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Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

In Britain, labor−management partnership has been the fulcrum of the Labor Government's employment relations programme since its election in 1997. The Involvement and Participation Association (IPA, 1997; website: http://www.partnership-at-work.com) − the influential employers’ organization − has been at the forefront of promoting labor−management partnership to improve productivity in UK firms through greater employee involvement and participation (see http://www.partnership-at-work.com). The Trades Union Congress (TUC; partnership institute website: http://www.partnership-institute.org.uk) and several of its constituent unions have also endorsed partnership with employers as a route to promote employee ‘voice’ at work, secure better bargaining outcomes and improve union membership levels and density (Undy, 2001). Union density in the UK private sector has declined from 19.9 per cent in autumn 1997 to 17.2 per cent in autumn 2005, while in the public sector it has declined from 60.9 per cent to 58.6 per cent over the same period of time (Grainger, 2006). Advocates of partnership argue that such arrangements deliver mutual gains to the parties involved, viz. higher productivity and profits for employers, better wages and higher employment security to workers and greater influence over management decisions for unions, which in turn help them to attract and recruit new members (e.g. Haynes & Allen, 2001; Deery & Iverson, 2005).

Given its importance in the brand management of sport teams, the present research initiative primarily concerns the investigation of the formation process of sport team loyalty. By integrating a hierarchy of effects model into a relational perspective, the study aims to investigate the role of sport consumers' involvement, self-expression, trust and attachment with a sport team in building loyal relationships. A conceptual model is proposed and tested in the context of professional soccer teams.

The data of the study comes from 287 consumers of a South East European country. The fit of the model is tested using structural equation modeling and the statistical program LISREL.

The results confirm that: all the hypothesized constructs constitute either direct or indirect determinants of sport team loyalty; a hierarchy of effects approach, cognition-affect-conation, can explain how strong consumers-team relationships can be developed; and team attachment acts as a partial mediator in the relationship between the cognitive components of the model (team involvement, trust and self-expression) and team loyalty.

The findings provide several implications to marketing managers of sport teams in how to go about and develop loyal sport fans.

No previous investigation has integrated relationship marketing with a hierarchy of effects in order to explain loyalty to a sport team.

CIRCULAR 452. MINISTRY OF HEALTH, Whitehall, S.W.1. 8th November, 1923. SIR, I am directed by the Minister of Health to forward for the information of the Local Authority the enclosed copy of the Public Health (Dried Milk) Regulations, 1923, prescribing the labelling and composition of dried milk. The Regulations will come into operation on the 1st May, 1924.

Sir Kingsley Wood, the Minister of Health, speaking at Plymouth on September 15th, said the problem of nutrition was one to which increased attention must be given in the light of modern scientific knowledge. In all our consideration of it we should not forget the necessity of pure, wholesome food. The consumption of food of all kinds in the United Kingdom had grown considerably. To‐day it was probably over 25 million tons a year. The consumption of dairy products and of eggs, fruit and vegetables, so important to good nutrition, had greatly increased. It was vital to our good health that our food supply should not only be unimpaired by the addition of harmful substances, but that there should be no abstraction from articles of food of their proper qualities. It was only fair that the public should get what they asked and paid for. There had undoubtedly been a considerable improvement in the food standards in this country. It had been achieved largely by the Health Authorities and their professional advisers, as well as producers and manufacturers themselves. Some 60 years ago some 15,000 samples only were submitted to Public Analysts, and over 19 per cent. were found to be adulterated or not up to standard. Last year over 143,000 samples were submitted—the highest on record—and the percentage adulterated or not up to standard was a little over 5 per cent. For a variety of reasons the true percentage of adulterated food was probably less than was indicated in this figure. It could be fairly said that nowadays there was very little gross adulteration or deliberate substitution of one article of food for another. But we still had to be vigilant to see to it that the public had some sort of guarantee that they were getting what they asked for, and that food did not contain ingredients which would render it injurious to health. The consumer's interest must always come first both from the point of view of fair trading and good health. There was also no doubt about the high nutritional value of milk, and we must do all we can to increase the consumption of clean and safe milk.

Developments in document supply in Australia in the five years following the Library Association of Australia's 1980 national interlending conference are surveyed. Little progress seemed to have been made, apart from the development of the Australian Bibliographic Network, by the time of the second interlending conference in 1983. Six resolutions from this conference were considered in the LAA's National Plan for Document Supply and Delivery. A Document Delivery Conference was called in November 1984 to discuss reactions to the plan, and a working party was formed to progress the Conference's recommendations. The working party's final report is due shortly, and indications are that the National Library of Australia is set to assume a major role in interlibrary lending.

Educational psychologists have, over the last half century or so, directed their attention to the study of student motivation. While teachers have not entirely been ignored, there has been little inquiry into teacher motivation that has been systematic and theory-driven. The concentration on students has tended to overlook the centrality of teacher motivations as integral to teachers’ goals, beliefs, perceptions, aspirations, and behaviours, and thereby to student motivations and learning. It is perhaps not surprising that those motivation researchers who have developed robust theories in relation to student learning in educational contexts would begin to turn their attention to teachers, to see whether those same theories might have explanatory power with regard to teacher motivations. Teacher self-efficacy research (e.g., Tschannen-Moran & Woolfolk Hoy, 2007; Woolfolk Hoy & Burke-Spero, 2005) has made important contributions to the study of teachers. Motivation researchers are now beginning to turn their attention to other aspects of the complex of motivational factors which demand greater attention and exploration. Robust theoretical frameworks already exist in the motivation literature, which can be applied to guide future research in this area. There has recently been a surge of interest, or what we have elsewhere described as a “Zeitgeist” (Watt & Richardson, 2008a) in applying well-developed theories in motivation research, to the domain of teaching.

Information transfer involves several agents and costs are incurred at various stages of the process. Although interlibrary loan practices were established on the basis of reciprocity among institutions, the imbalance between net lenders and net borrowers has been causing concern about the costs of such a service and who should bear them. Interlibrary loan charges are one means of distributing among libraries the actual costs of the information transfer process. On the other hand, it is in the public interest to allow access to appropriate information banks and interlibrary loan facilitates resource sharing schemes and therefore better use of those resources. Charging can be seen as a rationing mechanism: negative in effect and against the public good.