beta −0.028, 95% CI −0.04 to −0.02) and longer doubling times (log beta 0.02, 95% CI 0.01–0.03). Effects varied by Census region, for example, level 4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic and New England states. NPI heterogeneity can be explained by differential timing of policy initiation and by variable socio-demographic county characteristics that predict compliance, particularly poverty and racial/ethnic population. Climate exhibits relatively consistent relationships across Census regions, for example, higher minimum temperature and specific humidity were associated with lower doubling times and higher death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic, and New England states.Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and policy compliance. This county-level variability indicates that control strategies are best designed at community-levels where policies can be tuned based on knowledge of local disparities and compliance with public health ordinances.

Cultivating learners who ‘think like vocational professionals’: signature pedagogies, technology and vocational learning

ABSTRACT The author is Teaching and Learning Manager at the college with rsponsibility for observation of all teaching staff and their professional development. This research looks at differing concepts of pedagogy through an investigation of observation data and an analysis of ‘blended learning sessions’ at a college that is at the forefront of using technology as a tool for learning. Located in South Central England this is a relatively small vocational college with two sites in Hampshire. The observation data collected was analysed using the concepts of Pedagogical Content Knowledge (PCK), Technological Pedagogical Content Knowledge (TPCK), Signature Pedagogies and expansive vocational education to see how these concepts applied to practice. The conclusion shows that whilst there were differences in the pedagogical content approach, the concept of signature pedagogies was strong across all the curriculum areas looked at. It also highlights the possibility of further international research into post compulsory online learning using this college as an example of good practice. Finally, it observes that the college has the capacity in terms of a dedicated team of technologists to really improve the TPCK of the teachers further, together with a comprehensive digital strategy that encompasses a coherent and planned curriculum using ‘joined up’ schemes of work. In this way the PCK and the TPCK of teachers will be strengthened.

962P - Real world experience of nivolumab therapy in metastatic renal cancer patients: A 3 year multi-centre review

BackgroundIn the UK renal cancer has an incidence of around 12600 cases per year. Nivolumab is an anti-PD1 checkpoint inhibitor, which was approved in the UK for second or subsequent line treatment of advanced renal cancer in 2016. The aim of this study was to evaluate a regional experience of nivolumab use in this setting. MethodsA retrospective analysis was undertaken of patients who commenced nivolumab as monotherapy for advanced renal cancer at three Cancer Centres in South Central England between February 2016 and April 2019. Information was collated from electronic patient records and e-prescribing systems. Information was gathered on patient demographics, Heng (IMDC) prognostic scores, previous treatments, treatment toxicity, use of steroids and radiotherapy during treatment, physician assessment of response and survival data. Results109 eligible patients were identified. The average age was 59 with 72.5% of patients male. 67.9% (74/109) of patients had prior nephrectomy and 50.5% (55/109) had metastatic disease at diagnosis. 82.6% (90/109) had pure clear cell histology. 63.3% (69/109) received nivolumab as second-line treatment, 27.5% (30/109) as third-line treatment and 9.2% (10/109) as fourth-line and beyond. At the start of treatment 19.41% (19/103) had a ‘favourable’ risk Heng score, 61.2% (64/103) had an ‘intermediate’ risk and 18.3% (19/103) had a ‘poor’ risk. The number of Nivolumab cycles received ranged from 1-69, with a mean of 11 and median of 5. 45.9% of patients experienced toxicity of any grade, with 16.5% experiencing grade 3/4 toxicity. 24.8% (28/109) received radiotherapy and 40.4% (44/109) received steroids during nivolumab treatment. At response assessment 31.5% showed a response to nivolumab, 9.3% had stable disease and 59.3% had disease progression. From the start of nivolumab treatment median progression-free survival was 5.4 months, and the 12-month overall survival rate was 56.88%. 22.6% (24/109) are still receiving nivolumab. ConclusionsThis review has given us important real-world data on the safety and efficacy of nivolumab which reflects the findings of the pivotal phase 3 trials that led to it’s use. Further analysis will allow us to see the effect of different factors on these outcomes. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Willem Fourie: Obituary

Willem Fourie graduated from the University of Pretoria in 1976 as a physiotherapist. A family man, husband, father, grandfather, and international expert in the field of research and science, he trained his sights on the treatment of scar tissue and the treatment of the consequences of surgical interventions in post-operative breast cancer patients. A talented therapist and a loving human being, Willem's work touched the lives of many. From 1986 to 1991 he was Control Physiotherapist at the Chamber of Mines (Cottesloe) Hospital, Johannesburg. During this period Willem was also Head of Physiotherapy at Westvaal Hospital, Vaal Reefs Gold Mine, Orkney. He gained experience in sports physiotherapy at both the provincial and international level and he had extensive experience of treating trauma and providing effective rehabilitation for workers in the mining industry. Willem was competent in his knowledge of anatomy generally and fascia specifically. His reserved disposition was one of his enduring traits and when it came to the topic of fascia or scar therapy Willem was a leading authoritative figure on the global stage. In 2017 he gave a talk on urogynaecology for surgeons in Cape Town on how scars influence the pelvic floor. He had been asked to lead and demonstrate a dissection afternoon on the fascia of the pelvic floor/abdomen relationships, and his time spent as a dissector in the School of Anatomical Sciences of the University of the Witwatersrand Medical School in Johannesburg, South Africa paid off generously as the surgeons and others involved gained much from the presentation. Willem also had a strong interest in the topic of anatomy and fascia. He offered his skills and knowledge in the Department of Anatomy and Human Identification, University of Dundee, at the 2018 biotensegrity-focused Thiel cadaver dissection course, and his dissection skills and knowledge of anatomy provided valuable insight to all attendees. In his leisure time, Willem loved to cycle. On one occasion he wrote describing the wonderful day he had spent cycling in the Cotswolds in south central England while on one of his many touring workshops wandering the globe, and it was a travesty to learn of Willem's death due to a road traffic accident while out riding his bike close to his home in Johannesburg in South Africa. Though his clinical practice in physiotherapy was situated in South Africa, Willem traveled extensively, presenting at conferences and providing workshops and short courses to thousands of therapists across the globe, providing a special focus on scar tissue due to post-operative breast cancer treatment. On one such occasion in 2017, Willem and I sat in a Bistro in the Ivanhoe Inn on Saintfield Road, Carryduff, in Belfast, taking a short but well-deserved break while on a teaching tour that would include Manchester and Holland before returning to South Africa. During that conversation, armed with a quick wit and a keen appetite for conversation, Willem talked about one of the other loves of his life: craft beers. Willem loved a great tasting craft beer and he loved a good conversation about the time and effort that goes into producing it. Willem Fourie was a complete one-off and his spirit of sharing, educating, and his focus on detail will be sorely missed. His legacy will live on in those therapists who were fortunate enough to have shared his knowledge, skills and experience. Willie, as he was affectionately known, is survived by his loving wife Trudie, his children Elsa (Manie), Lizelle (Wynand), Pieter (Brenna) and Willem, his sister Susan, his grandchildren, his family and his many friends around the world.

The ups & downs of Iron Age animal management on the Oxfordshire Ridgeway, south-central England: A multi-isotope approach

The hillforts of the Oxfordshire Ridgeway in south-central England have been interpreted as central places in the Early/Middle Iron Age, ca. 600–100 BCE, serving, among other functions, to integrate the management of animals, particularly sheep, between the upland Chalk downs and the adjacent low-lying Vale of the White Horse. Since these landforms differ geologically and pedologically, they lead to distinct isotopic ratios in the biosphere and so present the potential to investigate animal management practices in some detail. Here, we report the results of a multi-isotope study on domestic fauna (cattle, sheep and pig) within a very constrained study area, with the aim of testing the hypothesis that the Ridgeway's hillforts were placed to control and coordinate the movement of sheep between the Chalk and the Vale. However, the results suggest a different scenario. Bone collagen δ15N results indicate that cattle and sheep were both kept locally. Strontium isotopes, conversely, indicate that, while sheep and pigs were raised locally, cattle appear to have been mainly kept in the Vale during at least the first year of their lives. The apparent discrepancy between the two isotopes can be reconciled by the different periods of life represented by enamel and bone collagen measurements, with the movement of cattle onto the Ridgeway in their second or third year of life. Sequential measurements of δ13C and δ15N in dentine, and of δ13Cc and δ18Oc in enamel, provide further detail on the management of cattle, and offer some support for the above scenario. Early/Middle Iron Age stock-keeping in south-central England was complex, being integrated in some respects but distinct in others. The study demonstrates the level of detail it is possible to achieve with a multi-isotope approach to animal management practices in prehistory. The focus on a micro-region contrasts with, or rather complements, studies addressing larger-scale movement of animals in the past.

Climate resilience in the United Kingdom wine production sector: CREWS-UK

As cool climate viticulture rapidly expands, the England and Wales wine sector is winning international acclaim, particularly for its sparkling wines, and is attracting significant investment. Supported by warming climate trends during the growing season, wine producers are establishing new vineyards planted predominantly with Pinot Noir and Chardonnay. Grape-friendly weather conditions in 2018 led to a record harvest and may be a sign of good things to come. Long term (100-years) Growing Season Average Temperatures (GSTs) in south-east and south-central England have noticeably increased with 6 of the top 10 warmest growing seasons (April–October), over the last 100 years, occurring since 2005. However, weather and growing season conditions fluctuate markedly from year to year, meaning that yields and grape quality continue to vary significantly. Weather extremes are anticipated to become more frequent under future climate change, further threatening the stability of production. Current uncertainty over future climatic conditions during the growing season and their potential effects on viticulture in the UK exposes both existing producers and potential investors to unquantified risks and opportunities. The CREWS-UK climate resilience research project is generating actionable information on how climate change may affect the wine production sector, to support better decision-making and investment.

Stable Isotope Dating of Historic Buildings

The recent development of an oxygen isotope (δ18O) master chronology for south central England (1200–2000 AD) has successfully demonstrated reliable cross-dating between the master chronology and undated samples from vernacular and high-status buildings. The method is well suited to complacent, wide-ringed samples, which are commonplace throughout the UK historic buildings archive and often fail to date by ring-width dendrochronology, or remain unsampled. This paper outlines briefly the isotope dating technique, and describes the application of the method to a number of case studies where ring-width dendrochronology has been unable to provide a robust date. The close association between ring-width dating and stable isotope dendrochronology is explored and its wider potential considered.Note: For illustrations of the buildings used in the case studies, see “Stable Isotope Tree-ring Dates: List 1,” Vernacular Architecture 50: 88–93.

Histories of deposition: creating chronologies for the Late Bronze Age–Early Iron Age transition in Southern Britain

ABSTRACT The Late Bronze Age–Early Iron Age midden sites of Southern Britain are amongst the richest archaeological sites in the country. The organic accumulations contain substantial quantities of animal bone, decorated ceramics, metalwork and other objects; the often deep stratigraphy allows for changes in material culture and depositional practices, food production and consumption, and shifts in social identities, to be traced through time. The well-stratified assemblages also provide useful materials for dating the deposits. This has been problematic, however, as the majority of samples produce unhelpfully broad calibrated radiocarbon dates, due to the effects of the earlier Iron Age plateau in the calibration curve, which spans c. 800–400 BC. Interpretation has relied on current understandings of the associated pottery and metalwork, which placed most midden sites somewhere between the tenth and the seventh/mid-sixth centuries cal BC (c. 1000–600/550 cal BC), but the end-date of these traditions is particularly uncertain. This article addresses this issue by presenting the results of a new dating programme for East Chisenbury in Wiltshire, southern England. Twenty-eight radiocarbon determinations were obtained and combined with the site stratigraphy in a Bayesian chronological model. The results have transformed the chronology of the site, with the end of the occupation sequence being pulled forward some one-hundred years, to the mid-to-late fifth century cal BC. These new chronologies have significant implications for our understanding of the Late Bronze Age–Early Iron Age transition and require a revision of the currently accepted chronology of post-Deverel Rimbury decorated wares in south-central England.

Affordances for drinking alcohol: A non‐participant observation study in licensed premises

AbstractAlcohol misuse is a pressing area of public health concern. This non‐participant observational study investigated the functional characteristics of on‐licensed premises where alcohol is consumed. Seven different licensed premises from South Central England were visited and observed for similar three hour periods on Saturday evenings. Observations within these ecological niches were grouped using a functional taxonomy of affordances and effectivities related to alcohol drinking. Affordances provide a theoretically grounded and useful concept for evaluating how individuals behave in drinking contexts, while identifying action opportunities for inhibiting and promoting consumption. Identified alcohol‐related affordances were related to: Alcohol access, regulations, furnishing, alternative opportunities for action, décor and lighting, drink and accessory availability, and action opportunities provided by others. This research has implications for understanding alcohol consumption in real‐time, social environments, with direct implications for preventing excessive consumption within community alcohol outlets.

Reading's Old or East Cemetery: the geological landscape of an urban burial ground in modern central Berkshire

ABSTRACTThe landscape of the private Old or East Cemetery in Reading was laid out as a garden, a plan popular in the early nineteenth century. Interments began in 1843 and continued after extension of the Cemetery in about 1900; in 1927 the rate of burials peaked in excess of 500 per decade. Although the town continued to grow, the interment rate subsequently plunged, in the face of competition from a new, municipal burial ground (Henley Road) in the eastern town. Burials continued at the Old Cemetery, but largely at established family plots. The Old Cemetery is now semi-wild, but in excess of 5,600 graves with accessible monuments are still to be found. The geological landscape presented by these memorials resembles that of other burial grounds in south-central and south-east England: chiefly Italian marble, Pennant sandstone, Scottish and Cornubian (Cornwall-Devon) granites, Portland limestone, and gabbro. There are minor applications of other granites, Lower Carboniferous Limestone, York stone, Banbury Ironstone, Bathstone, slate and gneiss, and some artificial stone (especially terrazzo) and cast iron. Pennant sandstone was the early stone of choice. Marble rose to great and sustained popularity from the late nineteenth century. Scottish granites had a modest but steady appeal, in contrast to granites from south-west England, which rose to prominence only in the early twentieth century. Gabbros from far overseas appeared mainly late, stimulated by the growth of cheap freight-container transport. The geological evolution of the landscape of the Old Cemetery therefore broadly matches that recorded in other burial grounds of the region, such as Oxford and west London.

A reconsideration of the origin of the early Pleistocene ‘Pebble Gravel Formation’ at Nettlebed, Oxfordshire, south central England

It is proposed that the meagre ‘Nettlebed Gravel’ does not merit its designation as the earliest sedimentary archive of the River Thames, nor is it a degraded river terrace. Rather the character of the gravel supports a derivation by slope processes with a quartz/quartzite component primarily sourced by the underlying Palaeogene Reading Formation. The associated Priest's Hill pollen bearing sediments are probably the infill of either a local palaeochannel or a doline. Although the ‘Nettlebedian Interglacial’ is likely to be early-middle Pleistocene in age, it bears no direct relationship to the Thames fluvial chronology. As a consequence any marine oxygen isotope stage assignment is unrealistic.

Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ-cell tumour: results from a 17-year UK experience

Following inguinal orchidectomy, management options for patients with stage I seminoma include initial surveillance or treatment with adjuvant radiotherapy or chemotherapy. The anticipated relapse rate for patients followed by surveillance alone is ∼15%, with adjuvant treatment this risk is reduced to ∼4%-5% at 5 years. After carboplatin treatment, follow-up strategies vary and there are no validated, predictive markers of relapse. We conducted a retrospective analysis of all patients presenting with stage I seminoma who received a single cycle of adjuvant carboplatin in South Central England between 1996 and 2013. We report on outcome and the results of univariate and multivariate analysis evaluating possible risk factors for post carboplatin relapse. A total of 517 eligible patients were identified. All underwent nuclear medicine estimation of glomerular filtration rate before treatment with carboplatin (dosed at area under the curve × 7). With a median follow-up of 47.2 months (range 0.4-214 months), 21/517 patients have relapsed resulting in a 5-year estimated relapse-free survival of 95.0% (95% confidence interval 92.8% to 97.3%). Median time to relapse was 22.7 months (range 12.5-109.5 months). Relapse beyond 3 years was rare (4/517; 0.8%). Twenty of 21 (95%) relapsed patients had retroperitoneal lymph node metastases. The majority (16/21; 76%) of patients had elevated tumour markers at relapse. Twenty of 517 (3.9%) patients developed a new contralateral testicular germ-cell cancer. There were no seminoma-related deaths. Tumour size was the only variable significantly associated with an increased risk of relapse. Overall results for this large cohort of patients confirm an excellent prognosis for these patients with outcomes equivalent to those seen in prospective clinical trials. Increasing tumour size alone appears to be associated with an increased risk of post chemotherapy relapse.

Initial experience in setting up a medical student first responder scheme in South Central England

Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention...