WALES Research Articles

К вопросу о базовых доминантах национальной идентичности валлийцев. (Basic Elements of the Welsh National Identity)

Russian Abstract: В статье рассматривается ряд аспектов, связанных с этнокультурной идентичностью Уэльса как части Соединенного Королевства Великобритании и Северной Ирландии, включая малоизвестные социокультурные особенности региона. Делается вывод об историчности этнического феномена валлийской идентичности с четко обозначенными этнокультурными доминантами, позволяющими дифференцировать культурную традицию Уэльса. English Abstract: The article deals with a number of specific aspects characterizing the national identity of the Welsh as one of the four constituent nations of the UK. The current study of the main Welsh cultural features reveals their historical interrelation and continuity of so called Welshness as a distinctive cultural phenomenon within the British Isles.

‘We’re Still Here’: Memory and Commemoration in the Alliances between the American Indian Movement and Welsh Nationalists

ABSTRACTFocusing on the role of historical memory and commemoration, this article explores the exchange of ideology and strategy between the American Indian Movement (AIM) and Welsh nationalists in the late twentieth-century. While these links might seem unexpected, they are part of a larger story of connections between the two groups, in which they shared information and supported each other’s campaigns. Despite the differences between the movements involved, these activists bonded through shared experiences of colonialism; their histories, in particular, were not being remembered. This article argues for a re-evaluation of AIM’s legacy through the transnational effects of their protests involving remembrance. AIM’s use of counter-commemorations not only shaped the tactics of historical remembering used by some Welsh nationalist groups but these Welsh activists, in turn, used the historical memory of AIM to raise awareness of their own causes. This article, therefore, uncovers some of the complicated and diverse ways that the American Indian Movement has influenced Welsh nationalism.

Seven new Neocallimastigomycota genera from wild, zoo-housed, and domesticated herbivores greatly expand the taxonomic diversity of the phylum

ABSTRACT We isolated and characterized 65 anaerobic gut fungal (AGF; Neocallimastigomycota) strains from fecal samples of five wild (W, axis deer, white-tailed deer, Boer goat, mouflon, and Nilgiri tahr), one zoo-housed (Z, zebra), and three domesticated (D, horse, sheep, and goat) herbivores in the US states of Texas (TX) and Oklahoma (OK), Wales (WA), and the Indian states of Kerala (KE) and Haryana (HA). Phylogenetic assessment using the D1–D2 regions of the large subunit (28S) rDNA and internal transcribed spacer 1 (ITS1) identified seven monophyletic clades that are distinct from all currently recognized AGF genera. All strains displayed monocentric thalli and produced exclusively or predominantly monoflagellate zoospores, with the exception of axis deer strains, which produced polyflagellate zoospores. Analysis of amplicon-based AGF diversity surveys indicated that zebra and horse strains are representatives of uncultured AL1 group, whereas domesticated goat and sheep strains are representatives of uncultured AL5 group, previously encountered in fecal and rumen samples of multiple herbivores. The other five lineages, all of which were isolated from wild herbivores, have not been previously encountered in such surveys. Our results significantly expand the genus-level diversity within the Neocallimastigomycota and strongly suggest that wild herbivores represent a yet-untapped reservoir of AGF diversity. We propose seven novel genera and eight novel Neocallimastigomycota species to comprise these strains, for which we propose the names Agriosomyces longus (mouflon and wild Boer goat), Aklioshbomyces papillarum (white-tailed deer), Capellomyces foraminis (wild Boar goat), and C. elongatus (domesticated goat), Ghazallomyces constrictus (axis deer), Joblinomyces apicalis (domesticated goat and sheep), Khoyollomyces ramosus (zebra-horse), and Tahromyces munnarensis (Nilgiri tahr).

Brian Frost-Smith: physician, author, and horologist

Brian Frost-Smith was born in Liverpool, in the year of the general strike, to Jane and Percy, both teachers at Appleby Grammar School. At the age of 11 he developed...

John Gwyn Thomas

John Gwyn Thomas (“Gwyn”) was born and educated in Denbigh. After national service he entered the Welsh National School of Medicine in Cardiff, where he met Mari Beddow. They married...

“A True and Patriotic Band!”: Welsh Anglican Resistance to a Colonial Victorian Church

This essay examines the colonial relationship between the Anglican Church and the British Empire's Welsh subjects across the nineteenth century. Focusing on the small output of a group of exiled Welsh clergymen (known as The Association of Welsh Clergy in the West Riding of the County of York), I consider Welsh Anglican responses to the church's neglect of Wales (exemplified by no Welsh-speaking bishop being assigned to a Welsh diocese between 1727 and 1870, despite the majority of the population not speaking English). The association believed that preaching in a foreign language such as English constituted a perversion from proper church practice and that this both reflected hegemonic attitudes toward indigenous and non-English speaking populations and pushed the Welsh population toward dissent. In response, the association sought to combine church reform with Welsh nationalism by elevating Welsh speakers as the spiritual inheritors of the true and primitive British church. They promulgated their visions in annual reports published between 1852 and 1856 into which they channeled other contemporary voices speaking against tyrannical and “Romish” Anglican Church practices. Through an analysis of post-Reformation Welsh church histories and the reports’ usages of such terminology as “alienation,” “Catholicism,” and “patriotism,” I reveal how the Welsh national identity the association fashioned at once operated within and aspired to correct the Anglican Church.

Careers Guidance and Transitions to Further Education in Wales

There is a general agreement that receiving appropriate and timely careers guidance enhances the likelihood of an individual’s participation in post-compulsory education. However, little is understood about how careers guidance influences the choices of learners. This paper explores the educational journey of learners’ who enrol within the Further Education sector in Wales, analysing whether the receipt of careers guidance is in anyway associated with these outcomes. This study utilises the linked database of school and pupil records, combining information from the Welsh National Pupil Database (NPD) with individual learner records from the Lifelong Learning Wales Record (LLWR) for young people who are registered at post-compulsory education providers, combined with anonymised client information held by Careers Wales. Data for two cohorts of Year 11 pupils (2012/13 and 2013/14) who subsequently enrolled in courses within the FE sector during the following academic year is analysed. Multivariate analysis reveals that, as expected, there is a strong link between GCSE attainment and learning aims at FE. However, the analysis also suggests that receipt of careers guidance may encourage learners to make choices at FE that are more commensurate with their abilities. Those with higher levels of attainment are also more likely to enrol on higher level learning programmes if they have also been in receipt of careers guidance. Likewise, those with low levels of attainment at GCSE are more likely to enrol on learning programmes with lower qualification aims if they have been in receipt of careers guidance. Receiving careers guidance through interviews increased the likelihood of registering on WBL programmes. Furthermore, learners on WBL programmes who have received careers guidance are less likely to withdraw from their courses early. The study offers important insights as to the role of career guidance in supporting young people in their transitions to post-compulsory education.

The Economic Burden of Patients with Eating Disorders to Healthcare Providers: A 27-Year Retrospective Record Linked Electronic Cohort Study

Background: 70 million people worldwide suffer from an eating disorder (ED) and long-term care is often needed. Patients are often young and vulnerable yet ambivalent about recovery. Without specific knowledge of the disease trajectory, patients with ED can evade detection, delaying time to diagnosis and treatment, and influencing long-term outcome and grossly underestimating treatment costs. Aim: The aim of this study was to estimate the healthcare economic burden from 1990 to 2017 of a cohort of patients with a diagnosis of an ED. Methods: The linkage and hosting of data were performed in the Secure Anonymised Information Linkage (SAIL) databank using a retrospective cohort study design. The SAIL databank is a large routine clinical database covering Wales. The data used was from the Patient Episode Database for Wales, Wales Demographics Service and Welsh General Practice datasets between 01/07/1990 and 30/06/2017, which are placed in SAIL by the Welsh National Health Service (NHS) and other data holders. Findings: Between 1990 and 2017, 15,558 individuals had an ED diagnosis. Patients with ED had large costs for inpatient admissions and GP contacts. Interpretation: Routine clinical data can be used effectively to quantify some burden of costs of a mental disorder beyond service use. ED incurred high NHS costs for GP contacts and inpatient admissions. The study included patients across the spectrum of severities, irrespective of whether they are known to specialist services. The scale of costs suggest that suffering from ED is likely to cost the NHS in areas well beyond what specific mental health service provision costs. We suggest that it may be cost-effective to invest in early intervention services that can help patients recover promptly from ED and potentially prevent high long-term costs of treatment and debility. Funding: Health and Care Research Wales (Grant HRA-15-1079). Declaration of Interest: All the authors have no competing interests to declare. Ethical Approval: The study design uses anonymised data and therefore the need for ethical approval and participant consent was waived by the approving IRB (Institutional Review Board), the UK National Health Service Research Ethics Committee. Instead, the SAIL Information Governance Review Panel (IGRP), which contains members from the UK National Health Service Research Ethics Committee, experts in information governance and members of the public, approved the study, IGRP 0487. This study was carried out in Swansea University.

Recurrent acute kidney injury: predictors and impact in a large population-based cohort.

This study examined the impact of recurrent episodes of acute kidney injury (AKI) on patient outcomes. The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients ≥18 years of age between April 2015 and September 2018. Patients were grouped according to the number of AKI episodes they experienced with each patient's first episode described as their index episode. We compared the demography and patient outcomes of those patients with a single AKI episode with those patients with multiple AKI episodes. Analysis included 153 776 AKI episodes in 111528 patients. Of those who experienced AKI and survived their index episode, 29.3% experienced a second episode, 9.9% a third episode and 4.0% experienced fourth or more episodes. Thirty-day mortality for those patients with multiple episodes of AKI was significantly higher than for those patients with a single episode (31.3% versus 24.9%, P < 0.001). Following a single episode, recovery to baseline renal function at 30 days was achieved in 83.6% of patients and was significantly higher than for patients who had repeated episodes (77.8%, P < 0.001). For surviving patients, non-recovery of renal function following any AKI episode was significantly associated with a higher probability of a further AKI episode (33.4% versus 41.0%, P < 0.001). Furthermore, with each episode of AKI the likelihood of a subsequent episode also increased (31.0% versus 43.2% versus 51.2% versus 51.7% following a first, second, third and fourth episode, P < 0.001 for all comparisons). The results of this study provide an important contribution to the debate regarding the need for risk stratification for recurrent AKI. The data suggest that such a tool would be useful given the poor patient and renal outcomes associated with recurrent AKI episodes as highlighted by this study.

Anthony David Griffiths

Anthony David Griffiths (“Tony”) was born on 5 March 1937 in Merthyr Tydfil. Tony’s mother, Eira (nee Lewis), was a haberdasher and needlewoman, and his father, Trefor, and grandfather were...

William Charles Donald Lovett

William Charles Donald Lovett (“Donald”) was born in Ystradowen in the Vale of Glamorgan, the eldest son of two school teachers. He was educated at Caerleon, where his father was...

Acceptability and Feasibility of Implementing Accelorometry-Based Activity Monitors and a Linked Web Portal in an Exercise Referral Scheme: Feasibility Randomized Controlled Trial.

BackgroundExercise referral schemes (ERSs) are recommended for patients with health conditions or risk factors. Evidence points to the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, but effects often diminish over time. Techniques such as goal setting, self-monitoring, and personalized feedback may support motivation for physical activity and maintenance of effects. Wearable technologies could provide an opportunity to integrate motivational techniques into exercise schemes. However, little is known about acceptability to exercise referral populations or implementation feasibility within exercise referral services.ObjectiveTo determine the feasibility and acceptability of implementing an activity-monitoring device within the Welsh National ERS to inform a decision on whether and how to proceed to an effectiveness trial.MethodsWe conducted a feasability randomized controlled trial with embedded mixed-methods process evaluation and an exploratory economic analysis. Adults (N=156) were randomized to intervention (plus usual practice; n=88) or usual practice only (n=68). Usual practice was a 16-week structured exercise program. The intervention group additionally received an accelerometry-based activity monitor (MyWellnessKey) and associated Web platform (MyWellnessCloud). The primary outcomes were predefined progression criteria assessing acceptability and feasibility of the intervention and proposed evaluation. Postal questionnaires were completed at baseline (time 0:T0), 16 weeks (T1), and 12 months after T0 (T2). Routine data were accessed at the same time-points. A subsample of intervention participants and scheme staff were interviewed following the initiation of intervention delivery and at T2.ResultsParticipants were on average aged 56.6 (SD 16.3) years and mostly female (101/156, 64.7%) and white (150/156, 96.2%). Only 2 of 5 progression criteria were met; recruitment and randomization methods were acceptable to participants, and contamination was low. However, recruitment and retention rates (11.3% and 67.3%, respectively) fell substantially short of target criteria (20% and 80%, respectively), and disproportionally recruited from the least deprived quintile. Only 57.4% of intervention participants reported receipt of the intervention (below the 80% progression threshold). Less than half reported the intervention to be acceptable at T2. Participant and staff interviews revealed barriers to intervention delivery and engagement related to the device design as well as context-specific technological challenges, all of which made it difficult to integrate the technology into the service. Routinely collected health economic measures had substantial missing data, suggesting that other methods for collecting these should be used in future.ConclusionsTo our knowledge, this is the first study to evaluate short- and long-term feasibility and acceptability of integrating wearable technologies into community-based ERSs. The findings highlight device- and context-specific barriers to doing this in routine practice, with typical exercise referral populations. Key criteria for progression to a full-scale evaluation were not met.Trial RegistrationISRCTN Registry ISRCTN85785652; http://www.isrctn.com/ISRCTN85785652

Acute Kidney Injury, Age, and Socioeconomic Deprivation: Evaluation of a National Data Set

IntroductionThis study examined the relationship among age, measures of social deprivation, and incidence and outcome of acute kidney injury (AKI).MethodsThe Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients 18 years or older between March 2015 and January 2017. Socioeconomic classification of patients was derived from the Welsh Index of Multiple Deprivation (WIMD). Patients were grouped according to their WIMD score, and Multivariate Cox proportional hazard modeling was used to adjust the data for age. The ranked data were categorized into percentiles and correlated with incidence, and measures of AKI severity and outcome.ResultsAnalysis included 57,654 patients. For the whole cohort, the highest 90-day survival was associated with the most socially deprived cohorts. There was a significant negative relationship between age-adjusted incidence of AKI and the WIMD score. In patients 60 years or older, there was an inverse correlation between WIMD score and survival that was not evident in those younger than 60. AKI severity at presentation was worse in patients from areas of social deprivation. Social deprivation was associated with a significantly higher proportion of preexisting chronic kidney disease (CKD) in patients with AKI older than 60, but not in those younger than 60.ConclusionOverall mortality following AKI was higher in least-deprived areas, reflecting an older patient cohort. In contrast, social deprivation was associated with higher age-adjusted AKI incidence and age-adjusted mortality following AKI. The excess mortality observed in more deprived areas was associated with more severe AKI and a higher proportion of preexisting CKD.

The Welsh Way of Colonisation in Patagonia: The International Politics of Moral Superiority

ABSTRACTThis article explores the ‘myth of friendship’ between the Welsh and indigenous communities of Patagonia in the mid to late nineteenth century. Drawing on extensive archival research, it unpacks the purpose of this myth which is to demonstrate the moral superiority of the Welsh nation. The proof of Welsh righteousness derives not only from their peaceful, loving approach to colonisation in Patagonia but from stories which recount that the ‘Indians’ loved them back. This technique of elevation works because it is framed by the international politics of colonial expansion, thus the Welsh settlers compare themselves favourably to the violent and oppressive actions of the British Empire and Argentine state. This assertion of moral superiority is not only a way to raise the position of the Welsh nation on the global stage, it targets those who enforce Welsh political and linguistic subordination, both in Wales (the English elite) and as settlers (the Argentine government). In this way, their claim to high status and national dignity based on ‘righteousness’ is an act of resistance, as well as elevation. I conclude that this new interpretation of Y Wladfa (the colony) offers fresh insight to understandings of Welsh internationalism. Moreover, its reflections on the use of moral capital as a tool of resistance might find wider parallels. Certainly, I argue, the persistence of the ‘myth of friendship’ continues to conceal the brutal reality of indigenous dispossession.

PP150 Bevan Health Technology Exemplars: Early Dialogue To Systematize HTA

IntroductionWales has ambitious health, wealth, and innovation policies and a clear goal to use the economic muscle of the Welsh National Health Service (NHS) to support its strong life sciences sector. Health Technology Wales (HTW) has a clear remit to appraise technologies over the span of their lifecycle from innovation to obsolescence. HTW is collaborating with the Bevan Commission through their national Health Technology Exemplars (HTEs), which partners NHS and industry stakeholders to strengthen innovation within the Welsh health system.MethodsHealth technology assessment (HTA) methods were used to produce topic exploration reports for assessing the evidence underpinning applicant innovations. A “Dragons’ Den” expert panel was convened to select the successful HTEs.ResultsFourteen Bevan HTEs were awarded funds, which were matched by industry partners. Application of HTA methods resulted in more critical consideration of technology value propositions, including: developing pull models of innovation focused on delivering health technology solutions for current problems facing NHS Wales; supporting early dialogue between the NHS and industry partners around demonstrating evidence of improved patient outcomes; and focusing on transformative rather than incremental innovation. The most promising innovations will progress to rapid HTA, where the evidence generated will be used to develop guidance for NHS Wales.ConclusionsHTA methods were productively deployed at the innovation phase of the technology lifecycle to support evidence-informed allocation of scarce innovation resources. In this way, HTW is working with key stakeholders to identify and offer early support to the most promising innovations, with the aim of expediting their adoption and realizing health benefits for patients as quickly as possible. The Bevan Commission has partnered with HTW to routinely build in HTA and evidence considerations in its future innovation calls and competitions. Thus, HTW has established a “feeder” pipeline for assessing bottom-up service-led innovations and encouraging evidence consideration throughout the lifecycle of innovative technologies.

Inaccurate diagnosis of COPD: the Welsh National COPD Audit.

The diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction. To evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD. A primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales. Patients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70). This audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations. Patients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.

SimonBrooks, Why Wales Never Was: The Failure of Welsh Nationalism. Cardiff: University of Wales Press, 199 pp. £54.99 (hbk).

SimonBrooks, Why Wales Never Was: The Failure of Welsh Nationalism. Cardiff: University of Wales Press, 199 pp. £54.99 (hbk).

The influence of socioeconomic status on presentation and outcome of acute kidney injury.

Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. Date was collected on a total of 57654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.

Review of Why Wales Never Was: the Failure of Welsh Nationalism by Simon Brooks

Simon Brooks is an independent academic and an author and a journalist, currently associated with the Morgan Academy, a research based think tank at the University of Swansea. This book was originally published in Welsh: Pam na fu Cymru – Methiant Cenedlaetholdeb Cymru, (Cardiff, UWP) in 2015 following his keynote lecture at the Llanelli National Eisteddfod, the previous year, in 2014. That speech was entitled Twf cenedlaetholdeb Seisnig – cyfaill ta gelyn? /The Growth of English Nationalism...

Predicting psychosis admission rates in Wales using neighbourhood deprivation

BackgroundSocioeconomic deprivation has been identified as a risk factor for psychosis and admission rates for psychosis are higher in deprived areas than more affluent areas. However, social gradients exist in many mental health conditions and it is unclear if this relationship is particularly important for psychosis.&#x0D; ObjectivesThe present study assesses whether there is a stronger relationship between the socioeconomic deprivation of an area and its rate of psychiatric admissions for psychosis than there is for other mental health diagnoses.&#x0D; MethodsWe linked a large dataset of routinely recorded psychiatric admissions from the Welsh National Health Service to small area indices of socio-economic deprivation (the Welsh Index of Multiple Deprivation). Poisson generalised linear mixed effects models were applied to stratified admission count data to test whether the relationship between deprivation and admission rates was stronger for psychosis admissions than for non-psychosis admissions. Data from Betsi Cadwaladr University Health Board (19,437 patients) were used as a discovery sample and an analysis protocol was pre-registered before being applied to data from the rest of Wales (116,641 patients).&#x0D; FindingsIn both samples, admission rates were higher in more deprived areas. In the discovery sample, this relationship was stronger for psychosis admissions than for other types of admission. However, in the larger replication dataset, this was not the case and the social gradient in admissions was equivalently steep for the two diagnosis categories.&#x0D; ConclusionsAlthough socio-economic deprivation was a risk factor for admission with psychosis, it is not a stronger risk factor for psychosis than for other psychiatric categories. Theoretical accounts of the relationship between psychosis and poverty should focus on factors common across mental health, rather than factors specific to psychosis.