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The NHS Bowel cancer screening programme (NHSBCSP) aims to reduce colorectal cancer (CRC) cumulative mortality by up to 23 per cent; long-term outcomes at national level are not yet known. The purpose of this paper is to examine a local population of CRC patients of screening age for their characteristics and long-term survival in relation to their presentation, including through the NHSBCSP.

Retrospective analysis of a prospectively maintained CRC database for the years 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 528 CRC patients diagnosed in the screening age range, 144(27.3 per cent) presented through NHSBCSP, 308(58.3 per cent) electively with symptoms and 76(14.4 per cent) as emergency. NHSBCSP-diagnosed patients were younger (median 66 vs 68 and 69 years, respectively, p=0.001), had more often left-sided cancers (59(41.0 per cent) vs 82(26.6 per cent) and 24(31.6 per cent), respectively, p=0.001), more UICC-stage I (42(29.2 per cent) vs 49(15.9 per cent) and 2(2.6 per cent)), stage III (59(41.0 per cent) vs 106(34.4 per cent) and 20(26.3 per cent)) and less stage IV disease (8(5.6 per cent) vs 61(19.8 per cent) and 34 (44.7 per cent), respectively, p<0.001). Three-year overall survival was best for NHSBCSP and worst for emergency patients (87.5 per cent vs 69.0 per cent and 35.3 per cent, respectively, LogRank p<0.001).

Patients diagnosed within the NHSBCSP have improved outcome compared to both symptomatic elective and emergency presentations. A reduction in overall cumulative mortality in order of 25 per cent may well be achieved, but continuing high levels of emergency presentations and undetected right-sided disease emphasise need for further improvement in public participation in the NHSBCSP and research into more sensitive and acceptable alternative screening methods.

Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients’ overall survival.

The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048).

Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.

After the electoral victory in 2018, the newly formed Pakistan Tehreek-e-Insaf (PTI) government presented its National Education Policy Framework, chalking out its priorities of bringing more than 22 million out-of-school children to schools, improving educational quality, and introducing a uniform education system in the country. However, the government’s grand ambitions, transpired quickly, only to produce a draft of a new unified curriculum in 2020. This chapter investigates the newly formulated Single National Curriculum (SNC) in Pakistan by using the lens of Critical Cultural Political Economy of Education (CCPEE). To understand the endogenous and exogenous factors shaping the SNC, the chapter argues that securitization and neoliberalization are the significant factors informing the development and the production of the new curriculum.

This study examines the osteoconductive and healing capabilities of locally implanted synthetic hydroxyapatite (sHAp) derived from eggshells in the central incisor sockets of rats.

Toxicity experiments were conducted in vitro and in vivo, to testify the safety dosage of sHAp. Around 24 mature male Sprague–Dawley (SD) rats had their upper central incisors extracted. The rats were placed into three groups of eight rats each: Group 1: the sockets of extracted central incisors were left unfilled (control), Group 2: filled up with commercially available hydroxyapatite (HAp) and Group 3: implanted with sHAp locally retrieved from eggshells. After extraction, four rats from each group were sacrificed at 2nd and 4th weeks. Maxillary tissue sections were obtained and stained with hematoxylin and eosin (H&E) and Masson’s trichome (MT) staining. Anti-osteocalcin (OCN) and proliferating cell nuclear antigen (PCNA) were used primary antibodies for immunohistochemistry (IHC) special labeling.

The results showed that the locally implanted sHAp was non-toxic and safe in cell lines (human osteoblast and fibroblast) and animals. Histological analysis of H&E, MT and IHC showed that the sockets treated with locally implanted sHAp from eggshells were filled with new bone tissue of comparable thickness to other groups.

This unique technique uses locally implanted eggshell-derived sHAp with osteoconductive characteristics. In an in vivo model, sHAps increased OCN and PCNA expression to improve bone repair.

The purpose of this paper is to provide an overview of different understandings regarding the concept of “what constitutes halal” and “who determines this concept?” In practice, this equates to contemporary legal understandings vs religious understandings. The paper further aims to provide an overview of competing Muslim understandings regarding the concept of “What does or does not constitute halal slaughter?” In practice, this equates to evaluating the application of no stunning at all upon an animal (unanimous acceptance) vs the application of reversible stunning upon an animal (contested).

The study includes a review of prior literature and considers the current scenario of the halal poultry trade and raises important questions regarding Islamic dietary practices, halal food integrity, religious and animal welfare understandings. Three key questions were raised: “To what extent does stunning impact halal slaughter?”; “Who determines what is halal slaughter?”; and “What are the variations and tensions between legal and religious understandings of halal slaughter?”.

The examination of such requirements and concomitant consumer and provider expectations is underpinned by a study of an operational framework, i.e. industry practices with poultry (hand slaughter, stunning, mechanical slaughter, etc.), ethical values and market forces to appraise whether there is a point of convergence for these that can be beneficial for both seller and consumer concerns. This paper has considered different perspectives on the religious slaughter and provided an overview of competing understandings regarding the above concepts.

This study although academic and philosophical in nature, raises questions on route to suggesting future research directions. It provides real value in stimulating more research in the area of halal food production and contributes to the understanding of different slaughter requirements for religious slaughter and the meat industry. It further sheds light on not only the religious and secular legal frameworks on animal slaughter and welfare but also the variations in understanding between them and provides examples of attempts to bridge any gap. The paper highlights the importance of halal food based on religious values and its implications for wider society.