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Temporomandibular joint disorders (TMD) affect up to 50% of the population. Chronic TMD may have a significant impact on patients' quality of life and is associated with a significant cost burden to health services.The aim of this study was to investigate the incidence of TMD in Greater Manchester and to determine the most appropriate setting for its management.Data were retrospectively collected on the demographics, symptoms and management provided to patients referred for TMD.There were 789 referrals analysed; 616 to a Tertiary Centre and 173 to a District General Hospital (DGH). The most common reason for referral was pain (82%), followed by limitation in opening (55%) and clicks or sounds (44%). 27% of referrals were managed with a splint and 12% were provided with advice or a patient information leaflet prior to referral.The effect of chronic pain on patients' quality of life and the cost burden of its management compels us to review current practices in referral and management of TMD. Barriers to provision of treatment in primary care may include a lack of training, remuneration or confidence. These may be overcome with the development of self-care plans for patients and a care pathway for practitioners.Based on existing evidence, timely and conservative management of TMD should be encouraged in primary care, enabling better outcomes to be achieved for patients and the maintenance of the experience and skill level of specialist services in secondary care.

Background: Molecular profiling has identified at least four subtypes of invasive breast carcinoma, which exhibit distinct clinical behaviour. There is good evidence now that DCIS represents the non-obligate precursor to invasive breast cancer and therefore it should be possible to identify similar molecular subtypes at this stage. In addition to a limited five-marker system to identify molecular subtypes in invasive breast cancer, it is evident that other biological molecules may identify distinct tumour subsets, though this has not been formally evaluated in DCIS.\ud \ud Methods: Tissue microarrays were constructed for 188 cases of DCIS. Immunohistochemistry was performed to examine the expression patterns of oestrogen receptor (ER), progesterone receptor (PR), Her2, EGFR, cytokeratin (CK) 5/6, CK14, CK17, CK18, β4-integrin, β6-integrin, p53, SMA, maspin, Bcl-2, topoisomerase IIα and P-cadherin. Hierarchical clustering analysis was undertaken to identify any natural groupings, and the findings were validated in an independent sample series.\ud \ud Results: Each of the intrinsic molecular subtypes described for invasive breast cancer can be identified in DCIS, though there are differences in the relative frequency of subgroups, in particular, the triple negative and basal-like phenotype is very uncommon in DCIS. Hierarchical cluster analysis identified three main subtypes of DCIS determined largely by ER, PR, Her2 and Bcl-2, and this classification is related to conventional prognostic indicators. These subtypes were confirmed in an analysis on independent series of DCIS cases.\ud \ud Conclusion: This study indicates that DCIS may be classified in a similar manner to invasive breast cancer, and determining the relative frequency of different subtypes in DCIS and invasive disease may shed light on factors determining disease progression. It also demonstrates a role for Bcl-2 in classifying DCIS, which has recently been identified in invasive breast cancer.

The performance of clinic-referred children aged 6-11 (N = 100) was examined using the Conners' Continuous Performance Test (CPT) and measures of auditory attention (Auditory Continuous Performance Test; ACPT), phonological awareness, visual processing speed, and visual-motor competence. The Conners' CPT overall index was unrelated to measures of visual processing speed or visual-motor competence. Although the Conners' CPT converged with the ACPT, the latter demonstrated age and order effects. Significant variance in Conners' CPT parameters was predicted by phonological awareness measures, suggesting that Reading Disordered (RD) children could be "false positives" on the Conners' CPT. The Conners' CPT overall index, phonological awareness, and visual-motor measures were submitted to a 2 x 2 MANCOVA (ADHD vs. RD, covarying for age and socioeconomic status): a main effect for RD status was found. Children with ADHD did not have higher Conners' CPT scores than did clinical controls; however, children with Reading Disorders did. Phonological measures distinguished RD children from ADHD children and other clinical controls. ADHD children who failed the Conners' CPT were rated by teachers as more hyperactive. Despite the strengths of the Conners' CPT, its utility for differential diagnosis of ADHD is questioned.

Although much research has been performed in recent years on the prevention of suicide, less attention has been focused on helping the persons left behind. This article outlines the history of establishing a support group for people who have been bereaved through suicide in an Australian city. It describes the difficulties in establishing the group, its structure, management, and helping functions, and the experiences gained from the initial 7 years of operation. The article has been written in response to requests from medical, social, and lay agencies for information in establishing similar support groups.

Extra items added to a list cause memory for the other items to decrease (the list-length effect). In one of the present studies we show that strengthening (or weakening) some items on a list harms (helps) free recall of the remaining list items. This is termed the list-strength effect. However, in seven recognition studies the list-strength effect was either absent or negative. This held whether strengthening was accomplished by extra study time or extra repetitions. The seven studies used various means to control rehearsal strategies, thereby providing evidence against the possibility that the findings were due to redistribution of rehearsal or effort from stronger to weaker items within a list. Current models appear unable to predict these results. We suggest that different retrieval operations underlie recall and recognition, as in the SAM model of Gillund and Shiffrin (1984), which can be made to fit the results with certain relatively minor modifications.

Ratcliff, Clark, and Shiffrin (1990) examined the list-strength effect: the effect of strengthening (or weakening) some list items upon memory for other list items. The list-strength effect was missing or negative in recognition, missing or positive in cued recall, and large and positive in free recall. We show that a large number of current models fail to predict these findings. A variant of the SAM model of Gillund and Shiffrin (1984), involving a differentiation hypothesis, can handle the data. A variant of MINERVA 2 (Hintzman, 1986, 1988) comes close but has some problems. Successful variants of a variety of composite and network models were not found (e.g., Ackley, Hinton,Sejnowski, 1985; Anderson, 1972, 1973; Metcalfe Eich, 1982; Murdock, 1982; Pike, 1984). The results suggest constraints on the future development of such models.

Tarsal tunnel syndrome is an infrequent and probably underdiagnosed clinical condition. Diagnosis and treatment depend on understanding the tibial branching pattern within the tarsal tunnel. A total of 68 foot dissections were performed. Bifurcation into the medial and lateral plantar nerves occurred within the tunnel in 93% and proximal in 7%. Proximal bifurcation may predispose to tarsal tunnel syndrome, and its infrequent occurrence correlates with the infrequent clinical diagnosis. Nine different calcaneal branching patterns were noted; they provide an anatomical explanation for heel sparing. An understanding of anatomic variations should aid in providing complete surgical release and in avoiding accidental heel denervations.

Summary. Platelet production time (PPT), based on the measurement of malondial-dehyde (MDA) production prior to and after the intake of acetylsalicylic acid (ASA), was determined in 20 healthy subjects. High MDA levels were produced by stimulating platelet lipid peroxidation with arachidonic acid, resulting in a reliable, sensitive and accurate technique. PPT correlated well with platelet survival time measured by 51Cr autologous labelled platelets when both methods were used simultaneously in the same patients. This modified non-radioisotope method might serve as a useful aid in the diagnosis of platelet disorders, thromboembolic diseases associated with increased platelet consumption and for the evaluation of drugs affecting platelet function.

Subjects learned to classify perceptual stimuli varying along continuous, separable dimensions into rule-described categories. The categories were designed to contrast the predictions of a selective-attention exemplar model and a simple rule-based model formalizing an economy-of-description view. Converging evidence about categorization strategies was obtained by also collecting identification and recognition data and by manipulating strategies via instructions. In free-strategy conditions, the exemplar model generally provided an accurate quantitative account of identification, categorization, and recognition performance, and it allowed for the interrelationship of these paradigms within a unified framework. Analyses of individual subject data also provided some evidence for the use of rules, but in general, the rules seemed to have a great deal in common with exemplar storage processes. Classification and recognition performance for subjects given explicit instructions to use specific rules contrasted dramatically with performance in the free-strategy conditions and could not be predicted by the exemplar model.