Search

There have been many studies that have supported the teaching of grammar and many that have not, mainly because grammar teaching did not seem to have a marked improvement on students' writing. In English speaking countries, traditional grammar ceased to be taught in the late 1960s after the Dartmouth Conference of 1966, which proved to be a catalyst for change in government policy in those countries. As a consequence, grammar has been taught in a progressively attenuated manner since that time. Australia has now inaugurated a national curriculum requiring teachers to teach grammar. The question is whether, after almost 50 years of this situation, teachers are equipped to fulfil this requirement. As this policy has been instrumental in the preparation of teachers in different educational sectors (in domestic school settings and in international English teaching settings), this study was conducted with a group of teachers in an English language teaching centre attached to an Australian university, providing tuition for international students intending to pursue tertiary studies through the medium of English language. The aim of this study was to discover whether teachers of English at the language teaching centre experience difficulties in their own understanding of English traditional grammar, and, if so, which aspects of grammar cause them particular difficulty. Those grammar items identified as problematic would be included in a professional development program specifically devised for teachers at that centre. Teachers' views on the importance of grammar were also canvassed. The study was conducted as an action research project, employing a mixed method approach with collection of both quantitative and qualitative data. The study was carried out in three distinct phases. This study was a sequential one, with each phase analysed before the next phase began, and with each phase informing the subsequent one. Instruments used in the three phases were (i) inventories; (ii) surveys; and (iii) semi-structured interviews. The study had five major findings, the first and most important of which was that many of the respondents showed a lack of understanding of certain aspects of grammar. There was also some evidence regarding lack of confidence in this area. Teaching grammar in context was the most preferred method among the respondents. The findings fulfilled the study objectives which included gaining teacher views on the significance and importance of grammar knowledge in TESOL teaching; discovering any gaps in the respondents' grammar knowledge; and devising a professional development program in grammar specifically tailored to their needs. Some of the implications resulting from this study are that: (i) universities should take a more visible and concerted lead in teaching grammar to student teachers to better prepare them for (a) teaching grammar in domestic schools to fulfil the aspirations of the new Australian Curriculum; and (b) teaching grammar to international students, who expect their teachers to impart sound grammar knowledge to them; (ii) all teaching institutions (both schools for domestic students and English teaching centres for international students at tertiary level) should provide professional development in grammar for current teachers.

Objective: We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries. Subjects and Methods: The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared. Results: The odds ratios for head and neck cancer sites associated with smoking duration differed between less developed and more developed countries. Smoking greater than 20 years conferred a higher risk for oral cavity and laryngeal cancer in more developed countries, whereas the risk was greater for oropharynx and hypopharynx cancer in less developed countries. Alcohol consumed for more than 20 years conferred a higher risk for oropharynx, hypopharynx, and larynx cancer in less developed countries. The proportion of cases that were young (

Objectives To assess a targeted ‘therapy as required’ model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty patient reported outcomes and whether it was possible to predict which patients would access post-discharge physiotherapy from pre-operative data. Design Prospective, observational, longitudinal cohort study. Setting Single National Health Service orthopaedic teaching hospital in the UK. Participants 1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty. Primary and secondary outcome measures Self-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric. Results 662 (48.2%) patients with TKA and 493 (35.3%) patients with THA accessed additional post-discharge physiotherapy. Patient-reported outcomes (p Conclusions In a choice-based service model of ‘therapy as required’ following hip and knee arthroplasty only a third of THA and half of TKA patients accessed post-discharge therapy. Patients who did not access physiotherapy reported greater post-operative outcomes. This variation in the need for post-discharge physiotherapy suggests that targeting of rehabilitation may be a cost-effective model, however it was not possible to reliably predict which patients would access post-discharge physiotherapy from pre-operative data.

The UK’s food supply will be affected by Brexit whatever the outcome of the Parliamentary vote on the Draft Withdrawal Agreement. As the 29 March 2019 date for leaving the EU approaches, preparations to ensure we maintain a safe, adequate and sustainable food supply need to start urgently. Local Authorities (LAs) have a vital part to play in these preparations. More guidance, paying attention to the food specifics, is felt to be needed.\ud \ud LAs have a key role in the UK’s food system, with responsibilities including the enforcement of food safety and standards regulation, the control of imported food at ports and airports and the certification of foods for export. They also have unique knowledge of relevant local professionals, institutions, businesses and networks.\ud \ud This briefing aims to help Local Authorities prepare for Food Brexit. It shows why LAs should prepare Food Brexit Plans, and outlines five courses of action they could consider.\ud \ud The briefing recommends that Local Authorities:\ud • Create Food Resilience Teams\ud • Anticipate and reduce the impact of Food Brexit, particularly on SMEs\ud • Narrow the information gap and treat the public openly and fairly\ud • Prepare for public engagement\ud • Be a local food voice so that central government knows the local realities.

Objective The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ' expert opinion'. Methods A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/nonpharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. Results 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on metaanalyses, the only ' strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on nonpharmacological therapies. In case of non-response, further therapies (all of which were evaluated as ' weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). Conclusions These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Objectives: The MUSICIAN study has previously\ud shown short-term benefit but only marginal costeffectiveness for two non-pharmacological\ud interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.\ud Methods: A 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.\ud Results: 884 persons were eligible, 442 were\ud randomised and 81.7% were followed up 24 months\ud post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more\ud intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs.\ud Cost per quality adjusted life year was £3957–£5917 depending on method of analysis.\ud Conclusions: A short course of tCBT for people with CWP was effective long-term and was highly costeffective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions.\ud Trial registration number: ISRCTN67013851.

Objectives - To assess the health impact of hip pain at the time of first presentation to primary care, and the influence on this of radiographic evidence of osteoarthritis. Subjects and methods - Cross sectional survey of 195 patients (63 male, 132 female), aged 40 years and over, presenting with a new episode of hip pain, recruited from 35 general practices across the UK. Health status at presentation was determined by a structured questionnaire on symptoms, healthcare use, and health related quality of life (SF-36). Pelvic radiographs were assessed blindly for hip osteoarthritis using standard scoring systems. Results - The overall impact on health was substantial. Before their first consultation, three quarters of patients needed analgesics, half used topical creams or ointments, and one in eight used a walking stick. Most of these impact measures were, however, unrelated to the degree of radiographic change, though use of a walking stick was increased in those with the most severe damage. Health status, as judged by the SF-36, was also impaired for measures of physical function and pain, but the impact on the 'mental health', 'general health', and 'vitality' dimensions was small. There was a weak relation between the SF-36 scores and radiographic change, with many domains unrelated to the severity of radiographic damage. Conclusions - This study is the first to show the therapeutic impact and pattern of impairment in health status resulting from hip pain at the time of first presentation to the healthcare services. Unlike many regional pain syndromes seen in primary care, such as back pain, hip pain does not impact on wider aspects of quality of life, such as general health status, mental health, or vitality. Furthermore, any impact of hip pain in this group is not markedly influenced by the degree of structural damage. Further follow up is required to determine whether such damage influences the persistence of any adverse impact.

BACKGROUND: The aim of the study was to test the hypothesis that associations with specific stress systems [hypothalamic-pituitary-adrenal (HPA) and growth hormone (GH) axes] would increase as the number of unexplained disorders increased while accounting for the possible confounding effects of psychosocial factors. METHODS: A cross-sectional study identified those reporting chronic widespread pain, irritable bowel syndrome, chronic orofacial pain and chronic fatigue. Of the 1315 subjects, disorder status was available for 1180 (89.7%), of whom 766 (64.9%) reported no disorders, 277 (23.5%) reported one and 137 (11.6%) reported two or more. Eighty subjects were sought from each group for assessment of HPA (morning 8:00 a.m. and evening 10:00 p.m. saliva, and post-dexamethasone serum cortisol levels) and GH [serum insulin-like growth factor 1 (IGF-1) level] axis function. Validated questionnaires informed current psychological state. RESULTS: Two hundred twenty-seven subjects participated [79 (35%) with no disorders, 78 (34%) with one disorder and 70 (31%) with two or more disorders]. There were no significant associations (p < 0.05) between individual disorders or an increasing disorder load with any of the neuroendocrine levels measured: saliva/serum cortisol, IGF-1 and dehydroepiandrosterone. Psychosocial factors were independently associated with disorders and with an increasing disorder load: health anxiety p < 0.01, anxiety p < 0.01, depression p < 0.01, life events p = 0.03. CONCLUSION: Although previous studies have shown that stress axis function acts to moderate the risk of onset of some of these disorders, the present study shows that the degree of dysfunction is not correlated with a corresponding increasing load of disorders. The uncertainty surrounding the role of these biomarkers in the aetiology of unexplained disorders needs further investigation.

Background: The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer. Methods: A multicentre (10 European countries) case-control study [Alcohol-Related CAncers and GEnetic susceptibility (ARCAGE) project]. Results: There were 1779 cases of UADT cancer and 1993 controls. History of warts or C. albicans infection was associated with a reduced risk [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.68-0.94 and OR 0.73, 95% CI 0.60-0.89, respectively] but there was no association with herpetic lesions, heartburn, regurgitation or medication for related symptoms. Regurgitation was associated with an increased risk for cancer of the oesophagus (OR 1.47, 95% CI 0.98-2.21). Regular aspirin use was not associated with risk of UADT cancer overall but was associated with a reduced risk for cancer of oesophagus (OR 0.51, 95% CI 0.28-0.96), hypopharynx (OR 0.53, 95% CI 0.28-1.02) and larynx (OR 0.74, 95% CI 0.54-1.01). Conclusions: A history of some infections appears to be a marker for decreased risk of UADT cancer. The role of medical history and medication use varied by UADT subsites with aspirin use associated with a decreased risk of oesophageal cancer and suggestive of a decreased risk of hypopharyngeal and laryngeal cancers.

Introduction: In the European Union, there are 180,000 new cases of upper aerodigestive tract (UADT) cancer cases per year - more than half of whom will die of the disease. Socioeconomic inequalities in UADT cancer incidence are recognised across Europe. We aimed to assess the components of socioeconomic risk both independently and through their influence on the known behavioural risk factors of smoking, alcohol consumption and diet. Patients and methods: A multicentre case-control study with 2198 cases of UADT cancer and 2141 controls from hospital and population sources was undertaken involving 14 centres from 10 countries. Personal interviews collected information on demographics, lifetime occupation history, smoking, alcohol consumption and diet. Socioeconomic status was measured by education, occupational social class and Unemployment. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using Unconditional logistic regression. Results: When controlling for age, sex and centre significantly increased risks for UADT cancer were observed for those with low versus high educational attainment OR = 1.98 (95% CI 1.67, 2.36). Similarly, for occupational socioeconomic indicators - comparing the lowest versus highest International Socio-Economic index (ISEI) quartile for the longest occupation gave OR = 1.60 (1.28, 2.00); and for unemployment OR = 1.64 (1.24, 2.17). Statistical significance remained for low education when adjusting for smoking, alcohol and diet behaviours OR = 1.29 (1.06, 1.57) in the multivariate analysis. Inequalities were observed only among men but not among women and were greater among those in the British Isles and Eastern European countries than in Southern and Central/Northern European countries, Associations were broadly consistent for subsite and source of controls (hospital and community). Conclusion: Socioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet. (C) 2009 Elsevier Ltd. All rights reserved.

OBJECTIVES: To assess the health impact of hip pain at the time of first presentation to primary care, and the influence on this of radiographic evidence of osteoarthritis. SUBJECTS AND METHODS: Cross sectional survey of 195 patients (63 male, 132 female), aged 40 years and over, presenting with a new episode of hip pain, recruited from 35 general practices across the UK. Health status at presentation was determined by a structured questionnaire on symptoms, healthcare use, and health related quality of life (SF-36). Pelvic radiographs were assessed blindly for hip osteoarthritis using standard scoring systems. RESULTS: The overall impact on health was substantial. Before their first consultation, three quarters of patients needed analgesics, half used topical creams or ointments, and one in eight used a walking stick. Most of these impact measures were, however, unrelated to the degree of radiographic change, though use of a walking stick was increased in those with the most severe damage. Health status, as judged by the SF-36, was also impaired for measures of physical function and pain, but the impact on the "mental health", "general health", and "vitality" dimensions was small. There was a weak relation between the SF-36 scores and radiographic change, with many domains unrelated to the severity of radiographic damage. CONCLUSIONS: This study is the first to show the therapeutic impact and pattern of impairment in health status resulting from hip pain at the time of first presentation to the healthcare services. Unlike many regional pain syndromes seen in primary care, such as back pain, hip pain does not impact on wider aspects of quality of life, such as general health status, mental health, or vitality. Furthermore, any impact of hip pain in this group is not markedly influenced by the degree of structural damage. Further follow up is required to determine whether such damage influences the persistence of any adverse impact.

OBJECTIVE: To determine the prevalence of radiographic osteoarthritis in subjects with hip pain newly presenting to primary care. METHODS: The study was cross-sectional in design, set in 35 general practices across the UK. It included 195 men and women aged 40 yr and over (median 63 yr) presenting with a new episode of hip pain. Hip radiographs were scored for minimum joint space (MJS) and overall-Croft's modification of the Kellgren and Lawrence (Croft)-grade of osteoarthritis. RESULTS: In all, definite evidence of radiographic change in the painful joint was common: Croft grade > or =2 in 44%, > or =3 in 34%. MJS of 2.5 mm or less was seen in 30% of whom half were below 1.5 mm. There were no significant gender differences in radiographic severity. CONCLUSIONS: Radiographic change is common in patients newly presenting with hip pain and many already have advanced disease.

The use of non-invasive geophysical techniques is becoming increasingly important in archaeological site studies as a means to increase the efficiency of excavation and to thereby avoid unnecessary disturbance. Ground-penetrating radar (GPR) surveys were performed over an orthogonal grid in order to guide the decision-making process for planning excavation at a Roman site in Pollena Trocchia (Italy), located just off the NW flank of Somma-Vesuvius. Archaeological planning for this site is complicated by contextual disruption and intermittent backfill, sometimes exacerbated by its proximity to building sites and by its use as a landfill, and by prior archaeological excavation and subsequent remediation. From a geophysical point of view, the site at Pollena Trocchia provided an ideal test-bed for visualization experiments (a) because the ground surface was readily cleared and smoothed by earth-moving machinery and (b) because the soil derived from geologically recent volcanic ash was dry at the time of the survey. State-of-the-art geophysical visualization techniques were applied to the pseudo-3D GPR data using conventional displays, seismic attribute analysis, and waveform connectivity schemes as employed in petroleum exploration. In this way, we assess the value of applying strategies adapted from industrial 3D seismic imaging to the problem of defining the effects of previous disturbance at a complex archaeological site.

Thyroid cancer is one of the rarest forms of cancer, yet there are wide variations in the degree of malignancy, ranging from the most rapidly fatal to the relatively benign. This is almost entirely dependent on the histological type. Generally speaking, data available on changing trends of incidence and mortality are subject to reservation, dependent on the degree to which they have been influenced by changing diagnostic criteria and the precision of histopathological description. Nevertheless, there is evidence that mortality is slowly decreasing, while incidence is slowly increasing. The purpose of this review is to try to interpret the temporal trends of incidence and mortality rates for thyroid carcinoma in the last 3 decades in light of the problems arising from changes in diagnostic standards and histological classification regarding thyroid neoplasms. Attention is also drawn to the implications, from a public health viewpoint, of the present intensive detection and treatment of occult thyroid carcinomas.

Background Alcohol is a well-established risk factor for head and neck cancer (HNC). This study aims to explore the effect of alcohol intensity and duration, as joint continuous exposures, on HNC risk. Methods Data from 26 case-control studies in the INHANCE Consortium were used, including never and current drinkers who drunk ≤10 drinks/day for ≤54 years (24234 controls, 4085 oral cavity, 3359 oropharyngeal, 983 hypopharyngeal and 3340 laryngeal cancers). The dose-response relationship between the risk and the joint exposure to drinking intensity and duration was investigated through bivariate regression spline models, adjusting for potential confounders, including tobacco smoking. Results For all subsites, cancer risk steeply increased with increasing drinks/day, with no appreciable threshold effect at lower intensities. For each intensity level, the risk of oral cavity, hypopharyngeal and laryngeal cancers did not vary according to years of drinking, suggesting no effect of duration. For oropharyngeal cancer, the risk increased with durations up to 28 years, flattening thereafter. The risk peaked at the higher levels of intensity and duration for all subsites (odds ratio = 7.95 for oral cavity, 12.86 for oropharynx, 24.96 for hypopharynx and 6.60 for larynx). Conclusions Present results further encourage the reduction of alcohol intensity to mitigate HNC risk.

Objective:\ud \ud To summarize the latest evidence on head and neck cancer epidemiology from the International Head and Neck Cancer Epidemiology (INHANCE) consortium.\ud \ud Subjects and Methods:\ud \ud INHANCE was established in 2004 to elucidate the etiology of head and neck cancer through pooled analyses of individual‐level data on a large scale. We summarize results from recent INHANCE‐based publications updating our 2015 overview.\ud \ud Results:\ud \ud Seventeen papers were published between 2015 and May 2020. These studies further define the nature of risks associated with tobacco and alcohol, and occupational exposures on head and neck cancer. The beneficial effects on incidence of head and neck cancer were identified for good oral health, endogenous and exogenous hormonal factors, and selected aspects of diet related to fruit and vegetables. INHANCE has begun to develop risk prediction models and to pool follow‐up data on their studies, finding that ~30% of cases had cancer recurrence and 9% second primary cancers, with overall‐ and disease‐specific 5‐year‐survival of 51% and 57%, respectively.\ud \ud Conclusions:\ud \ud The number and importance of INHANCE scientific findings provides further evidence of the advantages of large‐scale internationally collaborative projects and will support the development of prevention strategies.

Letter; International audience; Lung cancer is the most common cause of cancer death worldwide, with over one million cases annually1. To identify genetic factors that modify disease risk, we conducted a genome-wide association study by analysing 317,139 single-nucleotide polymorphisms in 1,989 lung cancer cases and 2,625 controls from six central European countries. We identified a locus in chromosome region 15q25 that was strongly associated with lung cancer (P = 9 × 10$^{-10}$). This locus was replicated in five separate lung cancer studies comprising an additional 2,513 lung cancer cases and 4,752 controls (P = 5 × 10$^{-20}$ overall), and it was found to account for 14% (attributable risk) of lung cancer cases. Statistically similar risks were observed irrespective of smoking status or propensity to smoke tobacco. The association region contains several genes, including three that encode nicotinic acetylcholine receptor subunits (CHRNA5, CHRNA3 and CHRNB4). Such subunits are expressed in neurons and other tissues, in particular alveolar epithelial cells, pulmonary neuroendocrine cells and lung cancer cell lines, and they bind to N′-nitrosonornicotine and potential lung carcinogens. A non-synonymous variant of CHRNA5 that induces an amino acid substitution (D398N) at a highly conserved site in the second intracellular loop of the protein is among the markers with the strongest disease associations. Our results provide compelling evidence of a locus at 15q25 predisposing to lung cancer, and reinforce interest in nicotinic acetylcholine receptors as potential disease candidates and chemopreventative targets