Writing in Britain and Ireland, c. 400 to c. 800

No abstract available

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

The impact of EU policies on energy use in and the evolution of the UK built environment

Energy use in buildings is influenced by a variety of factors in complex ways. Historically, in the UK the efficiency of energy use in buildings has not been a major consideration in their design. Now policy concern with climate change is changing this, because buildings have come to be perceived as the locus of energy use with the highest cost-effective energy savings potential. In the UK, the energy efficiency of the building stock is rather low. The paper focuses largely on energy use in the UK's existing building stock and the two main European Union Directives which affect it: the Energy Performance in Buildings Directive and the Energy Services Directive. The Directives are complex, and there are a number of supporting programmes set up by the European Commission to aid their implementation. Even so, they have been implemented in differing ways in different European countries, and implementation remains patchy. The Directives have the potential to be a major influence on the evolution of the UK's built environment, but their effect will depend on the details of the Directives' implementation and enforcement, many of which are not yet clear.Energy efficiency Energy services directive Energy performance in buildings directive

Energy Supplier Obligations and White Certificate Schemes - Comparative Analysis of Experiences in the European Union

A number of Member States of the European Union (EU) have introduced market-based policy portfolios based on quantified energy savings obligations on energy distributors or suppliers, possibly coupled with certification of project-based energy savings (via white certificates), and the option to trade the certificates or obligations. The paper provides an up-to-date review and analysis of results to date of white certificate schemes in the EU. In the EU supplier obligations and white certificate schemes have delivered larger savings than originally expected with obliged companies exceeding targets and, in some cases, at cost below what policy makers have anticipated. Supplier obligations foster the uptake of standardised energy efficiency actions often targeting smaller energy users (residential sector), lowering the transaction costs and contributing to market transformation. The role of certificate trading is more ambiguous. Trading can bring benefits where the target is set sufficiently high with respect to the energy saving potential in the sectors covered. Theoretically trading may be better suited for broader systems with comprehensive coverage, but even in smaller schemes trading may reduce the transaction costs of compliance for obliged actors without sufficient expertise on end-use energy efficiency. Yet, trading increases the administrative cost ratio of energy saving obligations.JRC.DG.F.8-Renewable Energy (Ispra

Energy supplier obligations and white certificate schemes: Comparative analysis of experiences in the European Union

A number of Member States of the European Union (EU) have introduced market-based policy portfolios based on quantified energy savings obligations on energy distributors or suppliers, possibly coupled with certification of project-based energy savings (via white certificates), and the option to trade the certificates or obligations. The paper provides an up-to-date review and analysis of results to date of white certificate schemes in the EU. In the EU supplier obligations and white certificate schemes have delivered larger savings than originally expected with obliged companies exceeding targets and, in some cases, at cost below what policy makers have anticipated. Supplier obligations foster the uptake of standardised energy efficiency actions often targeting smaller energy users (residential sector), lowering the transaction costs and contributing to market transformation. The role of certificate trading is more ambiguous. Trading can bring benefits where the target is set sufficiently high with respect to the energy-saving potential in the sectors covered. Theoretically trading may be better suited for broader systems with comprehensive coverage, but even in smaller schemes trading may reduce the transaction costs of compliance for obliged actors without sufficient expertise on end-use energy efficiency. Yet, trading increases the administrative cost ratio of energy-saving obligations.Energy-saving obligations White certificates

Prolonged SARS-CoV-2 viral shedding in patients with chronic kidney disease

Recent World Health Organization guidance has aimed to provide pragmatic guidance acknowledging the role of sequential nasopharyngeal swabs taken &gt;24 hours apart for SARS‐CoV‐2 in high‐risk populations. Patients with chronic kidney disease (CKD) are known to have an altered immune milieu which may be associated with a delay in viral clearance. Here, a cross‐sectional observational study of 138 patients admitted with SARS‐CoV‐2 infection at two large regional hospitals in Scotland, UK examined the median time to two consecutive negative nasopharyngeal swabs for SARS‐CoV‐2 in an inpatient population. The median time from admission to the first of two consecutive negative nasopharyngeal swabs was 18 days (range = 1‐44) in patients with CKD, compared with 11 days (range: 1‐71) in patients without CKD (P = .0007). Multivariable linear regression analysis using explanatory variables of age, sex, SARS‐CoV‐2 disease severity, key comorbidities and renal function showed that declining estimated glomerular filtration rate was independently associated with prolonged time to viral clearance. Our data suggest that patients with CKD who are admitted to hospital with SARS‐CoV‐2 take longer to achieve sequential negative nasopharyngeal swab reverse transcription‐polymerase chain reaction results than those without CKD. This has implications for renal service provision, discharge planning and hospital capacity as well as a direct impact on patients due to extended hospital stay, anxiety and stigmatisation