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Background: The configuration of having separate mental health services by age, namely child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), might be a barrier to continuity of care that adversely affects young people's mental health. However, no studies have investigated whether discontinuity of care in the transition period affects mental health. We aimed to discern the type of care young people receive after reaching the upper age limit of their CAMHS and examine differences in outcomes at 24-month follow-up between young people receiving different types of care. Methods: To assess mental health in young people from 39 CAMHS in eight European countries (Belgium, Croatia, France, Germany, Italy, Ireland, the Netherlands, and the UK), we did a longitudinal cohort study. Eligible young people were CAMHS users up to 1 year younger than the upper age limit of their CAMHS or up to 3 months older, if they were still in CAMHS. Information on mental health service use, mental health problems (ie, using the Health of the Nation Outcome Scale for Children and Adolescents, Youth Self-Report and Adult Self-Report, DSM-5, and ICD-10), and sociodemographic characteristics were collected using self-reported, parent-reported, and clinician-reported interviews and questionnaires. Mixed models were applied to assess relationships between baseline characteristics, mental health service use, and outcomes. Findings: The MILESTONE cohort included 763 young people. The participants were 60·0% female (n=458) and 40·0% male (n=305), 90·3% White (n=578), and had a mean age of 17·5 years (range 15·2–19·6 years). Over the 24-month follow-up period, 48 young people (6·3%) actively withdrew from the study. For young people, the higher their scores on the Health of the Nation Outcome Scale for Children and Adolescents (p=0·0009) and Youth Self-Report and Adult Self-Report (p=0·046), and who had a clinical classification of severe mental illness (p=0·0033), had suicidal thoughts or behaviours or self-harm (p=0·034), used psychotropic medication (p=0·0014), and had a self-reported or parent-reported need for continued treatment (p

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to become best practice guidelines for a future pragmatic randomised controlled trial with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London was analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, and the patterns of combined herb use and the correlations between these patterns and the presenting symptoms is analysed by means of factor analysis. Treating these use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice. We discuss the advantages and limitations of the methods – action based clinical study plus factor analysis – we employed to this end.

Almost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge - accessed directly or via practitioners' clinical usage - in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.

Purpose : Growing numbers of people with intellectual disabilities are diagnosed with a life-limiting illness such as cancer. Little is known about disclosure of diagnosis and prognosis to this group. The study aim was to explore how much people with intellectual disabilities who have cancer understand about their diagnosis and prognosis, and to explore how much they are told about their cancer. Method : 13 people with intellectual disabilities and cancer took part in a 3-year ethnographic study. Data collection consisted mostly of participant observation. Participants were visited regularly for a median of 7 months. Results : Eleven participants were told that they had cancer, but most were not helped to understand the implications of this diagnosis or their prognosis. Decisions around disclosure, as well as the task of truth-telling, rested mostly with relatives and paid carers. Those with severe/profound intellectual disabilities were most likely to be protected from the truth. Understanding was affected by cognitive ability, life experience and truth-telling. Lack of understanding affected the ability to take decisions about treatment and care. Conclusions : Existing models for breaking bad news are inadequate for people with intellectual disabilities. The findings suggest that more open communication is needed, but further studies are needed to establish best practice in this area.

First, to investigate cross-cultural variations in symptom prevalence for mid-life women using data from studies undertaken in the UK, Japan, China, Canada and the USA, and, second, to examine the relationship between symptoms, ethnicity, age and menopausal status for London's multi-ethnic urban women aged 45-55 years.Cross-sectional, self-administered, postal questionnaire of women aged 45-55 years in London, UK (n = 1115), recruited from general practitioner lists. Participants recalled 15 general symptoms and the prevalence rates were compared with those of cohorts from methodologically similar studies.London women experienced high levels of general symptom reporting. Tiredness was the most prevalent symptom (65%) followed by aches or stiffness in the joints (54%). The prevalence of seven symptoms varied by menopausal group. Only the symptom of hot flushes varied by age. Tiredness, insomnia and irritability varied by ethnic group. The pattern of symptom reporting for the London cohort was more similar to the pattern of women in Beijing than to the pattern of cohorts in Manitoba, Massachusetts and Japan.Our data do not support the existence of a single menopausal syndrome. There appears to be dialectic between culture and biology. It can be argued that symptoms experienced during the menopausal transition arise through a complexity of factors, not simply declining levels of estrogen or ethnicity; geographic location, local culture and temporality are factors that also need to be taken into account.

Reciprocal neonatal injections of spleen cells into CBA/HT6Crc and AKR mice rendered these animals highly tolerant as judged by persistence of reciprocal skin grafts. Chimaerism was demonstrated in several cases, although there was no AKR “takeover” as demonstrated in previous studies with early embryo aggregation (E.E.A.) chimaeras. Lymphoma incidence in AKR mice made tolerant to CBA was similar to that seen in normal AKR. In contrast to normal CBA in which there is no incidence of lymphoma, the CBA made tolerant to AKR died with lymphomas. However, the latent period was delayed and was similar to that seen in (CBA × AKR) Fl hybrids. Murine leukaemia virus (MuLV) p30 levels in the tolerant CBA were also elevated and comparable to those seen in AKR. Reciprocal thymic grafting, which was in some groups of mice accompanied by further injections of lymphoid cells from the donor strain, appeared to have no effect on lymphoma incidence. The CBA lymphomas were, therefore, attributed to MuLV present in the original spleen cell injections. These findings differ from those of Miller, who found that there was no occurrence of lymphoma in low leukaemic C3H mice made tolerant of AK1 cells during the neonatal period.

Marker chromosome analysis of 18 tetraparental AKR↔CBA/H-T6 chimaeras revealed a great excess of AKR mitoses over CBA mitoses in direct preparations from lymphomyeloid tissues, corneal epithelium, intestinal epithelium and skin (Table 1). The degree of AKR dominance was strongly influenced by anatomical site (Tables 2 and 3). The testes of three out of four XY/XY males contained a marked excess of AKR germ cells and produced a parallel excess of functional AKR gametes (Table 4). Mitotic spreads in mitogen-stimulated cultures of tail blood were overwhelmingly of AKR type in 1972, but less so in 1973 (Table 5). The coat phenotypes, and breeding results from known or presumptive XX/XX females, suggest that AKR and CBA cells were numerically balanced when melanoblasts and oocytes were formed during embryonic development, and therefore that the striking deviations from equality observed in mitotic populations of adult chimaeras arose later by differential proliferation or survival of AKR cells, or both. The low frequency of lymphomas, compared with normal AKR mice, previously reported in these chimaeras cannot therefore be accounted for by insufficiency of AKR cells in the thymus or elsewhere in the lymphomyeloid tissues. One of three lymphomas studied was CBA type. This suggests that the high risk of lymphomatous transformation is not an autonomous property of AKR cells.

The fluidized bed electrowinning of zinc from chloride electrolytes has been studied in a laboratory cell. The cell was operated at superficial current densities in the range 1200–7500 A/m 2 with catholytes containing up to 62 kg/m 3 Zn and up to 28 kg/m 3 HCl. Anolytes examined contained 58 kg/m 3 NaCl and up to 100 kg/m 3 HCl and, in some instances, had the same composition as the catholyte. Both “pure” catholytes and ones with deliberate additions of impurities (Ni, Co and Sb) were used. Pure solutions yielded current efficiencies and power consumptions comparable to or better than those of cells with conventional electrodes. Antimony (particularly in combination with Ni and Co) had a detrimental effect on cell performance; this detrimental effect was largely alleviated by simultaneous additions of glue.

We recently noted that, compared with the AKR, lymphoma development was delayed in the (ARK × CBA/H-T 6 Crc) F 1 hybrid, despite levels of murine leukaemia virus that were comparable to or even in excess of those of the ARK. We have now examined the (ARK × CBA/H-T 6 Crc) F 1 first and second backcross to AKR, to study the genetic factors which effect a delay in lymphoma incidence in the F 1 . In the [(AKR × CBA) × AKR] first backcross there appeared to be three distinct ‘peaks' in respect of incidence, also distinct patterns as to the morphological type of lymphoma seen. The earliest peak corresponded to and indeed is held to represent the development of lymphomas in the AKR × AKR progeny ( 25–55 weeks ). Here thymic involvement was frequent but more so in the second backcross. The third peak ( 80–110 weeks ) where tumours were generally confined to the second year of life, was considered to represent the delayed incidence of lymphomas in the (AKR × CBA) F 1 progeny where thymic involvement was less common than that seen in the AKR. The second peak was intermediate both in time of appearance ( 55–75 weeks ) and in frequency of thymic involvement. If the three groups represent true phenotypes including an intermediate ‘recombinant' this would indicate that the resistance of the CBA/H-T 6 Crc (Fv- 1 n , H- 2 k ) may not be due to one unknown dominant gene, but to two or more such genes. Results obtained with the second backcross substantiate this concept.

Early embryo transfer has been used here to investigate susceptibility to lymphomas in mice. Lymphoma resistant CBA were transplanted at the early blastocyst stage, derived and milk fostered from lymphoma-prone AKR. In spite of this, the tumour resistance of the CBA was maintained. The fact that no lymphomas were noted suggests that neither the transplacental nor the transmammary route is of significance in determining lymphoma susceptibility in this situation. CBA would therefore appear to possess one or more genes at loci (other than H- 2 , Fv- 1 and Fv- 2 susceptibility loci) which render them resistant to lymphomas.

An infant was delivered by caesarean section and maintained in a " germfree " isolation unit for 6 days during which absence of bacteria was demonstrated by microbiological tests. This procedure was done as part of a programme for the treatment of potential cases of immunity deficiency, but since this infant was not affected with combined immunity-deficiency state, as her brother had been, she was removed from the germfree isolation unit.