Journal articles on the topic 'British Challenge Glazing Co'

In mid-July 1961 the Conservative government in Britain, headed by Harold Macmillan, decided to apply for full membership of the European Economic Community (EEC). Successive British governments had persistently opted for intergovernmental co-operation instead of supranational integration as in the case of the European Coal and Steel Community (ECSC) and the EEC. Thus the application, which implied the intent to join a supranational structure and a customs union, marked an unexpected and somewhat surprising break with the well-established British post-war policy.

<em>Based on British and French archive material, this paper seeks to contribute to the limited “coalition warfare historiography” by exploring a neglected but revealing aspect of Franco-British chemical warfare between 1915-1918: Intelligence sharing. A contextual overview of the two allied intelligence services prior to and following the outbreak of war highlights their complementary strength and global reach. The tactical and strategic significance of French and British intelligence failures at the time of the first German poison gas attacks in April 1915 is examined and contrasted with subsequent allied experience. The discussion focuses upon the two most productive sources of allied intelligence information, mainly reports from secret agents and enemy prisoner of war interview digests. The volume, quality and detail of this material, and its importance to the Franco-British gas war effort are underlined. The article demonstrates how closely and effectively the two allies co-operated by exploiting their shared intelligence data to successfully anticipate German initiatives and to mitigate the searching battlefield challenge posed by an enemy whose technological superiority and resource advantages were evident especially during the earlier periods of the gas war on the Western Front.</em>

Abstract The modern British ideological centre has been neglected and its impact underestimated. This article highlights the persistence of the centre’s moderating influence and its progressive, indeed at times radical, contribution. This ideological dynamism emanated from centrists’ synthesis of objectives often considered to conflict. Notably, centrists sought social justice alongside individual aspiration, albeit that this cross-ideological marriage was partial and incomplete. The article also examines the relationship between the centre and the people – presently portrayed as one of popular disconnection from an aloof elite. Yet, centrists have received considerable electoral sustenance from voters, and in turn demonstrated an appreciation of the contradictory ‘mix’ in many people, conservatism and progressivism in complex co-existence. Centrist history points to the contemporary political challenge as being one of raising the sights of a collective national ‘us’, rather than demonizing a variously targeted ‘other’.

ABSTRACTThe roots of a British Antarctic policy can be traced, paradoxically, back to the establishment of a meteorological station by the Scottish Antarctic Expedition in the South Orkneys, in 1903, and the indifference of the British Government to its almost immediate transfer to the Argentine Government. It was from that modest physical presence upon Laurie Island that Argentina came increasingly to challenge British claims to the sovereignty of the Falkland Islands Dependencies (FID), first in the late 1920s and then more extensively in the second world war. This challenge shaped British policy for the next forty years, with further complications caused by overlapping territorial claims made by Chile and the possible territorial ambitions of the USA. Britain's eventual response, at the height of World War II, was to establish permanent occupation of Antarctica from the southern summer of 1943–1944. This occupation was given the military codename Operation Tabarin. However, it was never a military operation as such, although monitoring the activities of enemy surface raiders and submarines provided a convenient cover story, as did scientific research once the operation became public. Whilst successive parties, rich in professional scientists, considerably expanded the pre-war survey and research of the Discovery Investigations Committee, their physical occupancy of the Antarctic islands and Peninsula was essentially a political statement, whereby the Admiralty and Colonial Office (CO) strove to protect British territorial rights, whilst the Foreign Office (FO) endeavoured to minimise disruption to Britain's long-standing economic and cultural ties with Argentina, and most critically, the shipment of war-time meat supplies. In meeting that immediate need, Tabarin also provided the basis from which Britain's subsequent post-war leadership in Antarctic affairs developed.

In this paper, we analyze a PhotoVoice project - the Belonging Project that included 22 youth co-researchers and three researchers from the University of British Columbia. The project focused on concepts of belonging and exclusion and resulted in recommendations to a school district in Canada, a photo exhibit, and two of the co-researchers being interviewed by a local radio station about the project. This paper details the tensions between what the co- researchers saw as necessary for schools to be places that create a sense of belonging and how the role of students is constructed through policies from the district to provincial levels and through societal attitudes about schooling and young people. We also detail debates in the school district (simultaneous to the Belonging Project) concerning policy to address homophobia. Finally, this paper is a story about the challenge of undertaking youth participatory oriented research within the confines of schooling.

Wildfires pose a critical and ongoing challenge in British Columbia, Canada, threatening human life, property, and natural ecosystems. To understand and predict the behavior of such fires, our study employs Cellular Automata (CA), a mathematical model adept at simulating complex systems through grid-based cell interactions. This model, validated by prior research, incorporates a wind propagation rule that significantly enhances the prediction of wildfire spread in the direction of prevailing winds. Research centers on a wildfire event in Prince George, utilizing CA to simulate fire dynamics influenced by var-ious factors. The models strength lies in its ability to represent detailed local interactions and its flexibility in scenario testing, which is instrumental in understanding model uncer-tainties. By simulating different fire scenarios, the study aims to grasp the complexities and potential variables affecting wildfire behavior. The research provides a foundation for decision-makers to analyze and study wildfire events, leveraging a Multi-Criteria Evaluation (MCE) Model to assess the susceptibility of cells to fire. This comprehensive approach combines CA with MCE, offering a robust framework for simulating and manag-ing wildfire expansion in British Columbia.

While Britain was amassing the largest empire ever seen, her policy makers continued to believe that economic ties were a far more effective means of control than costly and provocative military domination. Fortunately for British empire-builders, the peoples they encountered were frequently divided amongst themselves, and lacked confidence in their ability to challenge British domination. This was not entirely the case with Japan's attempts to establish hegemony over Korea following the Russo-Japanese war (1904–05). Although there were serious political and regional divisions within Korea, these were subordinated to broad hostility towards Japan. Japanese technological superiority was seen as a hand-me-down from the West, and Korea's elite, raised in the Chinese tradition, was largely dismissive of Japanese cultural attainments. Even financially, Japan remained a small player in the international market, dependent for her own overseas development on New York, London and Paris. To win Korean converts, Japan had to introduce rapid, visible improvement. One means to support this aim was the idea of Asian unity underJapanese leadership. Failing this, she could enforce her actions with a sizeable, but expensive, military and police presence. However, the rhetoric of Japanese—Korean unity could not be overstressed in view of the burgeoning Western fear of an Asian resurgence. Moreover, the concept of Japan and Korea stemming from one family was unconvincing given the historical enmity of the two peoples. Consequently, Japan sought to diminish native antipathy and retain international sympathy by emulating Britain's exaple of discreet civilian control in Egypt.

It is becoming increasingly accepted among analysts of British voting behaviour that, contrary to the conventional wisdom, local campaigning matters. The widespread view, largely propagated by David Butler and his co-workers on the Nuffield election studies, has been that campaigning in the constituencies by party activists and their candidates has no influence on the outcome: the distribution of votes across the parties in each constituency is a function of the national campaign only. This view was initially challenged by studies of canvassing in the 1970s, and extended during the 1980s by studies of campaign spending in the constituencies; further support was provided by work in the late 1980s and early 1990s on party canvassing activity. This note takes the challenge forward with an analysis of the impact of different aspects of constituency campaigning.

Abstract For the first issue of the renamed journal, Modern British History co-editor Erik Linstrum convened a group of scholars to reflect on the past, present, and possible futures of the field. The resulting contributions make no claim to provide a comprehensive or representative survey. Rather, they offer a variety of perspectives on where modern British history has been and where it might be going. Several contributions, written by former editors of Twentieth Century British History, drawn on the history of the journal as a way of thinking about the direction of the field and its subfields. Others consider the place of modern Britain in the wider discipline of history, grappling with questions of temporality and embodiment; the institutional and material contexts of scholarship; the role of national histories in a transnational world; and the response of historical writing to epidemiological, humanitarian, and ecological crisis. The sequence of contributions mirrors the evolution of the journal since its founding in 1990, beginning with political history and gradually encompassing a much broader range of subjects and methodologies as well as an expanded geographical ambit. Here are archive stories, pleas for new subjects, roadmaps for new approaches to old subjects, and attempts to identify master narratives. Taken together, these contributions demonstrate that modern British history has many houses—which is both a sign of intellectual vitality and a challenge for anyone wishing to generalize about the ‘state of the field’. If British modernity remains an abundant resource for ‘thinking with’, its contours and frontiers are tantalizingly up for grabs.

The concept of micro-nations is not new, but until now little research has been conducted into how Governments have responded to the challenges they present. Such nations are invariably self-declared, often with tiny populations and no visible means of sustaining themselves, and usually to be found on remote islands. The Principality of Sealand, the name bestowed on Roughs Tower, an abandoned British military fort in the North Sea, by its 1960s occupiers, the Bates family, is perhaps the best known example of a micro-nation. The sheer longevity of their claim, which they have been putting forward for over forty years, makes it unique, and therefore worthy of analysis. This article draws together a narrative study of how Whitehall dealt with the Sealand challenge and how different departments of state viewed it in starkly contrasting ways, with a rigorous analysis of the Bates' claim from a legal perspective, setting it against the context of international law as defined by the UN, the EU and individual nations, with an emphasis on marine law and state recognition. The study concludes that the British Government could have done more to close Sealand down and that valuable lessons on inter-departmental co-ordination can still be drawn from this case study today.

The term ‘governance’ is popular but imprecise. It has at least six uses, referring to: the minimal state; corporate governance: the new public management; ‘good governance’; socio-cybernetic systems: and self-organizing networks. I stipulate that governance refers to ‘self-organizing, interorganizational networks' and argue these networks complement markets and hierarchies as governing structures for authoritatively allocating resources and exercising control and co-ordination. I defend this definition, arguing that it throws new light on recent changes in British government, most notably: hollowing out the state, the new public management, and intergovernmental management. 1 conclude that networks are now a pervasive feature of service delivery in Britain; that such networks are characterized by trust and mutual adjustment and undermine management reforms rooted in competition; and that they are a challenge to governability because they become autonomous and resist central guidance.

African chiefs under colonial rule are conventionally described as collaborators. Those who failed to co-operate with their colonial masters were deposed. Tshekedi Khama, Regent of the Bangwato for his nephew, Seretse, from 1926 to 1950, does not fit this description. During the first ten years of his regency, he was almost continuously locked in conflict with the British on a whole range of issues both large and small. His sustained opposition to the British is the more remarkable in that he became regent at the age of merely twenty without having been specifically prepared for the governance of the largest of the Tswana states under British rule.This article explores the reasons for Tshekedi's opposition to the British and the way in which he conducted this opposition, and asks why the British did not depose him as they almost certainly would have deposed a chief who behaved remotely like him in one of their other African territories. It concludes that while Tshekedi basically accepted the colonial situation in the Bechuanaland Protectorate, he was determined that the British should make no inroads into the powers of the chiefs as determined at the end of the nineteenth century when his father Khama III had accepted British protection. He was also resolved to hand over the chieftaincy intact to his ward, Seretse. Furthermore Tshekedi, unlike most African chiefs of his day, was Western-educated, having attended Fort Hare, and believed that the function of the British Administration was to teach him ‘how to govern…not how to be governed’. He reacted strongly against measures that were imposed on him without consultation or explanation, especially, those which he suspected were designed to limit his power or might affect the welfare of his people. In opposing such measures, he employed both ‘traditional’ and ‘modern’ resources and was as skilful as any African nationalist of the time in mobilising press, parliament and public opinion in Britain in his support.While the British did consider deposing him, and in 1933 temporarily suspended him from office, they were confronted by the fact that there was no other leader in Gammangwato who would be accepted as a legitimate alternative by the Bangwato or who would be remotely as competent as he was. After ten years of wrangling with Tshekedi the British learnt that it was in their interests to collaborate with him. For the next decade Tshekedi and the Administration worked largely in harmony. It was only in the late 1940s that Tshekedi began to use his formidable intellectual powers and administrative experience to challenge the colonial system itself.

Communicating with Chinese, Japanese, and Korean users in English is a challenge for Russians, even if they have a perfect command of English. This is due to the fact that while performing a global function and retaining local features, the English language, non-native to its users, has specific phonetic features revealed as an accent in oral speech, as well as certain graphic innovations, which aggravates translating proper names and culture-loaded words into Russian in a written form of communication. The challenges result from co-existence of several transliteration systems in these languages, non-traditional sound and letter correlations as compared with British and American Englishes, non-traditional translation correlations when transliterating from Roman to Cyrillic. Translation problems proper are complicated by lexico-semantic and pragmatic factors, which can be interpreted only on the cultural basis. These challenges make it necessary to integrate the World Englishes paradigm into the courses of English departments, as well as preparing special textbooks and reference sources.

AbstractIn September 2016, a case went to trial in British Columbia that seeks to test the constitutionality of provincial laws that (1) ban private health insurance for medically necessary hospital and physician services; (2) ban extra-billing (physicians cannot charge patients more than the public tariff); and (3) require physicians to work solely for the public system or ‘opt-out’ and practice privately. All provinces have similar laws that have been passed to meet the requirements of federal legislation, theCanada Health Act(and thus qualify for federal funds). Consequently, a finding of unconstitutionality of one or more of these laws could have a very significant impact on the future of Canada’s single-payer system (‘medicare’). However, should the court find that a particular law is not in compliance with theCanadian Charter of Rights and Freedoms, the baton is then passed back to the government which may respond with other laws or policies that they believe to be constitutionally compliant. The ultimate impact of any successfulCharterchallenge to laws protecting medicare from privatization will thus significantly depend on how Canadian governments respond. Provincial governments could allow privatization to undercut equity and access, or they could respond creatively with new legal and policy solutions to both improve equity and access and tackle some of the problems that have long bedeviled Canadian medicare. This paper provides an understanding – grounded in comparative health systems evidence – of law and policy options available to Canadian lawmakers for limiting two-tier care in the wake of any successful challenge to existing laws. The paper presents the results of a large inter-disciplinary, comparative study, started in 2015, that systematically reviewed the legal and broader regulatory schemes used to regulate the public/private divide in 15 Organization for Economic Co-Operation and Development countries with a particular eye to what the effect of such regulations would be upon wait times.

The Sino-u.s. agreement of May 1943 that granted the u.s. military exclusive criminal jurisdiction over its troops in China was a continuation of extraterritorial rights that the United States supposedly abolished the previous January. In light of the earlier British-u.s. negotiations on the same issue, China was an integral part of a legal regime that during World War ii shielded globally deployed u.s. troops from local laws. The Chinese Guomindang (gmd) government’s renewal of the 1943 agreement in June 1946 extended the wartime legal privileges of u.s. troops into an era of precarious peace in China and set a precedent for the Status of Forces Agreements between the United States and various allies during the Cold War. The demonstrations after the Shen Chong Incident in late 1946, a largely nationalist movement that the Chinese Communist Party (ccp) co-opted, highlighted the inadequacy of public indignation and ccp manipulation in mounting a consistent legal effort to challenge the entrenched extraterritorial privileges of u.s. troops and restore Chinese jurisdiction. The gmd government also lost the opportunity to use the jurisdictional issue to demonstrate its nationalist credentials to an agitated public.

Losses in forest productivity through poor soil management are typically evaluated by changes in crop production, but conflicting growth responses among co-occurring species can challenge criteria for sustainability. In this study, we evaluate species response to compaction and organic matter removal by contrasting the growth and foliar attributes at age 20 of lodgepole pine (Pinus contorta Dougl. ex Loud.) and hybrid white spruce (Picea glauca × engelmannii (Moench) Voss) in sub-boreal forests of central British Columbia. Bole volume increment was stable for lodgepole pine, averaging a 6 % difference across treatments. White spruce, in contrast, often had large growth increases on forest floor retained – compacted plots (average of 63 % gain) but reductions in productivity on the forest floor removed – compacted plots (40 % decline). Foliar nitrogen concentrations converged across treatments for both species, despite the removal of over 50 % of the site N capital. Some key differences in species traits were suggested by foliar δ15N, attributed to deeper rooting of pine, and foliar δ13C, indicating possibly higher CO2 assimilation potential for spruce. The implication is that standard metrics of sustainable forestry are contingent upon tree autecology and that comprehensive assessments of land management require a measure of collective species response.

The importance to reach the target to be carbon net zero by 2050, as presented by the European Commission in the European Green Deal, cannot be overestimated. In a current endoscopy world, where single use has found its place and techniques are constantly evolving, it will be a challenge to reach these goals. How can we reconcile this evolution to a carbon neutral status by 2050 without compromising patients care, clinical standards and training needs? The European Society of Gastrointestinal Endoscopy (ESGE) together with the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) recently published a position statement (1) whereas in the UK there is the work from the green endoscopy group (2) in line with the strategy of the British Society of Gastroenterology (BSG) on sustainability (3). In Flanders, a project called “greendeal in duurzame zorg” had its kick off in March 2023 (4) so it is about time that we in Belgium, as gastroenterologists, start with tangible actions to a more sustainable daily practice. We wrote this position statement in cooperation with the Vlaamse Vereniging voor Gastro-Enterologie (VVGE), the Société royale belge de Gastro-entérologie (SRBGE) and the Belgian Society of Gastrointestinal Endoscopy (BSGIE). We will also work together in the coming years to continue to motivate our members to work on these initiatives and to co-opt new projects within the framework of the greendeal.

AbstractLessons from conflict have contributed to military medical advances which have significantly improved the survivability of critically injured servicemen and women. However, survival following such severe combat polytrauma is often associated with devastating tissue loss and functional deficits that challenge conventional reconstruction. Despite recent advances, upper extremity prosthetic alternatives lack the fidelity to restore the complex intrinsic and sensory function of the human hand. Upper Limb Reconstructive Transplantation, or Vascularised Composite Allotransplantation (VCA), is currently an experimental procedure offering superior anatomical and functional outcomes compared to prostheses.Military candidates for VCA usually enjoy high pre-morbid fitness, mental health resilience and support, and relatively rich provision of rehabilitation. However, co-morbidities of polytrauma, such as traumatic brain injury and post-traumatic stress disorder, may have an impact on outcomes.Since 1998, over 120 upper limb transplants have been performed worldwide. Of these, six have been performed on servicemen and women across three continents. The morbidity and mortality associated with the requirement for lifelong immunosuppression, however, continues to skew the risk-benefit considerations of these promising procedures when compared to prostheses. Thus, although the technical surgical feasibility of upper limb and other VCA such as face, abdominal wall, uterus and penis transplants has been established over the past decade, these procedures remain restricted to recipients fulfilling stringent inclusion criteria.We review the current state of VCA in military recipients, and summarise ongoing collaborative VCA research conducted by British and American military medical teams.

After a long period during which the involvement of laypersons was considered undesirable in the Western tradition of science, we have recently witnessed numerous collaborations which suggest that the desirability of societal involvement in the scientific practice is becoming recognized. This article argues that the historical considerations that once led to this division in cognitive labour have been in transformation, having undergone diverse shifts. In a first instance, the exclusion of laypersons from science is analysed in terms of the key concepts of systematicity, universality, and authority. For that, two examples are given: the case of the British photographic survey and that of the American Museum of Natural History. Next, the dissolution of these barriers between scientists and laypersons is discussed and illustrated by examples: the Dystrophic Epidermolysis Bullosa Research Association in Austria, Fukushima nuclear monitoring stations, and the French Association of Muscular Dystrophy. It is concluded that, for science to be truly democratized, co-produced knowledge needs to be integrated in political decision-making processes, which is currently still lacking. Furthermore, since expertise can also be found in society, non-certified experts should work in conjunction with scientists, yet at the same time, the divide between experts and non-experts must be maintained. The inclusion of non-scientific experts in decision-making is fundamentally different from the inclusion of lay stakeholders. Hence, different participatory roles should be expected from stakeholders, experts, or scientists, and the most important challenge now is how to formally define such roles.

Library collection development is directly related to the issues of placement, storage and delivery of documents. The eternal storage of the totality of documents that make up the national heritage is one of the functions of national libraries (NL), which solve the problem of placing materials with consideration to their financial and other capabilities.An overview of the successful national libraries’ practice in solving the lack of storage space problem is presented (Library of Congress, British Library, German National Library, National Diet Library of Japan, National Library of France, Royal Library of Sweden, Austrian National Library, National Library of the Czech Republic, Royal Library of the Netherlands). The experience of the Russian State Library in solving this problem is also analyzed.Finding place for growing collections with a tight of storing conditions is a challenge that requires not only constant attention, but also a flexible approach. Various options for solving this problem are being considered: construction of new (including remote) storage facilities; efficient use of existing premises (for example, an implementation of high density storage systems or co-opting of premises built for other purposes — idle exhibition centers functional conversion, etc.); lease of rentable areas.The research is based on the analysis of information from official websites of the national libraries.The appendix presents the results of the NL survey on the following issues: withdrawing of certain categories of materials, dispatching them to depositories; construction of new storage buildings; statistics concerning active use and actual availability of collections.

-Valerie I.J. Flint, Margarita Zamora, Reading Columbus. Berkeley: University of California Press, 1993. xvi + 247 pp.-Riva Berleant-Schiller, Historie Naturelle des Indes: The Drake manuscript in the Pierpont Morgan Library. New York: Norton, 1996. xxii + 272 pp.-Neil L. Whitehead, Charles Nicholl, The creature in the map: A journey to Eldorado. London: Jonathan Cape, 1995. 398 pp.-William F. Keegan, Ramón Dacal Moure ,Art and archaeology of pre-Columbian Cuba. Pittsburgh: University of Pittsburgh Press, 1996. xxiv + 134 pp., Manuel Rivero de la Calle (eds)-Michael Mullin, Stephan Palmié, Slave cultures and the cultures of slavery. Knoxville: University of Tennessee Press, 1995. xlvii + 283 pp.-Bill Maurer, Karen Fog Olwig, Small islands, large questions: Society, culture and resistance in the post-emancipation Caribbean. London: Frank Cass, 1995. viii + 200 pp.-David M. Stark, Laird W. Bergad ,The Cuban slave market, 1790-1880. Cambridge: Cambridge University Press, 1995. xxi + 245 pp., Fe Iglesias García, María Del Carmen Barcia (eds)-Susan Fernández, Tom Chaffin, Fatal glory: Narciso López and the first clandestine U.S. war against Cuba. Charlottesville: University Press of Virginia, 1996. xxii + 282 pp.-Damian J. Fernández, María Cristina García, Havana USA: Cuban exiles and Cuban Americans in South Florida, 1959-1994. Berkeley: University of California Press, 1996. xiii + 290 pp.-Myrna García-Calderón, Carmen Luisa Justiniano, Con valor y a cómo dé lugar: Memorias de una jíbara puertorriqueña. Río Piedras: Editorial de la Universidad de Puerto Rico, 1994. 538 pp.-Jorge Pérez-Rolon, Ruth Glasser, My music is my flag: Puerto Rican musicians and their New York communities , 1917-1940. Los Angeles: University of California Press, 1995. xxiv + 253 pp.-Lauren Derby, Emelio Betances, State and society in the Dominican Republic. Boulder CO: Westview Press, 1995. xix + 162 pp.-Michiel Baud, Bernardo Vega, Trujillo y Haiti, Volumen II (1937-1938). Santo Domingo: Fundación Cultural Dominicana, 1995. 427 pp.-Danielle Bégot, Elborg Forster ,Sugar and slavery, family and race: The letters and diary of Pierre Dessalles, Planter in Martinique, 1808-1856. Elborg & Robert Forster (eds. and trans.). Baltimore: John Hopkins University Press, 1996. 322 pp., Robert Forster (eds)-Catherine Benoit, Richard D.E. Burton, La famille coloniale: La Martinique et la mère patrie, 1789-1992. Paris: L'Harmattan, 1994. 308 pp.-Roderick A. McDonald, Kathleen Mary Butler, The economics of emancipation: Jamaica & Barbados, 1823-1843. Chapel Hill: University of North Carolina Press, 1995. xviii + 198 pp.-K.O. Laurence, David Chanderbali, A portrait of Paternalism: Governor Henry Light of British Guiana, 1838-48. Turkeyen, Guyana: Dr. David Chanderbali, Department of History, University of Guyana, 1994. xiii + 277 pp.-Mindie Lazarus-Black, Brian L. Moore, Cultural power, resistance and pluralism: Colonial Guyana 1838-1900. Montreal & Kingston: McGill-Queen's University Press; Mona, Kingston: The Press-University of the West Indies, 1995. xv + 376 pp.-Madhavi Kale, K.O. Laurence, A question of labour: Indentured immigration into Trinidad and British Guiana, 1875-1917. Kingston: Ian Randle; London: James Currey, 1994. ix + 648 pp.-Franklin W. Knight, O. Nigel Bolland, On the March: Labour rebellions in the British Caribbean, 1934-39. Kingston: Ian Randle; London: James Currey, 1995. viii + 216 pp.-Linden Lewis, Kevin A. Yelvington, Producing power: Ethnicity, gender, and class in a Caribbean workplace. Philadelphia: Temple University Press, 1995. xv + 286 pp.-Consuelo López Springfield, Alta-Gracia Ortíz, Puerto Rican women and work: Bridges in transnational labor. Philadelphia: Temple University Press, 1996. xi + 249 pp.-Peta Henderson, Irma McClaurin, Women of Belize: Gender and change in Central America. New Brunswick NJ: Rutgers University Press, 1996. x + 218 pp.-Bonham C. Richardson, David M. Bush ,Living with the Puerto Rico Shore. José Gonzalez Liboy & William J. Neal. Durham: Duke University Press, 1995. xx + 193 pp., Richard M.T. Webb, Lisbeth Hyman (eds)-Bonham C. Richardson, David Barker ,Environment and development in the Caribbean: Geographical perspectives. Mona, Kingston: The Press-University of the West Indies, 1995. xv + 304 pp., Duncan F.M. McGregor (eds)-Alma H. Young, Anthony T. Bryan ,Distant cousins: The Caribbean-Latin American relationship. Miami: North-South-Center Press, 1996. iii + 132 pp., Andrés Serbin (eds)-Alma H. Young, Ian Boxill, Ideology and Caribbean integration. Mona, Kingston: The Press-University of the West Indies, 1993. xiii + 128 pp.-Stephen D. Glazier, Howard Gregory, Caribbean theology: Preparing for the challenges ahead. Mona, Kingston: Canoe Press, University of the West Indies, 1995. xx + 118 pp.-Lise Winer, Richard Allsopp, Dictionary of Caribbean English usage. With a French and Spanish supplement edited by Jeanette Allsopp. Oxford: Oxford University Press, 1996. lxxviii + 697 pp.-Geneviève Escure, Jacques Arends ,Pidgins and Creoles: An introduction. Amsterdam/Philadelphia: John Benjamins, 1995. xiv + 412 pp., Pieter Muysken, Norval Smith (eds)-Jacques Arends, Angela Bartens, Die iberoromanisch-basierten Kreolsprachen: Ansätze der linguistischen Beschreibung. Frankfurt am Main: Peter Lang, 1995. vii + 345 pp.-J. Michael Dash, Richard D.E. Burton, Le roman marron: Études sur la littérature martiniquaise contemporaine. Paris: L'Harmattan. 1997. 282 pp.

Abstract The Secord World War was a conflict which many British people feared might happen, but they strongly supported the efforts of Prime Minister Neville Chamberlain to seek a peaceful resolution of tensions with Germany over disputes in Continental Europe. Baptists in Scotland shared these concerns of their fellow citizens, but equally supported the declaration of war in 1939 after the German invasion of Poland. They saw the conflict as a struggle for spiritual values and were as concerned about winning the peace that followed as well as the war. During the years 1939 to 1945 they recommitted themselves to sharing the Christian message with their fellow citizens and engaged in varied forms of evangelism and extended times of prayer for the nation. The success of their Armed Forces Chaplains in World War One ensured that Scottish Baptist padres had greater opportunities for service a generation later. Scottish Baptists had seen closer ties established with other churches in their country under the auspices of the Scottish Churches Council. This co-operation in the context of planning for helping refugees and engaging in reconstruction at the conclusion of the war led to proposals for a World Council of Churches. Scottish Baptists were more cautious about this extension of ecumenical relationships. In line with other Scottish Churches they recognised a weakening of Christian commitment in the wider nation, but were committed to the challenge of proclaiming their faith at this time. They had both high hopes and expectations for the post-war years in Scotland.

The animosity which often prevails among French and German trade unionists in the wake of World War I disappears in the aftermath of the Second conflict. The meetings are more numerous, certain positions converge and the demands related to specific workforces often meet. Despite this, the two union worlds find it hard to understand each other. French and German union models seek to adapt to the evolution of capitalism. Undeniably German trade unionism seems to have better coped with this transformation. His weight, influence and co-management allowed him to achieve the highest standard of living for German labour forces, and gave them often better social protection in comparison with their French or British counterparts. Divided, folded over ideological identities and marked by the strategies of confrontation, French trade unionism has obviously greater difficulties. Favourable developments can be seen, however. The number of union members for instance is increasing and innovative thinking is emerging. European integration represents a challenge for these organizations, even if most of the organizations are in favour of it. It obliges trade unionists (as well as politicians, senior civil servants etc.) to take new approaches. Due to the contacts generated between French and German unionists, this period 1945-1962 prepares the two major developments of trade unionism during the next decade: the birth of a European trade unions’ confederation and that of the first Interregional Trade Union Council on Lorraine, Saarland and Luxembourg-level. Contacts and crossed views between French and German trade unionists were thus essential to establish a Europe of trade unions.

Author considers the issue of transforming the communicative strategy of the modern museum as a promising center for multicultural communication. multicultural communication is understood as a process of interaction between immigrants and the host society. In addition, the inconsistency and ambiguity of understanding the content and consequences of increased immigration, as well as the changes that occur with cultural institutions, also make this story relevant. The author of the article focuses on how a cultural institution such as a museum responds to the challenge of complicated intercultural and multicultural communications in the modern world. The methodological basis for the study is the concept of the «post-museum» and the achievements of the Leyster school of museology in the studies of the communicative and inclusive activities of modern museums. The article presents the author's classification of the levels of work of museums with immigrants and their multicultural communication. The first level is exhibiting and representing the cultural heritage of immigration communities, the second level is attracting immigrants to co-authorship, and the third one is the implementation of comprehensive inclusive work with all ethnic and cultural groups.The highlighted levels are confirmed by real examples and cases from the experience of Russian and British museums, information about which is available on their official websites. In the course of the study, the main conclusions were made. Firstly, to date, there has been a shift in the functional structure of the museum from its custody functions to communication, and the process of interacting with visitors has begun to build on the principle of participation. Secondly, the museum, as a social institution that collects and presents objects of cultural heritage and historical artifacts, works, first of all, with the phenomena of «cultural memory» and «identity», not only representing the latter, but also constructing it through the exposition and museum activity. And thirdly, it is this circumstance that allows museums to become an effective platform for building a multicultural dialogue and processes of social inclusion.

e18704 Background: Rapid advances in precision oncology challenge timely and sustainable reimbursement decisions. Life-cycle health technology assessment (LC-HTA) can enable conditional patient access to promising precision oncology innovations alongside evidence development. Our objective was to create a life-cycle evaluative framework, called PRecision oncology Evidence Development in Cancer Treatment (PREDiCT). Methods: Through an iterative, health system and stakeholder-informed approach, we designed our LC-HTA framework. Elements supporting data and evidence generation were subsequently implemented within British Columbia, Canada’s provincial cancer control system. Our development, refinement, and pilot implementation process included a structured literature review, multi-disciplinary international expert consultation, a formal gap assessment, and a series of pan-Canadian inter-disciplinary stakeholder workshops to refine framework elements. Results: We engaged n = 15 pan-Canadian and international stakeholders to co-develop the LC-HTA framework. Defining framework components include: (a) managed access that defines the time horizon and pricing conditions of real-world healthcare system trialing; (b) collection of core data elements required to enable economic evaluation of precision oncology using real world data; (c) externally leveraged real world data and evidence generation to determine comparative effectiveness, cost-effectiveness, and the value of conducting additional research; and (d) data interpretation updating decisions, including investment, continued evaluation, or disinvestment from managed access. Key to the success of early framework implementation is the expansion of infrastructure to enable routine collection and linkage of genomic sequencing and cancer treatment data, patient quality of life and clinical outcomes, as well as health resource use spanning the diagnostic, treatment, and follow up trajectory. Conclusions: Sustainable integration of precision oncology requires the design and implementation of learning healthcare systems (LHS) that integrate genomic data with other health information. LC-HTA moves beyond static estimates of clinical and cost-effectiveness to continuously generate evidence that reduces evidentiary uncertainty and supports life-cycle decisions. We are embarking on a PREDiCT pilot to implement the framework in real-time to demonstrate the ability of real-world data to support life cycle evaluation.

Background The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children’s Hospital. Objective This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change. Conclusions Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app.

-Stanley L. Engerman, B.W. Higman, Slave populations of the British Caribbean, 1807-1834. Baltimore: The Johns Hopkins University Press, Johns Hopkins Studies in Atlantic History and Culture, 1984. xxxiii + 781 pp.-Susan Lowes, Gad J. Heuman, Between black and white: race, politics, and the free coloureds in Jamaica, 1792-1865. Westport CT: Greenwood Press, Contributions in Comparative Colonial Studies No. 5, 1981. 20 + 321 pp.-Anthony Payne, Lester D. Langley, The banana wars: an inner history of American empire, 1900-1934. Lexington KY: University Press of Kentucky, 1983. VIII + 255 pp.-Roger N. Buckley, David Geggus, Slavery, war and revolution: the British occupation of Saint Domingue, 1793-1798. New York: The Clarendon Press, Oxford University Press, 1982. xli + 492 pp.-Gabriel Debien, George Breathett, The Catholic Church in Haiti (1704-1785): selected letters, memoirs and documents. Chapel Hill NC: Documentary Publications, 1983. xii + 202 pp.-Alex Stepick, Michel S. Laguerre, American Odyssey: Haitians in New York City. Ithaca and London: Cornell University Press, 1984. 198 pp-Andres Serbin, H. Michael Erisman, The Caribbean challenge: U.S. policy in a volatile region. Boulder CO: Westview Press, 1984. xiii + 208 pp.-Andres Serbin, Ransford W. Palmer, Problems of development in beautiful countries: perspectives on the Caribbean. Lanham MD: The North-South Publishing Company, 1984. xvii + 91 pp.-Carl Stone, Anthony Payne, The politics of the Caribbean community 1961-79: regional integration among new states. Oxford: Manchester University Press, 1980. xi + 299 pp.-Evelyne Huber Stephens, Michael Manley, Jamaica: struggle in the periphery. London: Third World Media, in association with Writers and Readers Publishing Cooperative Society, 1982. xi + 259 pp.-Rhoda Reddock, Epica Task Force, Grenada: the peaceful revolution. Washington D.C., 1982. 132 pp.-Rhoda Reddock, W. Richard Jacobs ,Grenada: the route to revolution. Havana: Casa de Las Americas, 1979. 157 pp., Ian Jacobs (eds)-Jacqueline Anne Braveboy-Wagner, Andres Serbin, Geopolitica de las relaciones de Venezuela con el Caribe. Caracas: Fundación Fondo Editorial Acta Cientifica Venezolana, 1983.-Idsa E. Alegria-Ortega, Jorge Heine, Time for decision: the United States and Puerto Rico. Lanham MD: North-South Publishing Co., 1983. xi + 303 pp.-Richard Hart, Edward A. Alpers ,Walter Rodney, revolutionary and scholar: a tribute. Los Angeles: Center for Afro-American Studies and African Studies Center, University of California, 1982. xi + 187 pp., Pierre-Michel Fontaine (eds)-Paul Sutton, Patrick Solomon, Solomon: an autobiography. Trinidad: Inprint Caribbean, 1981. x + 253 pp.-Paul Sutton, Selwyn R. Cudjoe, Movement of the people: essays on independence. Ithaca NY: Calaloux Publications, 1983. xii + 217 pp.-David Barry Gaspar, Richard Price, To slay the Hydra: Dutch colonial perspectives on the Saramaka wars. Ann Arbor MI: Karoma Publishers, 1983. 249 pp.-Gary Brana-Shute, R. van Lier, Bonuman: een studie van zeven religieuze specialisten in Suriname. Leiden: Institute of Cultural and Social Studies, ICA Publication no. 60, 1983. iii + 132 pp.-W. van Wetering, Charles J. Wooding, Evolving culture: a cross-cultural study of Suriname, West Africa and the Caribbean. Washington: University Press of America 1981. 343 pp.-Humphrey E. Lamur, Sergio Diaz-Briquets, The health revolution in Cuba. Austin: University of Texas Press, 1983. xvii + 227 pp.-Forrest D. Colburn, Ramesh F. Ramsaran, The monetary and financial system of the Bahamas: growth, structure and operation. Mona, Jamaica: Institute of Social and Economic Research, University of the West Indies, 1984. xiii + 409 pp.-Wim Statius Muller, A.M.G. Rutten, Leven en werken van de dichter-musicus J.S. Corsen. Assen, The Netherlands: Van Gorcum, 1983. xiv + 340 pp.-Louis Allaire, Ricardo E. Alegria, Ball courts and ceremonial plazas in the West Indies. New Haven: Department of Anthropology of Yale University, Yale University Publications in Anthropology No. 79, 1983. lx + 185 pp.-Kenneth Ramchand, Sandra Paquet, The Novels of George Lamming. London: Heinemann, 1982. 132 pp.

Background:COVID-19 has catalysed the transformation of healthcare services, with outpatient services increasingly dependent upon remote models of care. Healthcare professionals now have to make clinical assessments based on remote patient examinations. The number of tender and swollen joints a patient has drives decision-making in RA, making it particularly important that people with RA and HCPs have a shared understanding of these examinations.Even before remote consultations became widespread, long gaps between clinic visits create challenges in enabling HCPs to form an accurate picture of disease activity over time. The REMORA (REmote MOnitoring of Rheumatoid Arthritis) app aims to address this issue by asking people with RA to track disease activity, including counting the number of tender or swollen joints, weekly(1). Data are integrated into the electronic patient record for clinicians to access with patients during clinical consultations. As part of the supporting materials for the REMORA app, we planned to develop a video to train people with RA how to examine their own joints. This video may now help meet the need created by the recent expansion in remote consultations.Objectives:To describe the co-production, implementation and evaluation of a video to train patients how to examine their own joints.Methods:The need for the video to fill a current gap in patient education was identified by the REMORA patient and public involvement and engagement (PPIE) group. A core working group comprising the PPIE lead, a nurse consultant, rheumatology clinicians, project and communications managers was formed. A storyboard was drafted and feedback gained from the PPIE group and wider REMORA team. Images were sourced from licenced suppliers, or co-developed with the PPIE group where necessary. No ethical approval was required as the PPIE group lead was acting as an equal member of the research term. Written informed consent was gained from video participants. Filming took place between two national lockdowns during the COVID-19 pandemic, providing a challenge to ensure social distancing and requiring the use of masks.Results:A 15 minute video to train people with RA to self-examine for tender and swollen joints was developed. An introduction outlining the rationale behind self-examination is followed by a nurse consultant coaching an RA patient in individual joint self-examination. Shoulders, elbows, wrists, metacarpophalangeal joints, proximal interphalangeal joints and knees are included, all of which are counted in disease activity scores.Early feedback from stakeholders has been overwhelmingly positive. The video will be publicly available on YouTube from February 2021. A survey of patients and HCPs aims to obtain more formal feedback on the video, with a view to a further iteration, if required. Leading national organisations in rheumatology will promote the video, as it supports national programmes including the British Society for Rheumatology national early inflammatory arthritis audit and ePROMS (electronic patient report outcome measure) platform, both of which include entry of patient reported tender and swollen joint counts.Conclusion:This video was co-designed by people with RA, aiming to support self-examination of tender and swollen joint counts. Hits on YouTube and survey responses will help assess its impact. Evaluation to assess whether the video affects patients’ ability to self-examine for tender and swollen joints before and after watching is planned. We hope the video will support remote consultations and help people with arthritis to better understand and self-manage their arthritis, and to have shared decision making conversations with their clinicians.References:[1]Austin L, Sharp CA, van der Veer SN, Machin M, Humphreys J, Mellor P, et al. Providing ‘the bigger picture’: benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. Rheumatology. 2020;59(2):367-78.Disclosure of Interests:Charlotte Sharp: None declared, Karen Staniland: None declared, Trish Cornell Shareholder of: shares in Abbvie, Employee of: Abbvie, working as a Rheumatology Nurse Consultant, Will Dixon Consultant of: Google and Abbvie, unrelated to this work.

Bernard LEWIS, The Muslim Discovery of Europe (New York/London:W.W. Norton & Co., 1982), 350 pp., Index & Illustrations. Price $19.95.The Muslims have had a long history of relations with WesternEuropean peoples. Some part of it was tumultous and violent and theother was peaceful and harmonious. It was the Muslims who held thetorch of civilization when the lights went out in Europe and elsewhere inthe world. And indeed it was the Muslims who passed on to Europe in theMiddle Ages the coveted intellectual jewels of the ancient world.However, such transactions and ties between the Western Europeanpeoples and the Muslim world have led to two major historicaldevelopments. The first was the renaissance in Europe, whichinterestingly enough led to the distancing of Europe from the MuslimWorld. The second was the subsequent development of learning and thesciences in Europe and the rise of European power to challenge,threaten, and finally defeat Muslim power in the world.It is indeed against this background that one can examine this book bythe well-known but controversial British orientalist, Professor BernardLewis. His book is certainly an important contribution to the limitedliterature on early and medieval Muslim transactions with theEuropean world. But in order to do justice to the work and its author, letus analyze its contents and see how and to what extent the authorcaptures the salient points about the Muslim discovery of the West.The book is divided into twelve chapters with a preface and a note onthe source of illustrations. In the first chapter, entitled "Contact andImpact", Professor Lewis traces the rise of Islam in the Middle East andthe geopolitical revisions that accompanied the Muslim ascendancy. Hepoints out that at the time the Muslim armies made their sweep over theMediterranean region Christianity served as the dominant worldview ofthe area's inhabitants. But within a very short span of time the Muslimswere able not only to conquer Christian lands but also to Arabicize andIslamize the hitherto non-Arabic, Christian peoples.Professor Lewis goes on to identify important milestones in Islamichistory. Among these milestones four are of great importance. First ofall, he talks about the Western perception of the Islamic threat. This wasevident in the desperate attempt to check the tide of lslamism inByzantium and later in the southern part of Western Europe.particularly in the Iberian Peninsula. He brings out an important point ...

Expressed Emotion (EE) is a well-validated measure of the family environment of individuals with mental and physical conditions that examines relatives’ critical, hostile and emotionally overinvolved attitudes towards a family member with a condition. This review focuses on studies of EE on containing data of the impact of Expressed Emotion on the course of chronic illnesses and clinical outcomes in mental and physical health conditions. The structural literature review is based on the search of articles in peer-reviewed journals from 1991 to November, 2018 in the databases Psyc-Info and PubMed. Taken together, these results suggest that there is an association between EE towards patients with both physical and mental conditions and a poor clinical and personal recovery. Interestingly, the lower levels of EE towards individuals with a condition were observed in partners comparatively with parents, adult children and relatives. However, the results have been obtained only from two populations with dementia and Type I diabetes and have been considered as important issue for future research. References Ayilara, O., Ogunwale, A., & Babalola, E. (2017). Perceived expressed emotion in relatives of patients with severe mental illness: A comparative study. Psychiatry research, 257, 137-143. Bogojevic, G., Ziravac, L., & Zigmund, D. (2015). Impact of expressed emotion on the course of schizophrenia. European Psychiatry, 30, 390. Brown, G. W., Birley, J. L. T., & Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry, 121, 241–258. Chan, K. K., & Mak, W. W. (2017). The content and process of self-stigma in people with mental illness. American Journal of Orthopsychiatry, 87(1), 34-43. Cherry, M. G., Taylor, P. J., Brown, S. L., & Sellwood, W. (2018). Attachment, mentalisation and expressed emotion in carers of people with long-term mental health difficulties. BMC Psychiatry, 18(1), 257. Coomber, K., & King, R. M. (2013). Perceptions of carer burden: differences between individuals with an eating disorder and their carer. Eating Disorders, 21(1), 26-36 Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136. Flanagan, D. A., & Wagner, H. L. (1991). Expressed emotion and panic fear in the prediction of diet treatment compliance. British Journal of Clinical Psychology, 30, 231–240. Hooley, J. M., & Parker, H. A. (2006). Measuring expressed emotion: An evaluation of the shortcuts. Journal of Family Psychology, 20(3), 386. Rienecke, R. D., Lebow, J., Lock, J., & Le Grange, D. (2015). Family profiles of expressed emotion in adolescent patients with anorexia nervosa and their parents. Journal of Clinical Child & Adolescent Psychology, 46(3), 428-436. Safavi, R., Berry, K., & Wearden, A. (2018). Expressed emotion, burden, and distress in significant others of people with dementia. Journal of Family Psychology, 32(6), 835. Romero-Gonzalez, M., Chandler, S., & Simonoff, E. (2018). The relationship of parental expressed emotion to co-occurring psychopathology in individuals with autism spectrum disorder: A systematic review. Research in developmental disabilities, 72, 152-165. Wearden, A. J., Tarrier, N., Barrowclough, C., Zastowny, T. R., & Rahill, A. A. (2000). A review of expressed emotion research in health care. Clinical Psychology Review, 20(5), 633-666. Wearden, A. J., Tarrier, N., & Davies, R. (2000). Partners' expressed emotion and the control and management of Type 1 diabetes in adults. Journal of Psychosomatic Research, 49(2), 125-130.

Abstract Abstract 1602 Introduction: MCL presents a therapeutic challenge remaining incurable with standard therapy. Most pts exhibit aggressive behaving advanced (adv) stage disease at diagnosis and require multi-agent chemotherapy, while others may have an indolent course. Improved outcomes with rituximab (R) and autologous stem cell transplant (ASCT) have been reported for select pts within the context of small clinical trials. In the province of BC, a new policy was introduced in 2003 recommending upfront ASCT for all eligible pts with adv stage MCL. This largely coincided with the availability of R which was included in the protocol: 6 cycles R-CHOP induction followed by ASCT and 2 cycles R maintenance (R weekly × 4 at 2 and 6 mo). The aim of this study was to review the clinical profile of MCL within a non-selected population of pts and to evaluate outcomes before and after this policy change. Methods: Using the BC Cancer Agency Centre for Lymphoid Cancer database, we identified all pts diagnosed with MCL between Jan 1990 and Dec 2010. Pathology was centrally reviewed and clinical data was retrieved from the database and medical records. Within this grp, we identified a SCT eligible cohort (<66 y with adv stage, excluding pts initially observed) and outcomes were evaluated in the pre and post SCT era, based on the policy initiation date of Jan 2003. Results: In total 535 pts were identified, median age 67 y (range 22–94), 71% male, 88% adv stage, 8% limited (lim) stage (stage I/II, bulk <10 cm, no B-sx), 4% stage unknown. Pathology: 55% diffuse, 25% nodular, 6% mantle zone, 14% blastoid. Primary treatment information was available on 511/535 (96%) pts and was as follows: 335 (66%) various chemo regimens (59% anthracycline-based); 58 (11%) induction chemo followed by SCT (55 auto, 3 allo), 67 (13%) observed, 30 (6%) XRT and/or surgery alone, and 21 (4%) were too frail or refused therapy. Overall, 163/511 (32%) received R as part of initial therapy. With a median f/up for living pts of 53 mo (range 1–251), the median OS and PFS for the entire cohort was 3.1 y and 1.3 y, respectively. Blastoid variant was associated with a poorer outcome compared with other histologies (p<0.001). Lim stage pts (n=45) had a more favorable outcome than adv stage pts (n=469), median OS 7.7 y v 2.9 y (p=0.0001) and median PFS 3.4 y v 1.2 y (p=0.0002). Pts initially observed (n=67) had a similar outcome compared with those receiving any initial treatment (n=423), median OS 4.4 y v 3.2 y (p=0.24). Twenty-nine pts were identified as long-term survivors (OS >10 y), mainly diagnosed prior to SCT policy (where f/up is shorter) and were treated with various regimens. Within this grp, median age was 57 y and 28% had lim stage, but no obvious associated clinical parameters were noted. To evaluate the impact of initial SCT, we compared outcomes in SCT eligible pts (n=179), diagnosed prior to (pre-SCT, n=93) and following its introduction in 2003 (post-SCT, n=86). Clinical characteristics were comparable between the pre-SCT and post-SCT grps; median age 56 y, MIPI score 20% high, 28% intermed, 52% low. Within the pre-SCT grp, initial treatment included CHOP-like chemo (n=46), intensive chemo (n=20), non-anthracycline-based tx (n=20) and SCT (n=3, 1 allo; received prior to policy initiation), median f/up 11 y. Within the post-SCT grp, initial treatment included SCT (n=50, 2 allo), CHOP-like chemo (n=31), non-anthracycline-based tx (n=5), median f/up 4.4 y. Thirty-six post-SCT pts did not undergo SCT (13 co-morbidities, 13 progressive disease during induction, 6 unknown/not offered, 4 declined). R was received by 8/93 (9%) pre-SCT pts and 81/86 (94%) post-SCT pts. Based on era of treatment, outcomes were significantly improved in the post-SCT grp compared with the pre-SCT grp, median OS not reached v 3.4 y, p=0.001 (5-y OS 58% v 34%) and median PFS 3.5 y v 1.3 y, p<0.001 (5-y PFS 38% v 16%). (see figure) An analysis based on actual initial treatment received (SCT v no-SCT), demonstrates favorable outcome associated with SCT (5-y OS 78% v 31%; 5-y PFS 55% v 15%). Conclusion: Outcomes for MCL have significantly improved in the modern era following the introduction of upfront ASCT in BC. Availability of rituximab coincided with this policy change and likely contributed to this improvement. Similar to prior observations, a subset of pts with indolent behaving disease can be observed without impacting OS. Patients with limited stage disease have a more favorable outcome, but no survival plateau was noted. Disclosures: den Brok: F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Song:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. OLeary:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Klasa:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Savage:Roche: Research Funding. Shenkier:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Villa:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Slack:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Shepherd:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Gascoyne:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Connors:F Hoffmann-La Roche (Roche Canada): Consultancy, Research Funding. Sehn:F. Hoffmann-La Roche (Roche Canada): Research Funding.

Abstract Background Canada has the highest global age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD). Resulting from compounding prevalence and limited resources, timely access to specialty care is a challenge faced by patients and healthcare providers. Despite this issue, there has been no published research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. Aims To elicit a qualitative data stream to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, and British Columbia. All focus groups were audio recorded, transcribed, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of IBD specialty care access experiences. Results A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Conclusions The complexity of specialty care access for IBD patients in Canada cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in Canada can be better understood and improved on both a provincial and national scale. Funding Agencies CIHRNova Scotia Health Authority Research Fund

Acute Medicine is full of ‘C-words’ – the Nursing and Midwifery Council’s ‘Six Cs’ (Care, Compassion, Competence, Commitment, Courage and Competence) are as relevant on the AMU as anywhere else in the Health Service; acute physicians would probably also include co-ordination, collaboration and crisis management, as winter looms before us. Dan Beckett’s paper from Forth Valley in Scotland, suggests another word that should be added to the list. As we strive to design sustainable rotas which span 7 days and comply with European work-time directives it is understandable that continuity often falls by the wayside, particularly in smaller Units. The transition from the acute medicine team to an in-patient specialist ward will usually, and appropriately, require hand-over of care. However, as described in this paper, patients who remain within the AMU may find that they see a different consultant each day. Moving to a model whereby patients in the AMU remained under the care of the admitting consultant was shown to shorten their AMU length of stay, facilitating transfer to the appropriate in-patient team, although not increasing the proportion of patients discharged directly from the unit. The authors proposed that this latter finding related to changes in the skill mix of the consultant team covering the AMU, demonstrating the complexity of the challenges we face. It would have been interesting to study the impact on patient satisfaction – as well as consultant job satisfaction – from this new model; my own, purely anecdotal data, suggests both may be considerably improved. This month’s case report selection illustrates some interesting clinical conundrums. Lower limb cellulitis is a common reason for presentation to the acute medical, or ambulatory care unit; however, when the rash or erythema is bilateral, there is often an alternative diagnosis. In the case described by Cranga and colleagues, antibiotics turned out be the cause (rather than the solution) to the problem. Early liaison with the dermatology team enabled the diagnosis of acute generalized erythematous pustulosis to be made, and resolution of the condition followed discontinuation of antibiotics. The authors include a useful table to support clinicians in making this (albeit rare) diagnosis. Emily McNicholas reminds us of the importance of a collateral history – it is not hard to see how a patient with fever, confusion and incontinence might be labelled as having a urinary tract infection; the retrospective story of a cocktail stick in the throat prior to onset of the symptoms might have pointed to the correct diagnosis is this had been obtained at the time of admission. This case also shows the dangers of separation of Emergency Department notes from those of hospital in-patients, even within the same organization – a problem which will be familiar to many UK readers of this journal. Patients with frailty represent a significant proportion of admissions to the acute medical take and often provide considerable management challenges. Natalie Offord and colleagues from the British Geriatric Society have described the development of the Frailsafe collaborative which clearly provides a major step forward. At the other end of the age spectrum, adolescents and young adults (AYAs) may represent a different kind of challenge for the acute medicine team. Some of the key messages from the recent Royal College of Physicians’ Acute Care Toolkit for AYAs are summarized in the article on p157. Anyone who is involved in managing this group of patients is recommended to read this article, and please look out for the link to a survey about this at the end of the article.

Abstract Abstract 226 The major clinical challenge in treating patients with myeloproliferative diseases (MPD) such as essential thrombocythaemia (ET) and polycythaemia vera (PV) is to prevent thrombotic events. Despite adequate red cell and platelet count control by means of venesection or cytoreductive therapy and the use of anti-platelet agents, patients with ET and PV have a three-fold risk-increase of cardiovascular and cerebral ischaemic events. A V617F mutation in the Janus kinase 2 (Jak2) that causes constitutive activation of Jak2 has been shown to be present in >90% and ∼50% of PV and ET patients, respectively. The effect of this activation on the biology of primary megakaryocytic cells is not known and neither is it clear whether the thrombotic risk conferred by this mutation reflects the increase in red cell/platelet counts, an intrinsic increase in platelet reactivity or both. Studies in humans are hampered by the co-existence of normal and clonal haematopoiesis with significant clonal and phenotypic heterogeneity between patients. Chimaeric mouse models based on retroviral transduction of Jak2 V617F have marked overexpression of the mutant Jak2 and show a PV phenotype with normal platelet counts. Recently, Jak2 V617F transgenic mice models have been published but the transgenes have multiple (and variable) insertions and are therefore subject to position effects with varying degrees of expression of the mutant Jak2 compared to the wild-type allele. We have generated a Cre-inducible mouse model where the human Jak2 V617F gene has been knocked into one allele of the mouse endogenous Jak2 gene. Upon Cre induction, the mice exhibit an ET phenotype (platelet count increased by approximately 30% but with a normal haematocrit) that is stable for over 26 weeks. Bone marrow histology shows classical features of ET with increased numbers of megakaryocytes (MKs) and clusters with no fibrosis. Quantitative RT-PCR shows stable expression of Jak2 V617F in the MKs at a similar level to that of endogenous mouse Jak2 therefore reflecting the physiological situation found in human ET patients. In liquid cultures, bone marrow-derived MKs show increased ploidy in response to suboptimal concentrations of thrombopoietin (TPO) in keeping with the increased number of MKs found in the bone marrow histology. Crucially, in vitro proplatelet formation in mutant MKs was increased two-fold compared to MKs derived from litter-match control animals showing that platelet production may not only relate to the increased number of MKs but to intrinsic differences in MK biology and platelet production. Platelet aggregation studies and P-selectin expression in response to an array of agonists was not significantly different between mutant and controls but in vitro laminar flow assays show increased thrombus formation on collagen. Although Jak2V617F expression was down-regulated at protein level in mature MKs and platelets, analysis of downstream signalling pathways showed alteration of the phosphorylation status of Src kinases. This mouse model therefore provides a unique opportunity to understand the biological mechanism of increased platelet production and thrombotic risk in ET patients as well as unravelling the signalling pathways downstream of the Jak2 V617F in primary cells, which will be crucial in the context of specific therapeutic Jak2 inhibitors currently in clinical development. This work was supported by the British Heart Foundation Disclosures: No relevant conflicts of interest to declare.

Abstract Background Umbilical cord blood (UCB) is an established alternative haemopoietic cell source for use in clinical transplantation for life-threatening malignant and non-malignant disorders. One challenge in using UCB in adolescents and adults has been delayed engraftment due to the finite and limited cell dose of a single unit, which has been shown to be a key determinant of engraftment, transplant related mortality and survival. The use of double unit transplantation, pioneered at the University of Minnesota, has become one of the most successful approaches to overcome this limitation to date. This group have also developed a reduced intensity conditioning (RIC) regimen, successfully broadening access to UCB transplant to older patients and those with co-morbidities. The kinetics of granulocyte, T cell and B cell chimerism in this setting require detailed study. Methods Since 2009, the British Society of Blood and Marrow Transplantation have conducted a prospective, phase II study of UCB transplantation using the Minnesota RIC conditioning regimen (Fludarabine 200mg/m2, Cyclophosphamide 50mg/kg and TBI 2Gy), with Ciclosporin and Mycophenolate Mofetil graft versus host disease prophylaxis. Lineage specific chimerism was performed at days 7, 14, 21, 28, 35, 60, 100, 180, 360 and 720 post transplant and analysed at laboratories associated with participating centres. Results 28 consecutive adult trial patients who have received a double unit transplant, have engrafted and have chimerism data up to at least day 35 are included in this analysis. The ‘winning' unit had a median unit:recipient match of 4/6 (range 4-6/6), with a median pre freeze total nucleated cell (TNC) count of 189x107 (range 83-250) and CD34 of 84x105 (range 23-169). The ‘losing' unit had a median unit:recipient match of 5/6 (range 4-6/6), with a median pre freeze total nucleated cell (TNC) count of 183x107 (range 127-303) and CD34 of 55x105 (range 42-95). Despite the low white count early post transplant, peripheral blood (PB) lineage specific chimerism for mononuclear cells (PBMC), T cells and granulocytes was feasible in nearly all patients. B cell chimerism was unsuccessful or not available in 55% of time points. The pattern of early T cell and granulocyte chimerism is summarised in the table. From day 60 onwards, the median granulocyte and T cell chimerism remained 100% winning unit. However, T cell chimerism at day 14 identified the winning unit in all patients with a result at this time point (n=25). Contribution to the B cell compartment was 100% winning unit by day 35, with 83% recipient at day 7 and 24% at day 14 and 4% losing unit at day 7 and 14. Conclusions Lineage specific chimerism is technically feasible in the immediate post transplant period and gives important insights into the kinetics of double cord blood unit engraftment. Although the ‘losing' unit may contribute to the B and T cell compartments in the first 2 weeks, it contributes little after day 21. The winning unit is clearly identifiable by day 14 in all lineages. Early granulocyte recovery (driven by G-CSF) in the RIC setting is seen to be primarily due to autologous recovery until around day 21 after which the winning unit predominates. These data provide an insight into the biology of engraftment that may also inform additional novel strategies such as ex vivo CD34 expansion and adding in haploidentical stem cells. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 113 Introduction: DLBCL and HL represent highly curable lymphoid malignancies. Patients (pts) whose lymphoma is refractory to or relapses following initial therapy pose a significant therapeutic challenge. The goal of therapy is to proceed to a non-cross-resistant salvage regimen followed by high dose chemotherapy (HDC) and stem cell transplantation (SCT) for transplant eligible pts. The optimal choice of salvage therapy remains unknown. The combination of gemcitabine, dexamethasone and cisplatin (GDP) has been shown in phase II studies to induce high response rates with minimal toxicity (Baetz T, Ann Oncol, 2003; Crump M, Cancer, 2004). Based on these promising results, British Columbia Cancer Agency (BCCA) policy has recommended GDP as the preferred salvage regimen for pts with relapsed/refractory DLBCL and HL since 2002. Patients and Methods: We conducted a retrospective analysis using the BCCA Lymphoid Cancer Database and included all pts with relapsed/refractory DLBCL and HL who received GDP as salvage therapy between September 2002 and June 2010. Pts were treated with gemcitabine 1000 mg/m2 IV day 1,8; dexamethasone 40 mg PO days 1–4 and cisplatin 75 mg/m2 IV day 1, administered at 3 week intervals (2-3 cycles for transplant eligible patients and up to 6 cycles for non-transplant candidates). Primary endpoints were response rate, PFS (defined as the interval from the beginning of GDP to first progression, relapse or death from any cause) and OS. Results: 235 pts treated with GDP were identified; 152 and 83 pts with relapsed/refractory DLBCL and HL, respectively. Clinical characteristics at time of diagnosis for patients with DLBCL were: 68% male, 65% stage III/IV, 42% bulky disease ≥ 10 cm, 43% B-symptoms, 59% IPI 0–2, 41% IPI 3–5. Median age at time of GDP was 57 y (range 20–79 y). 57 pts (37%) had primary refractory disease to first-line R-CHOP; 144 (95%) were treated with GDP at first relapse/progression; median time from diagnosis to relapse after R-CHOP (excluding primary refractory pts) was 21 m (range 7–139 m). 30 pts (20%) received rituximab with GDP. Detailed radiologic response assessment following GDP(+/−R) was available for 82% pts with response rates as follows: 16% CR/CRu, 33% PR, 17% SD, 34% PD. 9 pts (6%) underwent HDC followed by allogeneic SCT and 57 pts (38%) underwent HDC followed by autologous SCT. With median follow-up of 24 m from start of GDP (range 0–84 m), 51 pts (34%) were alive and 101 pts (66%) have died (99 from lymphoma, 1 treatment toxicity during allogeneic SCT, 1 unrelated cause). 2-y PFS and OS were 21% and 28%, respectively. The 2-y PFS and OS for the subset of patients who underwent HDC/SCT were 36% and 47%, respectively. Clinical characteristics at diagnosis for the 83 pts with relapsed/refractory HL were: 55% male, 59% stage III/IV, 39% bulky disease ≥ 10 cm, 55% B-symptoms, 80% nodular sclerosis, 4% mixed cellularity, 2% nodular lymphocyte predominant, 2% lymphocyte depleted and 12% HL NOS. IPS variables were retrievable on 66% patients: 82% IPS ≤ 3 and 18% IPS ≥ 4. Median age at time of GDP was 31 y (range 17–73 y). 30 pts (36%) had primary refractory HL and 73 (88%) received GDP at first relapse/progression. Median time from diagnosis to relapse following ABVD-like therapy (excluding primary refractory pts) was 20 m (range 9–186 m). Detailed radiologic response assessment following GDP was available in 67% pts with response rates as follows: 7% CR/CRu, 64% PR, 13% SD, 16% PD. In total, 1 pt underwent HDC followed by allogeneic SCT and 69 pts (83%) proceeded to HDC and autologous SCT. With a median follow-up of 30 m from start of GDP (range 0–86 m), 70 pts (84%) were alive and 13 (16%) have died (all from HL). 2-y PFS and OS were 58% and 85%, respectively, and for the subset of pts who underwent HDC/SCT were 57% and 86%, respectively. Hospitalization rates due to complications during GDP were higher in patients with DLBCL than HL (20% vs 7%), likely reflecting differences in age and co-morbidities between the 2 cohorts. No failures of stem cell mobilization were recorded and the only toxic death was a consequence of HDC and allogeneic SCT. Conclusions: GDP is an effective and well-tolerated out-patient salvage regimen for relapsed/refractory DLBCL and HL. Outcomes appear to be comparable to those reported with more aggressive regimens. Results from an ongoing Canadian prospective trial comparing R-GDP to R-DHAP will help clarify the role of GDP in the treatment of relapsed/refractory DLBCL. Disclosures: Connors: Hoffmann-La Roche: Research Funding.

Acute physicians are confronted daily by the relentless increase in clinical demand, inadequate continuity of care, breakdown in out of hours care and a looming crisis in the medical workforce. The scale and gravity of these factors, together with changes to patient’s needs relating to the ageing demography, were detailed in the RCP report published in September 2012 ‘Hospitals on the edge’. The top concern of RCP members and fellows was the lack of continuity of care, ahead of financial pressures and clinical staff shortages. Worryingly one in ten physicians stated they would not recommend their hospital to a family member, and a further 25% were ambivalent on this question. Concern about the provision of acute medical care is not confined to consultants and specialist registrars. Another RCP report, ‘Hospital workforce, fit for the future?’ (2013) highlighted that 37% of FT2s and CMTs considered the workload of the medical registrar on call ‘unmanageable’. The outcome of the Mid Staffs independent inquiry in February 2013 provided critical context for the launch of the Future Hospital Commission (FHC) report, which was launched seven months later in September. The report was met with an extremely positive response from patients, carers, NHS staff, healthcare leaders and politicians. Lancet Editor Richard Horton said that the Commission had ‘produced the most important statement about the future of British medicine for a generation.’ Secretary of State for Health Jeremy Hunt praised the report and its ‘buck stops here’ approach. The Daily Mirror even noted that the report was one of the few areas on which the government and the opposition could agree! ‘Future Hospital: caring for medical patients’ places the patient at the centre of healthcare. Organising healthcare delivery around the needs of the patient is at its heart and features extensively in the core principles and 50 recommendations. A series of unequivocal commitments were made to patients, on issues generating considerable patient concern: moving beds in hospital, quality of communication and arrangements to leave hospital. Patients and carers were represented in each of the Commission’s five work streams, led on the recommendations relating to building a culture of compassion and respect, and participated in launch of the report to the media. The primary focus of the FHC report is on the acute care of medical patients and the views of acute physicians were key to articulating these recommendations. However the report is clear that the solution to current acute pressures on hospitals and specifically in-patient pathways, lie across the whole health and social care system. Care must be delivered in the setting in which the patient’s clinical, care and support needs can best be met and not merely delegated to the acute hospital site. This inevitably means 7 day services in the community as well as in hospital and a consistent new level of “joined up care” with integration, collaboration and information sharing across hospital and all healthcare settings. In keeping with this the report highlights the urgent need to establish alternatives to hospital admission including the extensive use of ambulatory emergency care (AEC), the provision of secondary care services in the community and an expansion of intermediate care rehabilitation services. Many of the report’s recommendations arose from clinical staff devising innovative solutions to improve the quality of care and ameliorate clinical demand. The report showcased a range of case studies describing service developments and new patterns of care, innovations that would not have been possible without the leadership and sheer determination of physicians and their teams. Dr Jack Hawkins, Acute Physician in Nottingham Queen’s Medical Centre, described how analysis of performance data showing that 50% of acute medical patients were discharged within 15 hours, led to the starting vision for their new AEC service as “everyone is ambulatory until proven otherwise”. The case studies highlight the resources needed to implement service change and the supportive staff relationships and changes to working practices that underpin their success. The report describes the “acute care hub” as the focus of acute medical services, comprising colocation of the AMU, short stay wards, enhanced care beds and the AEC. Much of this echoes the front door configuration described by the acute medicine task force report in 2007 ‘Acute medical care: The right person, in the right setting, first time’. What the FHC adds are recommendations to co-locate AEC and a clinical co-ordination centre to provide clinicians with real time data on capacity in community-based services (rehabilitation and social services), and link to rapid access specialist clinics or community services to support pathways out of AEC and AMU. Recommendations to structure acute services to maximise continuity of care is a major theme. There should be sufficient capacity in the acute care hub to accommodate admitted patients who do not require a specialist care pathway and are likely to be discharged within 48 hours. This is supported by recommended changes to working practices of consultant led teams where they commit to two or more successive days working in the hub. This allows the consultant led team who first assess the patient in AMU to continue to manage them on the short stay ward through to their discharge – an approach familiar to acute physicians but which may be novel to GIM physicians assigned a single on call day. Striving to deliver continuity by a stable clinical team should also simplify handover, improve training, feedback and the quality and safety of the care delivered. The commission recommends designating enhanced care (level 1) and high dependency (level 2) beds in the acute care hub to improve the care of acutely ill patients requiring an increased intensity of monitoring and treatment. The RCP acute medicine taskforce made the same recommendation in 2007 but acute trusts have been slow to embed level 2 beds in particular, on AMUs. In the future hospital every effort should be made to enhance rapid access to specialist pathways that benefit patients, including entry to pathways for acute coronary disease or stroke or the frail elderly direct from the community or emergency department. Here the report is clear that the responsibility for continuity of care rests with the specialty consultant, who should review the patient on the day of admission. Patient experience should be valued as much as clinical effectiveness. Patients want “joined up care” that is tailored to their acute illness, comorbidities and requirements for social support. From a patient’s perspective, failures of information sharing between primary and secondary care, or specialist services within the same or neighbouring Trusts, are incomprehensible. The report highlights that this informatics disconnect undermines accurate clinical assessment at the time of presentation with an acute illness, when patients are most vulnerable, and this deficit will impact on patient experience, timely access to specialist staff, patient outcome and resource use. Robert Francis, in commenting on the report of the Mid Staffordshire public enquiry highlighted that the subject was ‘too important to suffer the same fate as other previous enquiries .. where after initial courtesy of welcome, implementation was slow or non existent’. The RCP shares this urgency and having accepted the recommendations of the FHC as a comprehensive ‘treatment’ for the care of patients in the future hospital, is determined that the FHC report itself will not sit on a shelf, gathering dust. The RCP is now embarking on a future hospital implementation programme. This programme gathers momentum this month with the appointment of future hospital officers and staff and the immediate priority is to identify partners to set up national development sites. The RCP is seeking enthusiastic clinical teams to investigate changes to a range of hospital and community based medical services in line with the FHC principles and to evaluate the impact on patient care. Over the next 3 years it is envisaged that the programme will also include research and new approaches to commissioning, workforce deployment, healthcare facility design and integrated working across the health economy. The evaluation of these projects, in relation to the quality and safety of patient care and patient experience, will be crucial and will be shared through the RCP and its partners. In addition, from April the RCP will publish a Future Hospital journal to help share the learning from the implementation programme and welcomes submissions of innovative best practice in acute care. The challenge now is to convert the goodwill generated by publication of the FHC principles, into an implementation programme nationally, that helps build an effective evidence base to support new ways of providing high quality, safe, patient care. Acute physicians are crucial partners in meeting this challenge.

Religious tolerance is a supporter of social harmony and brings a country to a better life. Instilling tolerance in early childhood is a challenge for early childhood educators. This study aims to describe the transformation of religious tolerance values ​​by teachers in early childhood education. This research is a type of qualitative case study research model with researchers as observer participants. This research produces the following findings, that (1) transformation of tolerance values ​​among religious communities, is explicitly not taught in Early Childhood Education (ECE) on the grounds that all students are of the same religion, (2) transformation of tolerance of values among religious students taught through learning integrated with other lessons, (3) although explicitly the values ​​of tolerance among religious students are not taught, but the values ​​of togetherness such as greeting, sharing something that is owned, and helping the needs of other students are taught by practicing at the same time. Keywords: Early Childhood Education, Tolerance Values in Religion References: Adams, K. (2019). Navigating the spaces of children’s spiritual experiences: influences of tradition(s), multidisciplinarity and perceptions. International Journal of Children’s Spirituality, 24(1), 29–43. https://doi.org/10.1080/1364436X.2019.1619531 Adams, K., Bull, R., & Maynes, M. L. (2016). 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Retrieved from https://www.driestar-educatief.nl/medialibrary/Driestar/Engelse-website/Documenten/2014-VanderWalt-Measuring-religious-tolerance-in-education.pdf Yulianti, E., Sutarto, J., & Sugiyo. (2019). Sentra Nasima Learning Strategies to Enhance Religious Nationalist Characters in Kindergarten. Journal of Primary Education, 8(69), 238–247.

In the context of research into the relationship between secularism and multiculturalism in contemporary India, this paper points to their specific interrelatedness and the distinctive Indian approach to secularism through the idea of a principled distance as a way to adjust to religious pluralism that has a close affinity with multiculturalism. Contrary to opinions that secularism is alien to the Indian civilisation, by a selection of instances through Indian history, the paper illustrates the broader meaning of “Indian” religious and secular thinking and also points to the significance of interaction among various religious cultures and subcultures, particularly between Hinduism and Islam/Sufism. However, the paper focuses on the analysis of Indian constitutional secularism and legally warranted multiculturalism. Debates on multiculturalism follow two distinct directions: the first examines multiculturalism as a state policy in the form of federalisation of its political system, whereas the second is concerned with the meaning of multiculturalism and its implications for the issues of individual and group rights, culture, religion, and secularism. It also touches upon the influence of the British colonial rule on the shaping of interreligious relations in independent India. The last section questions the ascendancy of Hindu nationalism, particularly in view of the rise to power of the Bharatiya Janata Party (BJP) in 2014, its appropriation of the new “idea” of India, especially the Hindu nationalist narrative, which endangers India’s official ideology of secularism, as well as the position of the minorities, in particular of the Muslim minority. The article is divided into seven sections. The Introduction outlines, in general, the main distinction between secularism and multiculturalism and their relationship, referring to the two principal approaches to secularism: (1) neutrality between different religions, and (2) prohibition of religious associations in state activities. Indian secularism tends to emphasise neutrality in particular rather than prohibition in general. The second section, Traces of the Indian Secular Thought through History, examines the view, particularly pervasive among Hindutva supporters, that secularism is alien to the Indian civilisation from the perspectives of history and philosophy, which both provide evidence that “the constituents of secularism which make up the concept are not alien to Indian thought” (Thapar, 2013: 4). In this context, the most evoked name in connection with religious tolerance is that of Ashoka Maurya, who in his edicts called not only for the co-existence of all religious sects but also for equal respect for those who represented them. Many centuries later, Moghul Emperor Akbar supported dialogue across adherents of different religions, including atheists. He laid the formal foundations of a secular legal structure and religious neutrality of the state. The paper here also points to the significance of interaction among various religious cultures and subcultures, the more so between Hinduism and Islam/Sufism. It focuses on extending the meaning of “Indian” religion in the sense that it includes multiple religions, such as Brahmanism, Buddhism, Jainism, Bhakti, Shakta, Islam/ Sufism, Guru-Pir tradition, which, but for Brahmanism, challenge orthodoxy by giving greater weight to social ethics rather than to prescriptive religious texts. The third section, Multiculturalism in Indian Context, refers to the Indian legally warranted multiculturalism and relating debates followed by two distinct directions. The first examines multiculturalism as a state policy in the form of federalisation of its political system; a process which involves the political accommodation of ethnic identities, which remains the most effective method of management and resolution of conflicts. The second direction is concerned with the meaning of multiculturalism and its implications for the issues of individual and group rights, culture, religion, secularism. According to Rajeev Bhargava (1999: 35, 2007), cultural particularity might undermine the “common foundation for a viable society”, and might also lessen individual freedom, thus invalidating the values of liberal democracy. From there follows the question of constitutional protection of personal laws of religious communities, which is, in a way, in collision with the primary secular identity, that of a citizen (Thapar, 2010, 2013). The fourth section, Characteristics of Indian Secularism, analyses in some detail the Articles of the Indian Constitution concerned with the basic understanding of secularism, i.e., that religion must be separated from the state “for the sake of religious liberty and equality of citizenship.” The analysis indicates that, while some Articles (Indian Constitution, Articles 25–26) depart from the mainstream western secularism, others are close to the Western liberal leanings, like those stipulating that the state will have no official religion (constitutional amendment 42) or that no religious instruction will be allowed in educational institutions maintained wholly out of state funds, as well as that no person attending any educational institution receiving financial aid from state funds shall be required to take part in compulsory attendance at religious instruction or worship (Articles 27–28/1/). But, more specifically, the idea of a principled distance from religious pluralism points to India’s highly contextual, thus distinctively Indian, version of secularism. The fifth section, The Question of Indian Identity, argues that, with the inauguration of democracy in India, multiculturalism was adopted as a policy of recognising and respecting diversity, guaranteeing the protection and rights of minorities and positive discrimination for the historically marginalised, and emphasising intergroup equality, while leaving the issue of intragroup equality somewhat aside. In the last section, Challenges of Hindu Nationalistic Ideology, the author points to some manifestations of the current ascendency of Hindu nationalism, particularly resulting from the Bharatiya Janata Party coming to power in 2014, such as the increasing identification of state leaders with Hindu cultural symbols and, at the same time, decreasing official support for the public festivals of minorities, Mus lims and Christians in the first place. According to Hindu nationalists, most Muslims and Christians are converts from Hinduism and should therefore recognise the precedence of the Hindu culture in India. Anti-Muslim prejudice in India stems not from the ideas of their racial or cultural differences but, above all, from questioning their loyalty to India. Here emerges the question of the “secular nationalism” of the Congress Party as opposed to the “Hindu nationalism” of the Bharatiya Janata Party, which insists on Hinduism as the essential token of the Indian national identity, implying cultural and political pre-eminence of Hindus in India. The Conclusion summarises some of the main points regarding the relationship between secularism and multiculturalism in the Indian context, indicating that despite the present challenges that Hindu nationalism poses to both, “…the Indian experience suggests that some form of moderate secularism will continue to remain necessary as a state framework to check the advance of religious majoritarianism” (Bajpai, 2017: 224). The author assumes that the article offers some constructive avenues for future studies on secularism and multiculturalism, which should not only provide further insights into the Indian case but also enhance the understanding of the varieties of secular trajectories worldwide, as well as their implications for democracy.

The global spread of Salafism, though it began in the 1960s and 1970s, only started to attract significant attention from scholars and analysts outside of Islamic studies as well as journalists, politicians, and the general public following the September 11, 2001 terrorist attacks perpetrated by Al-Qaeda Central. After the attacks, Salafism—or, as it was pejoratively labeled by its critics inside and outside of the Islamic tradition, “Wahhabism”—was accused of being the ideological basis of all expressions of Sunni militancy from North America and Europe to West and East Africa, the Arab world, and into Asia. According to this narrative, Usama bin Laden, Ayman al-Za- wahiri, Abu Bakr al-Baghdadi, and other Sunni jihadis were merely putting into action the commands of medieval ‘ulama such as Ibn Taymiyya, the eighteenth century Najdi Hanbali Muhammad ibn ‘Abd al-Wahhab, and modern revolutionary ideologues like Sayyid Qutb and ‘Abdullah ‘Azzam. To eradicate terrorism, you must eliminate or neuter Salafism, say its critics. The reality, of course, is far more complex than this simplistic nar- rative purports. Salafism, though its adherents share the same core set of creedal beliefs and methodological approaches toward the interpretation of the Qur’an and hadith and Sunni legal canon, comes in many forms, from the scholastic and hierarchical Salafism of the ‘ulama in Saudi Arabia and other Muslim majority countries to the decentralized, self-described Salafi groups in Europe and North America who cluster around a single char- ismatic preacher who often has limited formal religious education. What unifies these different expressions of Salafism is a core canon of religious and legal texts and set of scholars who are widely respected and referenced in Salafi circles. Thurston grounds his fieldwork and text-based analysis of Salafism in Nigeria, Africa’s most populous country and home to one of the world’s largest single Muslim national populations, through the lens of this canon, which he defines as a “communally negotiated set of texts that is governed by rules of interpretation and appropriation” (1). He argues fur- ther that in the history of Nigerian Salafism, one can trace the major stages that the global Salafi movement has navigated as it spread from the Arab Middle East to what are erroneously often seen as “peripheral” areas of the Islamic world, Africa and parts of Asia. The book is based on extensive fieldwork in Nigeria including interviews with key Nigerian Salafi scholars and other leading figures as well as a wide range of textual primary sourc- es including British and Nigerian archival documents, international and national news media reports, leaked US embassy cables, and a significant number of religious lectures and sermons and writings by Nigerian Salafis in Arabic and Hausa. In Chapter One, Thurston argues that the Salafi canon gives individ- ual and groups of Salafis a sense of identity and membership in a unique and, to them, superior religious community that is linked closely to their understanding and reading of sacred history and the revered figures of the Prophet Muhammad and the Ṣaḥāba. Salafism as an intellectual current, theology, and methodological approach is transmitted through this can- on which serves not only as a vehicle for proselytization but also a rule- book through which the boundaries of what is and is not “Salafism” are determined by its adherents and leading authorities. The book’s analytical framework and approach toward understanding Salafism, which rests on seeing it as a textual tradition, runs counter to the popular but problematic tendency in much of the existing discussion and even scholarly literature on Salafism that defines it as a literalist, one-dimensional, and puritani- cal creed with a singular focus on the Qur’an and hadith canon. Salafis, Thurston argues, do not simply derive religious and legal rulings in linear fashion from the Qur’an and Prophetic Sunna but rather engage in a co- herent and uniform process of aligning today’s Salafi community with a set of normative practices and beliefs laid out by key Salafi scholars from the recent past. Thurston divides the emergence of a distinct “Salafi” current within Sunnis into two phases. The first stretches from 1880 to 1950, as Sun- ni scholars from around the Muslim-majority world whose approaches shared a common hadith-centered methodology came into closer contact. The second is from the 1960s through the present, as key Salafi institutions (such as the Islamic University of Medina and other Saudi Salafi bodies) were founded and began attracting and (perhaps most importantly) fund- ing and sponsoring Sunni students from countries such as Nigeria to come study in Saudi Arabia, where they were deeply embedded in the Salafi tra- dition before returning to their home countries where, in turn, they spread Salafism among local Muslims. Nigeria’s Muslim-majority north, as with other regions such as Yemen’s northern Sa‘ada governorate, proved to be a fertile ground for Salafism in large part because it enabled local Muslims from more humble social backgrounds to challenge the longtime domi- nance of hereditary ruling families and the established religious class. In northern Nigeria the latter was and continues to be dominated by Sufi or- ders and their shaykhs whose long-running claim to communal leadership faced new and substantive theological and resource challenges following the return of Nigerian seminary students from Saudi Arabia’s Salafi scho- lastic institutions in the 1990s and early 2000s. In Chapters Two and Three, Thurston traces the history of Nigerian and other African students in Saudi Arabia, which significantly expanded following the 1961 founding of the Islamic University of Medina (which remains the preeminent Salafi seminary and university in the world) and after active outreach across the Sunni Muslim world by the Saudi govern- ment and Salafi religious elite to attract students through lucrative funding and scholarship packages. The process of developing an African Salafism was not one-dimensional or imposed from the top-down by Saudi Salafi elites, but instead saw Nigerian and other African Salafi students partici- pate actively in shaping and theorizing Salafi da‘wa that took into account the specifics of each African country and Islamic religious and social envi- ronment. In Nigeria and other parts of West and East Africa, this included considering the historically dominant position of Sufi orders and popular practices such as devotion to saints and grave and shrine visitation. African and Saudi Salafis also forged relationships with local African partners, in- cluding powerful political figures such as Ahmadu Bello and his religious adviser Abubakar Gumi, by attracting them with the benefits of establishing ties with wealthy international Islamic organizations founded and backed by the Saudi state, including the Muslim World League. Nigerian Salafis returning from their studies in Saudi Arabia actively promoted their Salafi canon among local Muslims, waging an aggressive proselytization campaign that sought to chip away at the dominance of traditional political and religious elites, the Sufi shaykhs. This process is covered in Chapter Four. Drawing on key sets of legal and exegetical writ- ings by Ibn Taymiyya, Muhammad ibn ‘Abd al-Wahhab, and other Salafi scholars, Nigerian Salafis sought to introduce a framework—represented by the canon—through which their students and adherents approach re- ligious interpretation and practice. By mastering one’s understanding and ability to correctly interpret scripture and the hadith, Salafis believe, one will also live a more ethical life based on a core set of “Salafi” principles that govern not only religious but also political, social, and economic life. Salaf- ism, Thurston argues, drawing on the work of Terje Østebø on Ethiopian Salafism, becomes localized within a specific environment.As part of their da‘wa campaigns, Nigerian Salafis have utilized media and new technology to debate their rivals and critics as well as to broad- en their own influence over Nigerian Muslims and national society more broadly, actions analyzed in Chapter Five. Using the Internet, video and audio recorded sermons and religious lectures, books and pamphlets, and oral proselytization and preaching, Nigerian Salafis, like other Muslim ac- tivists and groups, see in media and technology an extension of the phys- ical infrastructure provided by institutions such as mosques and religious schools. This media/cyber infrastructure is as, if not increasingly more, valuable as the control of physical space because it allows for the rapid spread of ideas beyond what would have historically been possible for local religious preachers and missionaries. Instead of preaching political revo- lution, Nigerian Salafi activists sought to win greater access to the media including radio airtime because they believed this would ultimately lead to the triumph of their religious message despite the power of skeptical to downright hostile local audiences among the Sufi orders and non-Salafis dedicated to the Maliki juridical canon.In the realm of politics, the subject of Chapter Six, Nigeria’s Salafis base their political ideology on the core tenets of the Salafi creed and canon, tenets which cast Salafism as being not only the purest but the only true version of Islam, and require of Salafis to establish moral reform of a way- ward Muslim society. Salafi scholars seek to bring about social, political, and religious reform, which collectively represent a “return” to the Prophet Muhammad’s Islam, by speaking truth to power and advising and repri- manding, as necessary, Muslim political rulers. In navigating the multi-po- lar and complex realm of national and regional politics, Thurston argues, Nigerian Salafi scholars educated in Saudi Arabia unwittingly opened the door to cruder and more extreme, militant voices of figures lacking the same level of study of the Salafi canon or Sunni Islam generally. The most infamous of the latter is “Boko Haram,” the jihadi-insurgent group today based around Lake Chad in Nigeria, Chad, and Niger, which calls itself Jama‘at Ahl al-Sunna li-l-Da‘wa wa-l-Jihad and is led by the bombastic Abubakar Shekau. Boko Haram, under the leadership first of the revivalist preacher Mu- hammad Yusuf and then Shekau, is covered at length in the book’s third and final part, which is composed of two chapters. Yusuf, unlike mainstream Nigerian Salafis, sought to weaponize the Salafi canon against the state in- stead of using it as a tool to bring about desired reforms. Drawing on the writings of influential Arab jihadi ideologues including Abu Muhammad al-Maqdisi and the apocalyptic revolutionary Juhayman al-‘Utaybi, the lat- ter of whom participated in the 1979 seizure of the Grand Mosque in Mecca, Yusuf cited key Salafi concepts such as al-walā’ min al-mu’minīn wa-l-bara’ ‘an al-kāfirīn (loyalty to the Believers and disavowal of the Disbelievers) and beliefs about absolute monotheism (tawḥīd) as the basis of his revival- ist preaching. Based on these principle, he claimed, Muslims must not only fulfill their ritual duties such as prayer and fasting during Ramadan but also actively fight “unbelief” (kufr) and “apostasy” (ridda) and bring about God’s rule on earth, following the correct path of the community of the Prophet Abraham (Millat Ibrāhīm) referenced in multiple Qur’anic verses and outlined as a theological project for action by al-Maqdisi in a lengthy book of that name that has had a profound influence on the formation of modern Sunni jihadism. Instead of seeing Boko Haram, particularly under Shekau’s leadership, as a “Salafi” or “jihadi-Salafi” group, Thurston argues it is a case study of how a group that at one point in its history adhered to Salafism can move away from and beyond it. In the case of Shekau and his “post-Salafism,” he writes, the group, like Islamic State, has shifted away from the Salafi canon and toward a jihadism that uses only stripped-down elements from the canon and does so solely to propagate a militaristic form of jihad. Even when referencing historical religious authorities such as Ibn Taymiyya, Thurston points out, Boko Haram and Islamic State leaders and members often do so through the lens of modern Sunni jihadi ideologues like Juhay- man al-‘Utaybi, al-Maqdisi, and Abu Mus‘ab al-Zarqawi, figures who have come to form a Sunni jihadi canon of texts, intellectuals, and ideologues. Shekau, in short, has given up canonical Salafism and moved toward a more bombastic and scholastically more heterodox and less-Salafi-than- jihadi creed of political violence. Thurston also pushes back against the often crude stereotyping of Af- rican Islamic traditions and movements that sees African Muslims as being defined by their “syncretic” mix of traditional African religious traditions and “orthodox” Islam, the latter usually a stand-in for “Arab” and “Middle Eastern” Islam. Islam and Islamic movements in Africa have developed in social and political environments that are not mirrors to the dominant models of the Arab world (in particular, Egypt). He convincingly points out that analysis of all forms of African Islamic social and political mobi- lization through a Middle East and Egypt-heavy lens obscures much more than it elucidates. The book includes useful glossaries of key individuals and Arabic terms referenced in the text as well as a translation of a sermon by the late, revered Salafi scholar Muhammad Nasir al-Din al-Albani that is part of the mainstream Salafi canon. Extensive in its coverage of the his- tory, evolution, and sociopolitical and religious development of Salafism in Nigeria as well as the key role played by Saudi Salafi universities and religious institutions and quasi-state NGOs, the book expands the schol- arly literature on Salafism, Islam in Africa, and political Islam and Islamic social movements. It also contributing to ongoing debates and discussions on approaches to the study of the role of texts and textual traditions in the formation of individual and communal religious identity. Christopher AnzaloneResearch Fellow, International Security ProgramBelfer Center for Science and International Affairs, Harvard University& PhD candidate, Institute of Islamic Studies, McGill University

The global spread of Salafism, though it began in the 1960s and 1970s, only started to attract significant attention from scholars and analysts outside of Islamic studies as well as journalists, politicians, and the general public following the September 11, 2001 terrorist attacks perpetrated by Al-Qaeda Central. After the attacks, Salafism—or, as it was pejoratively labeled by its critics inside and outside of the Islamic tradition, “Wahhabism”—was accused of being the ideological basis of all expressions of Sunni militancy from North America and Europe to West and East Africa, the Arab world, and into Asia. According to this narrative, Usama bin Laden, Ayman al-Za- wahiri, Abu Bakr al-Baghdadi, and other Sunni jihadis were merely putting into action the commands of medieval ‘ulama such as Ibn Taymiyya, the eighteenth century Najdi Hanbali Muhammad ibn ‘Abd al-Wahhab, and modern revolutionary ideologues like Sayyid Qutb and ‘Abdullah ‘Azzam. To eradicate terrorism, you must eliminate or neuter Salafism, say its critics. The reality, of course, is far more complex than this simplistic nar- rative purports. Salafism, though its adherents share the same core set of creedal beliefs and methodological approaches toward the interpretation of the Qur’an and hadith and Sunni legal canon, comes in many forms, from the scholastic and hierarchical Salafism of the ‘ulama in Saudi Arabia and other Muslim majority countries to the decentralized, self-described Salafi groups in Europe and North America who cluster around a single char- ismatic preacher who often has limited formal religious education. What unifies these different expressions of Salafism is a core canon of religious and legal texts and set of scholars who are widely respected and referenced in Salafi circles. Thurston grounds his fieldwork and text-based analysis of Salafism in Nigeria, Africa’s most populous country and home to one of the world’s largest single Muslim national populations, through the lens of this canon, which he defines as a “communally negotiated set of texts that is governed by rules of interpretation and appropriation” (1). He argues fur- ther that in the history of Nigerian Salafism, one can trace the major stages that the global Salafi movement has navigated as it spread from the Arab Middle East to what are erroneously often seen as “peripheral” areas of the Islamic world, Africa and parts of Asia. The book is based on extensive fieldwork in Nigeria including interviews with key Nigerian Salafi scholars and other leading figures as well as a wide range of textual primary sourc- es including British and Nigerian archival documents, international and national news media reports, leaked US embassy cables, and a significant number of religious lectures and sermons and writings by Nigerian Salafis in Arabic and Hausa. In Chapter One, Thurston argues that the Salafi canon gives individ- ual and groups of Salafis a sense of identity and membership in a unique and, to them, superior religious community that is linked closely to their understanding and reading of sacred history and the revered figures of the Prophet Muhammad and the Ṣaḥāba. Salafism as an intellectual current, theology, and methodological approach is transmitted through this can- on which serves not only as a vehicle for proselytization but also a rule- book through which the boundaries of what is and is not “Salafism” are determined by its adherents and leading authorities. The book’s analytical framework and approach toward understanding Salafism, which rests on seeing it as a textual tradition, runs counter to the popular but problematic tendency in much of the existing discussion and even scholarly literature on Salafism that defines it as a literalist, one-dimensional, and puritani- cal creed with a singular focus on the Qur’an and hadith canon. Salafis, Thurston argues, do not simply derive religious and legal rulings in linear fashion from the Qur’an and Prophetic Sunna but rather engage in a co- herent and uniform process of aligning today’s Salafi community with a set of normative practices and beliefs laid out by key Salafi scholars from the recent past. Thurston divides the emergence of a distinct “Salafi” current within Sunnis into two phases. The first stretches from 1880 to 1950, as Sun- ni scholars from around the Muslim-majority world whose approaches shared a common hadith-centered methodology came into closer contact. The second is from the 1960s through the present, as key Salafi institutions (such as the Islamic University of Medina and other Saudi Salafi bodies) were founded and began attracting and (perhaps most importantly) fund- ing and sponsoring Sunni students from countries such as Nigeria to come study in Saudi Arabia, where they were deeply embedded in the Salafi tra- dition before returning to their home countries where, in turn, they spread Salafism among local Muslims. Nigeria’s Muslim-majority north, as with other regions such as Yemen’s northern Sa‘ada governorate, proved to be a fertile ground for Salafism in large part because it enabled local Muslims from more humble social backgrounds to challenge the longtime domi- nance of hereditary ruling families and the established religious class. In northern Nigeria the latter was and continues to be dominated by Sufi or- ders and their shaykhs whose long-running claim to communal leadership faced new and substantive theological and resource challenges following the return of Nigerian seminary students from Saudi Arabia’s Salafi scho- lastic institutions in the 1990s and early 2000s. In Chapters Two and Three, Thurston traces the history of Nigerian and other African students in Saudi Arabia, which significantly expanded following the 1961 founding of the Islamic University of Medina (which remains the preeminent Salafi seminary and university in the world) and after active outreach across the Sunni Muslim world by the Saudi govern- ment and Salafi religious elite to attract students through lucrative funding and scholarship packages. The process of developing an African Salafism was not one-dimensional or imposed from the top-down by Saudi Salafi elites, but instead saw Nigerian and other African Salafi students partici- pate actively in shaping and theorizing Salafi da‘wa that took into account the specifics of each African country and Islamic religious and social envi- ronment. In Nigeria and other parts of West and East Africa, this included considering the historically dominant position of Sufi orders and popular practices such as devotion to saints and grave and shrine visitation. African and Saudi Salafis also forged relationships with local African partners, in- cluding powerful political figures such as Ahmadu Bello and his religious adviser Abubakar Gumi, by attracting them with the benefits of establishing ties with wealthy international Islamic organizations founded and backed by the Saudi state, including the Muslim World League. Nigerian Salafis returning from their studies in Saudi Arabia actively promoted their Salafi canon among local Muslims, waging an aggressive proselytization campaign that sought to chip away at the dominance of traditional political and religious elites, the Sufi shaykhs. This process is covered in Chapter Four. Drawing on key sets of legal and exegetical writ- ings by Ibn Taymiyya, Muhammad ibn ‘Abd al-Wahhab, and other Salafi scholars, Nigerian Salafis sought to introduce a framework—represented by the canon—through which their students and adherents approach re- ligious interpretation and practice. By mastering one’s understanding and ability to correctly interpret scripture and the hadith, Salafis believe, one will also live a more ethical life based on a core set of “Salafi” principles that govern not only religious but also political, social, and economic life. Salaf- ism, Thurston argues, drawing on the work of Terje Østebø on Ethiopian Salafism, becomes localized within a specific environment.As part of their da‘wa campaigns, Nigerian Salafis have utilized media and new technology to debate their rivals and critics as well as to broad- en their own influence over Nigerian Muslims and national society more broadly, actions analyzed in Chapter Five. Using the Internet, video and audio recorded sermons and religious lectures, books and pamphlets, and oral proselytization and preaching, Nigerian Salafis, like other Muslim ac- tivists and groups, see in media and technology an extension of the phys- ical infrastructure provided by institutions such as mosques and religious schools. This media/cyber infrastructure is as, if not increasingly more, valuable as the control of physical space because it allows for the rapid spread of ideas beyond what would have historically been possible for local religious preachers and missionaries. Instead of preaching political revo- lution, Nigerian Salafi activists sought to win greater access to the media including radio airtime because they believed this would ultimately lead to the triumph of their religious message despite the power of skeptical to downright hostile local audiences among the Sufi orders and non-Salafis dedicated to the Maliki juridical canon.In the realm of politics, the subject of Chapter Six, Nigeria’s Salafis base their political ideology on the core tenets of the Salafi creed and canon, tenets which cast Salafism as being not only the purest but the only true version of Islam, and require of Salafis to establish moral reform of a way- ward Muslim society. Salafi scholars seek to bring about social, political, and religious reform, which collectively represent a “return” to the Prophet Muhammad’s Islam, by speaking truth to power and advising and repri- manding, as necessary, Muslim political rulers. In navigating the multi-po- lar and complex realm of national and regional politics, Thurston argues, Nigerian Salafi scholars educated in Saudi Arabia unwittingly opened the door to cruder and more extreme, militant voices of figures lacking the same level of study of the Salafi canon or Sunni Islam generally. The most infamous of the latter is “Boko Haram,” the jihadi-insurgent group today based around Lake Chad in Nigeria, Chad, and Niger, which calls itself Jama‘at Ahl al-Sunna li-l-Da‘wa wa-l-Jihad and is led by the bombastic Abubakar Shekau. Boko Haram, under the leadership first of the revivalist preacher Mu- hammad Yusuf and then Shekau, is covered at length in the book’s third and final part, which is composed of two chapters. Yusuf, unlike mainstream Nigerian Salafis, sought to weaponize the Salafi canon against the state in- stead of using it as a tool to bring about desired reforms. Drawing on the writings of influential Arab jihadi ideologues including Abu Muhammad al-Maqdisi and the apocalyptic revolutionary Juhayman al-‘Utaybi, the lat- ter of whom participated in the 1979 seizure of the Grand Mosque in Mecca, Yusuf cited key Salafi concepts such as al-walā’ min al-mu’minīn wa-l-bara’ ‘an al-kāfirīn (loyalty to the Believers and disavowal of the Disbelievers) and beliefs about absolute monotheism (tawḥīd) as the basis of his revival- ist preaching. Based on these principle, he claimed, Muslims must not only fulfill their ritual duties such as prayer and fasting during Ramadan but also actively fight “unbelief” (kufr) and “apostasy” (ridda) and bring about God’s rule on earth, following the correct path of the community of the Prophet Abraham (Millat Ibrāhīm) referenced in multiple Qur’anic verses and outlined as a theological project for action by al-Maqdisi in a lengthy book of that name that has had a profound influence on the formation of modern Sunni jihadism. Instead of seeing Boko Haram, particularly under Shekau’s leadership, as a “Salafi” or “jihadi-Salafi” group, Thurston argues it is a case study of how a group that at one point in its history adhered to Salafism can move away from and beyond it. In the case of Shekau and his “post-Salafism,” he writes, the group, like Islamic State, has shifted away from the Salafi canon and toward a jihadism that uses only stripped-down elements from the canon and does so solely to propagate a militaristic form of jihad. Even when referencing historical religious authorities such as Ibn Taymiyya, Thurston points out, Boko Haram and Islamic State leaders and members often do so through the lens of modern Sunni jihadi ideologues like Juhay- man al-‘Utaybi, al-Maqdisi, and Abu Mus‘ab al-Zarqawi, figures who have come to form a Sunni jihadi canon of texts, intellectuals, and ideologues. Shekau, in short, has given up canonical Salafism and moved toward a more bombastic and scholastically more heterodox and less-Salafi-than- jihadi creed of political violence. Thurston also pushes back against the often crude stereotyping of Af- rican Islamic traditions and movements that sees African Muslims as being defined by their “syncretic” mix of traditional African religious traditions and “orthodox” Islam, the latter usually a stand-in for “Arab” and “Middle Eastern” Islam. Islam and Islamic movements in Africa have developed in social and political environments that are not mirrors to the dominant models of the Arab world (in particular, Egypt). He convincingly points out that analysis of all forms of African Islamic social and political mobi- lization through a Middle East and Egypt-heavy lens obscures much more than it elucidates. The book includes useful glossaries of key individuals and Arabic terms referenced in the text as well as a translation of a sermon by the late, revered Salafi scholar Muhammad Nasir al-Din al-Albani that is part of the mainstream Salafi canon. Extensive in its coverage of the his- tory, evolution, and sociopolitical and religious development of Salafism in Nigeria as well as the key role played by Saudi Salafi universities and religious institutions and quasi-state NGOs, the book expands the schol- arly literature on Salafism, Islam in Africa, and political Islam and Islamic social movements. It also contributing to ongoing debates and discussions on approaches to the study of the role of texts and textual traditions in the formation of individual and communal religious identity. Christopher AnzaloneResearch Fellow, International Security ProgramBelfer Center for Science and International Affairs, Harvard University& PhD candidate, Institute of Islamic Studies, McGill University

Background: Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Methods: Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Results: Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering “vicious” cyclical patterns to increase coordinated multisector PPAP are key. Conclusions: The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points.

AbstractSignificant evidence highlights processes of marketisation within British higher education since the 1980s, with changes to the funding, management, and expectations of higher education institutions, students, and staff. Through a cross-national and cross-institutional analysis, this paper explores the identities of students within a marketised British higher education landscape, and specifically, explores the identity of the ‘student-consumer’. Using a mixed methods approach with students from 37 higher education institutions across Britain, this research explores the attitudes, expectations, behaviours, and relationships held by students regarding higher education. Student identity orientations are explored, before the extent to which students’ express attitudes of instrumentalism and entitlement is investigated. The paper concludes that whilst there is evidence of consumerist discourses framing students’ relationship to higher education, students challenge the perception that they are passive consumers, and instead recognise the need to remain active co-producers throughout higher education. These findings have implications for policy and have resonance beyond Britain, as the marketisation of higher education is an increasingly international phenomenon.

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chief Scientist Office Background Atrial fibrillation (AF) related stroke risk can be reduced with oral anticoagulants (OACs). OACs need to be taken once or twice a day to maintain effectiveness but non-adherence remains a challenge mHealth applications are one way to support patients to take medication. Purpose We aimed to co-design an mHealth intervention to increase medication adherence to OACs in patients with AF. Methods We recruited individuals with AF via British Heart Foundation social media advertisement and using established contacts from the Scottish AF survey to take part in a series of remote and in-person workshops. These were 1) an initial patient experience session, gathering personal stories to contextualise the intervention 2) an interactive session, using existing mHealth AF applications identified via scoping review, and 3) a pilot session of the co-designed mobile app prototype. Data were collected using flipchart, post-it notes and researcher field notes, with emphasis placed on the use of direct quotations and storytelling. Development work was overseen by a steering group including clinicians, digital health experts, and four AF patient representatives. Results Eleven patients (7 males) aged 35-80 years took part. Six participants were diagnosed with AF within the last five years and eight had one or more co-morbidities. Number of daily medications ranged from 0-12, with 8/11 (72%) of participants taking OACs. Experience with smartphone use varied and only two reported using a smartphone to manage their own health. We developed a prototype mHealth app, MyAFNurse. The talking avatar-based app increases accessibility regardless of user health literacy level. It incorporates behaviour change techniques including a medication tracker and reminders, information about AF, advice on when and where to seek help, and a quiz to test knowledge. Conclusions A robust co-design process developed an avatar-based mHealth app that incorporates behaviour change techniques which will be evaluated in a feasibility trial.

Recent educational reforms in England have sought to reshape public education by extending central government control of curriculum and assessment, while replacing local government control of schools with a quasi-private system of academies and multi academy trusts. In this paper, we resist reading this as the latest iteration of the debate between “traditional” and “progressive” education. Instead, we note how, despite the mobilisation of the rhetoric of the public and public education, schooling in England has never been public in any deeply meaningful sense. We develop a genealogical reading of public education in England, in which ideas of British universalism – “the public” – and inequality and exclusion in education and society have not been opposed but have gone hand-in-hand. This raises the question whether it is possible to envisage and enact another form of collective – one that is based on action rather than fantasy and that is co-authored by, comprising, and exists for, the people. The final part of this paper seeks to grapple with this challenge, in the context of past, present and future potential developments in education, and to consider possibilities for the imaginary reconstitution of public education in England in the twenty-first century.

A key debate in higher education is how assessment and feedback can be constructed to maximize opportunities for meaningful student learning. In this paper, we explore how a learning-focused model of feedback, teacher-student dialogic feed-forward, is enacted in practice, exposing many affordances but also some challenges. Adopting a small-scale intensive approach, we trace the learning journeys of four students through a second-year undergraduate unit at a British university and on into their third and final year of study, accessing verbal testimony, teacher written comments on draft and final summative coursework, and student performance within and beyond the unit. We present in-depth student responses, understanding, behaviours, and achievement with respect to the feed-forward dialogue, revealing the subtleties of their reactions. Our findings evidence the transformative power of assessment dialogue on student learning for a range of achievers. Dialogic feed-forward can act as a pivotal moment in learning, where students reflect on their work, judge their standards against criteria, and co-create positive actions for improvement. Students develop cognitively, meta-cognitively, and affectively, becoming more comfortable with challenge and more productive in their learning. We conclude by widening our frame of reference to problematize dialogic feed-forward within current debates about higher education pedagogy.

Abstract Illusions of common interest and joint purpose falter when states choose to break up, as with the recent changes to the European Union, or according to more dangerous precipitants such as those which shaped the Franco-German Armistice 1940, 80 years ago as a detail of war. The latter bares the sudden end of the Franco-British alliance and holds an invitation from history to re-examine the troubling political, social and legal layers of the concept of the vital interests of states. That category opened to radically different interpretations for political and legal thinkers who witnessed the fall of France yet did not respond directly or immediately. Hannah Arendt’s theory of politics, conceived in the aftermath of war as a corrective to the internal fragmentation of the European nation-state, elucidates the instability of the concept of vital interests which underpinned international legal and political thought in the 1930s and 1940s and frustrates the co-operative relations between states. The problem pairs back, she says, to whether interests signify an associative technique or sword. Her invitation for legal thought is to challenge the expectation of rupture implicit in the juridical category by outlining an alternative that recovers the pacifistic function of law and implicates the international lawyer.

Abstract Background Bariatric surgery is a safe and effective treatment for obesity and associated co-morbidities. Equality of access to bariatric surgery in the NHS has long posed a serious challenge with significant variation in eligibility criteria between different regions. Obesity disproportionately affects more deprived groups and some ethnic minorities, who have also been shown to experience a worse quality of healthcare and poorer health outcomes. This study aimed to understand the profile of patients accessing bariatric surgery and explore changes in trends over a 15-year period to identify important areas of development for obesity-related healthcare services in our region. Methods This was a retrospective study of all patients undergoing primary and revisional bariatric surgery (gastric band, sleeve gastrectomy, RNY and single anastomosis bypass) for weight loss at our regional bariatric surgical centre since its inception in 2008 until the end of 2022. Data was extracted from a combination of electronic records and a surgical database. Variables included gender demographic and procedure related data, baseline characteristics including height, weight, deprivation scores, co-morbidities, bloods, and micronutrient levels. Changes in patient profiles were mapped over the 15-year period and compared to population-level data derived from the national census and other publicly available sources. Results 2062 (mean age 47) patients were included. 11 (0.5%) patients were aged over 70 and 155 (7.5%) were less than 30 years of age. 75% patients were women; 42% of patients in 2013 were men which steadily decreased to 17% in 2022 (p &lt; 0.05). The mean BMI of patients undergoing surgery was 54 in 2010 and gradually decreased to 48 in 2022 (p&lt;0.05). White British patients represented 93% of all patients. This decreased from 96.5% in 2009 to 86% in 2022. White British ethnicity was estimated to make up 81% of patients with obesity in the NW of England. Conclusions Several major groups who are likely to significantly benefit from bariatric surgery are disproportionately under-represented by patients accessing treatments for obesity. This includes those at the extremes of ages, men, lower BMI patients and ethnic minority groups. Trends over the last 15 years have either worsened or have insufficiently improved to bridge the gap in health inequalities. The findings from our study underscore the urgent need for wider-scale targeted approaches which aim to address obesity and increase more equitable access to these life-changing treatments.

ABSTRACT ObjectivesDataSHIELD (www.datashield.ac.uk) was born of the requirement in the biomedical and social sciences to co-analyse individual patient data (microdata) from different sources, without disclosing identity or sensitive information. Under DataSHIELD, raw data never leaves the data provider and no microdata or disclosive information can be seen by the researcher. The analysis is taken to the data - not the data to the analysis. Text data can be very disclosive in the biomedical domain (patient records, GP letters etc). Similar, but different, issues are present in other domains - text could be copyrighted, or have a large IP value, making sharing impractical. ApproachBy treating text in an analogous way to individual patient data we assessed if DataSHIELD could be adapted and implemented for text analysis, and circumvent the key obstacles that currently prevent it. ResultsUsing open digitised text data held by the British Library, a DataSHIELD proof-of-concept infrastructure and prototype DataSHIELD functions for free text analysis were developed. ConclusionsWhilst it is possible to analyse free text within a DataSHIELD infrastructure, the challenge is creating generalised and resilient anti-disclosure methods for free text analysis. There are a range of biomedical and health sciences applications for DataSHIELD methods of privacy protected analysis of free text including analysis of electronic health records and analysis of qualitative data e.g. from social media.