Swaffham Community Hospital

We report the first probable identification of encephalomyocarditis virus (EMCV) in a bonobo (Pan paniscus) that had been part of a forest re-introduction programme. Clinical presentation was of episodic acute on chronic heart failure and cerebral infarction with end-stage renal failure rather than sudden death which is more commonly associated with EMCV infection. A postmortem diagnosis of probable EMCV was made using gross pathological and histopathological examination. Findings included acute on chronic heart failure combined with the unusual but characteristic histopathological features of non-suppurative necrotizing myocarditis with mononuclear, inflammatory infiltration of the brain.

This article is an account of how a group of Year 1 children (age 5/6 years) responded to and appropriated aspects of the National Literacy Strategy. In each of the three episodes of the account they worked with a different aspect of the Strategy. Displaying increasing literacy and collaborative skills they worked with consonant blends, alphabetical order and spelling. Led by a child who disliked the discourse of public display, the children collaborated over extended periods of time, transforming the style of the NLS to achieve their own literacy purposes and showing that the NLS is not the whole story when it comes to learning about literacy.

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011-2014) ¹ identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimising patient care. Fifty (89%) of the General Practices caring for 415,152 patients (27,587 diagnosed with asthma (prevalence 7%;range 4-12%)), participated. <b>Results</b> identified a wide variation in process of care and presence of risk factors including: excess short acting reliever and insufficient preventer prescriptions, failure to issue personal asthma action plans and to perform annual reviews or check inhaler technique. Identification of these patients involved high intensity input by trained asthma nurses using sophisticated data extraction software. GP computer systems used in UK primary care currently do not have the functionally, without the need for manual audit, to implement the NRAD recommendations, starting with the identification of patients at risk. Modifications to existing systems within both primary and secondary care are required in order to prevent unnecessary deaths related to asthma. There is a pressing need to move towards a more pro-active model of care. 1) https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills

<h3>Introduction and Objective</h3> Inhaled asthma therapy contributes to global warming but is currently a non-negotiable element of patient care. The carbon footprint of inhalers has previously been described. Pressurised metered dose inhalers (pMDIs) may have a higher carbon footprint than dry powder inhalers (and soft mist inhalers), but the volume of inhalers is also an important contributor. Those with poor asthma control may have higher numbers of inhalers prescribed. We sought to determine whether people with self-reported poor asthma control (Royal College of Physicians 3 Questions for Asthma (RCP 3 questions)) contributed a different carbon footprint to those with better control. <h3>Methods</h3> National Services for Health Improvement (NSHI) staff conduct primary care clinical assessments of people with asthma. Permission has been obtained from participating practices for NSHI to hold anonymised aggregated routinely collected data. Between 1stJanuary 2022 and 30th April 2023, NSHI conducted respiratory audits in 447 practices across 111 CCGs/Health Boards/ICBs in the UK. Demographic data, RCP 3 questions, inhaler brands and number of items prescribed for each patient were collected throughout this period. Greenhouse gas (GHG) emission values per inhaler were allocated from a publicly available source (PrescQIPP).¹ Numbers of prescribed inhalers were multiplied by the GHG emission values per inhaler to give total GHG emissions per year. <h3>Results</h3> Complete data were available for 116,841 individuals aged between 20–69 years: 59.2% female. The median (lower quartile, upper quartile) GHG was 77.0 (28.7, 160.1) Kg CO₂/year. The minimum value was 0 CO₂ Kg/year and the maximum value 1336.2 Kg CO₂/year. The number of patients and total GHG emissions from inhaler use by RCP 3 questions score (0–3) are shown. <h3>Conclusion</h3> In asthma patients with a self-reported, single assessment of asthma control, those with a higher RCP 3 questions score (poorer control) contributed a higher inhaler related GHG emission. <h3>Reference</h3> <b>Bulletin 295: Inhaler carbon footprint | PrescQIPP C.I.C</b>. Please refer to page A289 for declarations of interest related to this abstract.

(1838). XLV.—Further remarks on the British Shrews, including the distinguishing characters of two species previously confounded. Annals and Magazine of Natural History: Vol. 1, No. 6, pp. 417-427.

(1838). VI.—Additional note on the British shrews. Annals and Magazine of Natural History: Vol. 2, No. 7, pp. 43-43.

BACKGROUND: Randomized trials show inconsistent estimates on risks of direct-acting oral anticoagulants (DOACs) versus warfarin in bleeding and mortality for atrial fibrillation (AF) patients. Trials are confounded by additional DOAC adherence support, while warfarin has a low time in therapeutic range. Few real-world studies compared emergency hospitalization risk between DOAC and warfarin users in AF. This study aimed to determine emergency hospitalization risk for AF patients on DOACs or warfarin in real-world settings. METHODS: A tapered-matched real-world cohort extracted data from 412 English general practices' primary care records linked with emergency department (ED) and hospitalization data from the ECLIPSE database. AF patients with new DOAC or warfarin prescriptions were included. The primary outcome was all-cause ED attendance; the secondary outcomes were ED re-attendance, nonelective hospitalization, and rehospitalization within 12 months. Weighted Cox regression estimated relative risk difference. RESULTS: 39 201 DOAC patients were matched with 13 145 warfarin patients. DOAC patients had a 25% higher likelihood of attending ED (odds ratio 1.25; 95% confidence interval [CI] 1.01-1.55). DOAC use also associated with higher ED re-attendance, nonelective hospitalization, and rehospitalization within 12 months: 1.41 (95% CI 1.00-1.98), 1.26 (1.00-1.57), and 1.54 (1.01-2.34), respectively, with p-values < .05. CONCLUSIONS: DOACs for AF thromboprophylaxis are associated with the increased risk of ED attendance, recurrent hospitalization, and numerical rise in ED re-attendance and first nonelective hospitalization compared to warfarin. However, these real-world data cannot establish if this difference results from medication adherence, lack of regular DOAC clinic monitoring, unmeasured confounders, or fundamental agent efficacy disparities.

Dogs with endocrinopathy have been reported to have hair follicles with excessive trichilemmal keratinization (flame follicles). These follicles have been described in cases clinically diagnosed as hypothyroidism, hyperadrenocorticism, hyposomatotropism and sex hormone abnormality. Breed variation in the incidence of these follicles has also been described. Recently, endocrine alopecias have been better defined, and a number of these conditions (previously known as congenital adrenal hyperplasia, pseudo‐Cushing's disease, castration‐responsive dermatosis and adult‐onset hyposomatotropism) are now grouped under the name alopecia X. In this prospective study, a group of 24 spitz‐type dogs, which included 15 Pomeranians, had an extensive hormonal work‐up. This included thyroid and adrenocorticotrophic hormone stimulation tests and sex hormone assays. Histopathology of the skin specimens collected from alopecic and clinically normal skin indicated features common to many endocrinopathies such as surface and infundibular hyperkeratosis and comedone formation. However, catagenization with flame follicle formation was a prominent feature of skin specimens from 22 dogs. This feature was so marked in 20 of these specimens that it was considered to be diagnostic for alopecia X when the specimens were evaluated in a blinded manner. The other two specimens could not be differentiated reliably from hyperadrenocorticism. Histopathology is a useful diagnostic procedure to support a diagnosis of alopecia X in dogs. Funding: Self‐funded.

A seven‐year partnership between a Norfolk high school and an NHS drug treatment agency has raised awareness about drugs, alcohol, HIV and AIDS among all sections of the school community. In an innovative approach to drug education, factual lessons have been augmented in Personal and Social Education (PSE) by videoed discussions touching on a range of issues, filmed at Year 9 and played back at Year 11. The sessions have had a powerful effect and helped give participants greater awareness of the transition from youth to adulthood. The insights gained and the techniques used may well have relevance to other aspects of a PSE programme.

Journal Article The prehistoric races of Italy Get access J. J. Coulton J. J. Coulton 1Pentney, Swaffham, Norfolk Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s7-X, Issue 248, 27 September 1890, Page 246, https://doi.org/10.1093/nq/s7-X.248.246a Published: 27 September 1890

Castles, crown and countryside - Andrew Saunders. Excavations at Launceston Castle, Cornwall. (Society for Medieval Archaeology Monograph 24). xviii+490 pages, 344 b&amp;w &amp; colour illustrations. 2006. London: Maney; 978-1-904350-75-0 paperback £45. - David Austin. Acts of Perception. A Study of Barnard Castle in Teesdale, Volumes 1 &amp; 2 (Architectural and Archaeological Society of Durham and Northumberland Research Report 6). xxii+706 pages in 2 volumes, 243 illustrations, 116 tables. 2007. Durham: AASDN &amp; English Heritage; 978-0-9510388-57 (Vol. 1); 978-0-9510388-50 (Vol. 2) paperback. - Volume 82 Issue 316

autumn of 1837, brought with him a small collection of shrews, which had been all obtained in the neighbourhood of Francfort-upon-Mayne.These he very obligingly submitted to my inspection, allowing me to compare them with our British-species, and to describe any amongst them which might appear new.The collection consists of fourteen individuals, referrible to at least five distinct species, one of which is either undescribed,

<title>Extract</title> Breathlessness is a common presentation to primary care yet one where a delay in appropriate investigation and diagnosis may result in adverse patient outcomes [1, 2]. The NHS England (NHSE) Adult Breathlessness Pathway facilitates a structured approach to the evaluation of breathlessness [3]. The common conditions responsible for breathlessness appear to disproportionately affect those most at risk from healthcare inequality [4, 5]. Evidence is emerging regarding the role of local football clubs in improving the health of communities especially in targeting groups traditionally deemed “hard to reach” when accessing mainstream healthcare services [6, 7]. Furthermore, as healthcare systems globally struggle to balance capacity including the provision of trained medical staff with increasing service demands, there is increasing emphasis on technology in aiding the appropriate investigation of breathlessness [8]. We report on the feasibility of implementing clinical decision support system software in order to enhance uptake of the NHSE Adult Breathlessness pathway in the setting of a weekly “one stop-shop” clinic at “<italic>Everton In the Community</italic>” (EitC), the official charity of Everton Football Club.

<h3></h3> Patients’ peak inspiratory flow rate (PIFR) may help clinicians select a suitable inhaler device. The In-Check® device has gained some status as a simple tool to estimate PIFR (scale reflecting inhaler resistance from R0 to R5). It has been suggested that some patients with asthma may not be able to generate sufficient PIFR with high resistance devices (R5) to satisfy the minimum requirements of 30 L/min. We conducted a prospective service evaluation study to identify what proportion of patients with asthma are able to generate a correct PIFR at In-Check device R0-R5 resistance settings and what the phenotypical features of those patients are. As part of UK general practice asthma review service, sequential patients were recruited from 41 centres by 10 respiratory specialist nurses. Patients had PIFR checked at the resistance corresponding to their current preventer inhaler device, at R5 (high resistance dry powder inhaler (DPI) setting), and, at R0 (no resistance, pressurised metered dose inhaler (pMDI) setting. Correct PIFR (pass) was defined for R5 as 30–90 L/min, and, for R0 as 20–60 L/min. 994 adults (female 64.3%) were included, of whom 90.4% currently used a preventer inhaler (71.5% MDI (R0), 0% R1, 6.3% R2, 14.5% R3, 4.9% R4, 2.8% R5). 93.7% of patients passed at R5 resistance, compared to 70.5% at R0 (p&lt;0.0001). This difference was observed in all age groups: among younger patients (18–24 years) 100% passed at R5 compared to 73.7% at R0, and among the older patients (&gt;71 years) 90.2% passed at R5 compared to 71.0% at R0. <h3>Conclusion</h3> Patients with asthma can achieve adequate inspiratory flow 30–90 L/min with high resistance DPI (R5).

Wellington Get access J. J. Coulton J. J. Coulton 1Pentney, Swaffham Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s7-X, Issue 250, 11 October 1890, Page 298, https://doi.org/10.1093/nq/s7-X.250.298f Published: 11 October 1890

Between September 1979 and June 1980 , David Taylor , a pupil at Swaffham Hamond's High School designed and built a test tank for model boats as his major project for '0' level Technology (Cambridge Board) . The project was also entered for the Schools Design Prize (Design Council) and won a prize. The tank is now the property of the school and is in constant use. This is an account of the project. David wanted to build an airship . It would have to be a model, he realized , but he wanted to test the feasibility of larger designs capable of carrying enormous loads . The whole ship, he felt, could be a huge aerofoil section which would supply dynamic lift . I pointed out that Barnes Wallis had said that airships should never be flown with dynamic lift as it made them susceptible to catastrophic stalling and that it was suspected by many, Wallis and Nevil Shute included, that this may have been a contributory factor to the RIOI disaster . David quietly pointed out that what was true in the 1920s and 30s was not necessarily true today : advances had been made in material science and aero - engines. But I began to feel we were getting lost in detail . What gas could we use? I wouldn't counenance Hydrogen . And where would we get a supply of expensive Helium? Firmly, and with great regret , I ruled out the project . Guiding pupils towards a suitable 5th year project is always a problem, but I could see that in this case it was going to be particularly acute. David is a boy with large ideas and the ability to carry them out , but had we the resources to meet his demands, particularly financially? His project would , we decided , have to be something for the school so that we could share the cost, but also it would have to be something he was interested in. A consideration of David's interest didn't narrow the field much; he is interested in most things technical, but I knew what I wanted - a test tank for model boats. And that fitted in nicely with one of David's many hobbies.

History of Pickwick.' Get access J. B. Firman, M.A. J. B. Firman, M.A. 1Castlencre, Swaffham Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s8-XI, Issue 273, 20 March 1897, Page 225, https://doi.org/10.1093/nq/s8-XI.273.225f Published: 20 March 1897

<b>Introduction:</b> The Global Initiative for Chronic Obstructive Lung Disease (GOLD) have published their 2017 report. In 2014 we published the classification according to GOLD 2013 of a large database of people with COPD.¹ <b>Aim:</b> We now describe the same population using the GOLD classification 2017 <b>Methods:</b> We re-analysed the database drawn from 80 UK practices representative of UK primary care. An electronic search of practice databases and a hand search of individual patient records was conducted. Demographic data and co-morbid conditions were documented. <b>Results:</b> 9219 patients had their exacerbation history recorded. 7480 had spirometry results. 7119 patients had an MRC score. Table 1 The original distribution of this cohort of patients, according to the GOLD 2013 categories Table 2 The distribution of patients according to the GOLD 2017 revised COPD assessment. ^#: ≥1 hospitalisations Conclusion The proportion of people with COPD under treatment in the high-risk groups C and D falls from 48.0% (2013) to 29.6% (2017). The GOLD 2017 ABCD tool results in greater homogeneity as the risk stratification is based on exacerbation history alone. This revision of the COPD grading system is commendably clear, avoiding the need for sub-classification of patients. It will therefore be useful for practising clinicians in patient management. 1. Haughney et al Eur Respir J 2014; 43: 993-1002.

Patients’ peak inspiratory flow rate (PIFR) may help clinicians select a suitable inhaler device. The In-Check® device has gained some status as a simple tool to estimate PIFR (scale reflecting inhaler resistance from R0 to R5). It has been suggested that some patients with asthma may not be able to generate sufficient PIFR with high resistance devices (R5) to satisfy the minimum requirements of 30 L/min. We conducted a prospective service evaluation study to identify what proportion of patients with asthma are able to generate a correct PIFR at In-Check device R0-R5 resistance settings and what the phenotypical features of those patients are. As part of UK general practice asthma review service, sequential patients were recruited from 41 centres by 10 respiratory specialist nurses. Patients had PIFR checked at the resistance corresponding to their current preventer inhaler device, at R5 (high resistance dry powder inhaler (DPI) setting), and, at R0 (no resistance, pressurised metered dose inhaler (pMDI) setting. Correct PIFR (pass) was defined for R5 as 30-90 L/min, and, for R0 as 20-60 L/min. 994 adults (female 64.3%) were included, of whom 90.4% currently used a preventer inhaler (71.5% MDI (R0), 0% R1, 6.3% R2, 14.5% R3, 4.9% R4, 2.8% R5). 93.7% of patients passed at R5 resistance, compared to 70.5% at R0 (p&lt;0.0001). This difference was observed in all age groups: among younger patients (18-24 years) 100% passed at R5 compared to 73.7% at R0, and among the older patients (&gt;71 years) 90.2% passed at R5 compared to 71.0% at R0. <b>Conclusion:</b> Patients with asthma can achieve adequate inspiratory flow 30-90 L/min with a high resistance DPI (R5).