An update on UK rheumatology consultant workforce provision: the BSR/ARC Workforce Register 2005–07: assessing the impact of recent changes in NHS provision

Objectives. To describe changes in the provision of rheumatology services, monitor the pattern of inequalities in UK rheumatology service provision since 2005, and to summarize the 3-yr impact of the new National Health Service (NHS) consultant contract and the Musculoskeletal Services Framework in England and Wales

Direct health costs of inflammatory polyarthritis 10 years after disease onset:Results from the Norfolk Arthritis Register

Objectives: To explore the change in direct medical costs associated with inflammatory polyarthritis (IP) 10 to 15 years after its onset. Methods: Patients from the Norfolk Arthritis Register who had previously participated in a health economic study in 1999 were traced 10 years later and invited to participate in a further prospective questionnaire-based study. The study was designed to identify direct medical costs and changes in health status over a 6-month period using previously validated questionnaires as the primary source of data. Results: A representative sample of 101 patients with IP from the 1999 cohort provided complete data over the 6-month period. The mean disease duration was 14 years (SD 2.1, median 13.6, interquartile range 12.6–15.4). The mean direct medical cost per patient over the 6-month period was £1496 for IP (inflated for 2013 prices). This compared with £582 (95% CI £355–£964) inflated to 2013 prices per patient with IP 10 years earlier in their disease. The increased cost was largely associated with the use of biologics in the rheumatoid arthritis subgroup of patients (51% of total costs incurred). Other direct cost components included primary care costs (11%), hospital outpatient (19%), day care (12%), and inpatient stay (4%). Conclusion: The direct healthcare costs associated with IP have more than doubled with increasing disease duration, largely as a result of the use of biologics. The results showed a shift in the direct health costs from inpatient to outpatient service use

University embeddedness: Validating a new means for predicting retention and curbing dropout

Student retention is a significant issue for the higher education sector. There is need for a tool that can reliably identify students at risk of dropout or before their performance begins to deteriorate. Borrowing a relatively new concept from organisational psychology that has been found to reliably determine how “enmeshed” or “embedded” an employee is within their employment, the “university embeddedness” concept was tested using data from an online survey. Structural Equation Modeling revealed some encouraging results in support of future development of the new construct, however certain hurdles remain

Self-reported pain severity is associated with a history of coronary heart disease

This study was funded by Arthritis Research UK (grant number: 17292).Peer reviewedPublisher PD

Ecodrive Training Delivers Substantial Fuel Savings for Heavy Vehicle Drivers

A small group of heavy vehicle drivers underwent an ecodrive training course. Their driving was assessed for various ecodrive variables as they completed an 18 mile circuit in normal traffic immediately after the course and again 6 and 12 weeks later. Compared to pre-course measures, these drivers reduced their fuel consumption by an average of 27%, the number of gear changes by 29%, and the number of brake applications by 41%, though not all differences were statistically significant due to the size of this pilot and large driver variability. Importantly, the improvements were not offset by increases in the time taken to complete the circuit. At the 6 week point a control group was also assessed, and they used more fuel and more gear changes, and applied their brakes more often than the control group. Safety variables were inconclusive. A larger, in-service trial is warranted

Aspects of early arthritis. What determines the evolution of early undifferentiated arthritis and rheumatoid arthritis? An update from the Norfolk Arthritis Register

Over 3500 patients with recent onset inflammatory polyarthritis (IP) have been recruited by the Norfolk Arthritis Register (NOAR) since 1990. Longitudinal data from this cohort have been used to examine the prevalence and predictors of remission, functional disability, radiological outcome, cardiovascular mortality and co-morbidity and the development of non-Hodgkin's lymphoma. Rheumatoid factor titre, high baseline C-reactive protein and high baseline HAQ score are all predictors of a poor outcome. There is a strong association between possession of the shared epitope and the development of erosions. Patients who satisfy the American College of Rheumatology criteria for rheumatoid arthritis (RA) have a worse prognosis than those who do not. However, it appears that these patients are a poorly defined subset of all those with IP rather than having an entirely separate disease entity. New statistical techniques offer exciting possibilities for using longitudinal datasets such as NOAR to explore the long-term effects of treatment in IP and RA

Through Ancient Rings Thread Programming Strings

A new crystal structure of assembled subunits from the eukaryotic exosome complex gives insight into the interactions underpinning its various functions (Bonneau et al., 2009). Here, we focus on what the emerging structures tell us about the regulation of the exosome interactions with, and actions on, RNA

Mapping the <i>Shh</i> long-range regulatory domain

Coordinated gene expression controlled by long-distance enhancers is orchestrated by DNA regulatory sequences involving transcription factors and layers of control mechanisms. The Shh gene and well-established regulators are an example of genomic composition in which enhancers reside in a large desert extending into neighbouring genes to control the spatiotemporal pattern of expression. Exploiting the local hopping activity of the Sleeping Beauty transposon, the lacZ reporter gene was dispersed throughout the Shh region to systematically map the genomic features responsible for expression activity. We found that enhancer activities are retained inside a genomic region that corresponds to the topological associated domain (TAD) defined by Hi-C. This domain of approximately 900 kb is in an open conformation over its length and is generally susceptible to all Shh enhancers. Similar to the distal enhancers, an enhancer residing within the Shh second intron activates the reporter gene located at distances of hundreds of kilobases away, suggesting that both proximal and distal enhancers have the capacity to survey the Shh topological domain to recognise potential promoters. The widely expressed Rnf32 gene lying within the Shh domain evades enhancer activities by a process that may be common among other housekeeping genes that reside in large regulatory domains. Finally, the boundaries of the Shh TAD do not represent the absolute expression limits of enhancer activity, as expression activity is lost stepwise at a number of genomic positions at the verges of these domains

Predictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis:Results from the Norfolk Arthritis Register

Objectives: Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP.  Methods: Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ⩾3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time.  Results: A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5.  Conclusion: Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy

The Historical Film in the Era of New Hollywood, 1967-1980.

PhDThis thesis is the first sustained analysis of historical films made in the New Hollywood era (1967-80). It explores the mediation of the era’s social, cultural and ideological concerns in feature films that represent key periods in American history. The terms New Hollywood and the historical film are utilised with revisionist aims. As well as considering the new wave of ‘auteur’ cinema synonymous with the New Hollywood, the thesis demonstrates the diverse range of films produced in this era. Similarly, it rejects the boundary drawing practiced by many studies of history and film, and submits that any film set in the past can be used to explore the values, assumptions and ideological conflicts of the present. Furthermore, the thesis contends that analysis of historical films allows us to understand how audiences of a given period engage with the past in emotional, moral and aesthetic terms. The method and approach of this research is robust and wide reaching, providing evidence based analysis of each film’s production and reception, as well as close readings of individual texts. The primary sources utilised include production files, draft screenplays, film reviews, press interviews and other forms of publicity. The vast majority of new Hollywood historical films are set in the recent past, and the six case studies undertaken in this thesis include a broad section of the era’s significant historical films: The Day of the Locust (1975), a drama centred on 1930s Hollywood; Sounder (1972), a story of Depression-era African American sharecroppers in the deep South; The Dirty Dozen (1967), a Second World War combat drama; The Way We Were (1973), a romantic film bridging the radical 1930s and the McCarthy ‘witchhunts’ of the 1950s; and American Graffiti (1973) and Grease (1978), which look back on the early rock and roll era of the late 1950s and early 1960s with nostalgia.Arts and Humanities Research Counci