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Non-therapeutic medical interventions on the bodies of children born with disorders of sex development (DSD)/intersex variations have been subject to increasing critical scrutiny. In response to recent criticism directed at the United Kingdom, and early moves to consider reform, we report on a freedom of information exercise that sought to evaluate whether National Health Service England is meeting international standards on optimal clinical management of DSD/intersex variations. The study explored what medical protocols are being followed to help inform potential reform, particularly with regard to non-therapeutic surgery. While the exercise revealed limited examples of promising practice, current protocols in the majority of Trusts appear unlikely to meet the complex needs of these children. We identify areas where significant improvement is needed, including data management, consistency in guideline use, composition of multidisciplinary teams and addressing disciplinary hierarchies within teams. These concerns sharpen criticisms of the lack of recognition of children's rights in this context. [ABSTRACT FROM AUTHOR]

Abstract: We describe contemporaneous changes in environmental quality and social deprivation in English local authority districts over four decades, using secondary source GIS modelled data on environmentally intrusive development. The distribution of this development is described with respect to the Townsend material deprivation score, corroborated against the Breadline Britain index. Spatial patterns of environmental intrusion and material deprivation change markedly over the period, although a clear environmental inequality remains throughout. However, it is not the most deprived who experience the greatest decline in their environmental quality, as most of the increase in environmental intrusion occurs in those districts whose population were amongst the most affluent in the early 1960s. We note that the environmental justice implications of these observations are dependent upon conceptions of justice held, and reflect on the challenge of testing, through empirical longitudinal analysis, the notion that environmental sustainability and social justice are incompatible. [Copyright &y& Elsevier]

The article offers an overview on the decision of English composer Edward Elgar's family to move from Hereford to Hampstead in January 1912 in London, England. It mentions that his wife Alice Elgar began to search for houses around the capital and chose the Severn House in Netherhall Gardens. It notes that the composer would be near his publishers and promptly meet conductors as well as persons who wield power and influence in the music world.

Introduction Dental access centres (DACs) were introduced in England at the turn of the twenty-first century in response to a growing problem of access to NHS dental services. DACs were expected to offer NHS dental care primarily to those patients that were unwilling or unable to attend 'high street' dental practice. At the same time, the new NHS primary care dental contract in England, introduced in April 2006, has been associated in some areas with access difficulties, with routine dental patients having difficulty accessing NHS dental care. In light of these changes, have DACs become an alternative provider of NHS dental services to patients seeking routine dental care?Method In summer 2007, a cross sectional dental epidemiological study was undertaken in Halton & St Helens PCT and Warrington PCT to compare the dental health and attitudes to dental visiting of adult patients attending DACs and neighbouring 'high street' dental practices.Results The results of the study showed that DAC patients: were younger and from a more disadvantaged background than patients attending 'high street' practices; had worse oral health than 'high street' dental patients; experienced more frequent episodes of dental pain than 'high street' dental patients and were more likely to be dentally anxious; had different attitudes to dental health than their 'high street' counterparts.Conclusions The study suggests that the DACs in Halton, St Helens and Warrington are offering treatment to a different population of patients to that seen in neighbouring 'high street' practices and therefore the DACs are fulfilling the function expected of them locally. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical performance of a plasma arc light (Ortho LITE, 3M Unitek, Monrovia, CA, USA) against a conventional tungsten-quartz halogen curing light (Visilux 2, 3M Unitek, Monrovia, CA, USA) for direct orthodontic bonding. Design: A single centre prospective randomized controlled clinical trial. Setting: The Orthodontic Department at St Luke's Hospital, Bradford, UK. Subjects and methods: Forty-three consecutive patients requiring fixed appliances from the orthodontic waiting list. A split mouth technique was adopted; with quadrants randomly assigned to either the plasma arc light or the conventional halogen curing light and bonded directly with APC pre-adjusted edgewise brackets (3M Unitek, Monrovia, CA, USA). Main outcome measure: Bracket failures. Secondary out come measures: Time taken to bond-up the appliances, patient sensitivity or discomfort during curing and time to replace failed brackets were investigated. Results: No statistically significant difference in bracket failure rates over the full course of treatment was found between the plasma arc light (6.7%; 95% CI 4.5-10.0) and the halogen curing light (9.5%; 95% Cl 6.8-13.1). There was no statistically significant difference in bracket survival times. The bond-up times were typically reduced by 204 seconds per patient with the plasma arc light. There were no differences in patient reported sensitivity or discomfort or rebond times. Conclusion: The plasma arc light is a viable clinical alternative to the conventional halogen curing light with benefits for both the clinician and patient due to reduced bonding times. [ABSTRACT FROM AUTHOR]

This is a report on the use of a regional database of patients undergoing orthognathic treatment in the South West of England. The benefits and difficulties of using a regional database are discussed. [ABSTRACT FROM AUTHOR]

Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study. [ABSTRACT FROM AUTHOR]

Objective To determine dental attendance and treatment outcomes following two models of dental screening.Design An observational prospective cohort study.Setting Infant, primary and junior schools in the North West of England.Subjects Children aged six to nine years at the start of the study.Interventions Subjects received a screening examination according to either a 'Traditional model' or 'New model' of school dental screeningMain outcome measures Attendance at a dentist within four months of the intervention and treatment received by children referred via the 'New model' with caries in their permanent teeth.Results In the 'New model' of school dental screening 46% of screened positive and 41% of screened negative children attended a dentist during the study period. Some 44% of children referred with caries in permanent teeth attended a dentist and 53% of those attending received treatment for the referred condition. Larger proportions of children from disadvantaged backgrounds were screened positive but higher proportions of children from more affluent backgrounds attended the dentist and subsequently received treatment.Conclusion School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment. The programme fails to reduce inequalities in utilisation of dental services. [ABSTRACT FROM AUTHOR]

Objective To obtain consensus amongst a sample of primary care dentists in the North West of England on a set of clinical criteria that should trigger referral following school dental screening.Design Delphi process.Setting Primary dental care, England 2002Method Primary care dentists in the North West of England were randomly selected to complete a two round 'Delphi exercise' that included 10 potential referral criteria. The dentists were invited to express their level of support for the inclusion of each referral criterion.Main outcome measures Level of agreement for each referral criterion. Acceptance of any criterion was that the interquartile range should be no more than 3 scale points with the lower value being no less than 7.Results Eighty-eight dentists, (72.7%), completed the Delphi exercise. Six referral criteria met with the groups' approval:Child with caries in permanent dentitionChild with darkened/discoloured permanent incisorsChild aged 9-10 years with overjet greater than 10 mmChild over six years with either gross plaque, calculus or swollen gumsChild with evidence of sepsisChild registered with a GDP with caries in permanent dentition.Conclusion It is possible for a representative sample of primary care dentists in the North West to agree referral criteria following school dental screening. [ABSTRACT FROM AUTHOR]

Background. Surgeons are increasingly placed under pressure to accept publication of their results and to abide by recommendations to change practice which others derive. Considerable concern exists about misinterpretation of such data. The issue is well illustrated by this study. Method. Data on outcome following treatment for subarachnoid haemorrhage were prospectively collected from 1993–1998 in two centres in the British Isles: Newcastle and Nottingham. Findings. Initial examination of this data suggest a substantial difference in the performance favouring Nottingham over Newcastle. The odds of a poor outcome was 1:1.86 in Newcastle compared with 1:4.26 in Nottingham giving an odds ratio of 2.3 in favour of Nottingham and this difference was highly significant with p<0.00001. On a more detailed examination taking account of confounding variables, this difference disappeared entirely. Newcastle was able to operate a less selective admissions policy than Nottingham because of the deficiency of beds at the latter unit. A summary of these results has been published elsewhere. Interpretation. These results illustrate the dangers of applying statistical tools developed for simpler situations such as industrial process control to complex medical problems. We conclude that comprehensive and accurate data on all factors likely to influence the outcome for a particular treatment should be collected as an absolute prerequisite to any judgments being made on apparent statistical differences between the performances of differing units. [ABSTRACT FROM AUTHOR]

Presents information on the prevention of smallpox in the British Army during the nineteenth century in Windsor, England. Complication resulting from the inoculation of smallpox; Advantage of the cowpox vaccination developed by doctor Edward Jenner; Prevalence of deaths from smallpox between 1838 to 1940.

This article describes an unusual approach to the evaluation of the effectiveness of assessed coursework provided for a group of graduate students at the University of Brighton, UK. It makes use of metadata exposed and created by the students to discover common values and attitudes to the work that they are required to perform. These metadata are the product of a Web-based system known as CoFIND (Collaborative Filter in N Dimensions). [ABSTRACT FROM AUTHOR]

This article investigates the rural depopulation and social structure in England. The use of the term structure embraces more than the statistical divisions into which people may be grouped--age,sex, occupation, and others. The structure of a society includes the manifold relationships existing between individuals and groups of individuals in a wide range of different social activities--economic, recreational, political, religious and so on. These differing relationships combine to form distinctive cultural patterns each possessing a characteristic ethos. It is said that depopulation is a function of the following: the reduced demand for labor, the changing economic structure, the real and apparent reductions in the economic and non-economic attractions of rural life and insufficient housing. It was found out that the chief reasons for population remaining relatively static or increasing in the rural area are twofold: the introduction of new industrial activity which provides employment alternative to agriculture, or provides servicing industries for agriculture and the influx of retired people. Of the ten parishes in the rural area there are two whose populations have remained fairly static and two where there has been a marked proportional increase. Different localities in the area investigated possess marked individual characteristics. It is not possible to regard the area as a single, or part of a single, rural society except in a rather superficial sense. There are several societies. Societies may be regarded as being socially integrated, or as undergoing a process of disintegration.

Background: Early pregnancy losses are common, but their psychologic sequelae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of posttraumatic stress symptoms and the psychologic response specifically to ectopic pregnancies have not been investigated.Objective: The purpose of this study was to investigate levels of posttraumatic stress, depression, and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy pregnancy.Study Design: This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys that contained standardized psychologic assessments that included the Hospital Anxiety and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months after loss. Control subjects were assessed after a dating scan. We assessed the proportion of participants who met the screening criteria for posttraumatic stress and moderate/severe anxiety or depression. We used logistic regression to calculate adjusted odds ratios.Results: Seven hundred thirty-seven of 1098 women (67%) with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies) and 171 of 187 control subjects (91%) agreed to participate. Four hundred ninety-two of the women with losses (67%) completed the Hospital Anxiety and Depression Scale after 1 month; 426 women (58%) completed it after 3 months, and 338 women (46%) completed it after 9 months. Eighty-seven control subjects (51%) participated. Criteria for posttraumatic stress were met in 29% of women with early pregnancy loss after 1 month and in 18% after 9 months (odds ratio per month, 0.80; 95% confidence interval, 0.72-0.89). Moderate/severe anxiety was reported in 24% after 1 month and in 17% after 9 months (odds ratio per month, 0.69; 95% confidence interval, 0.50-0.94). Moderate/severe depression was reported in 11% of the women after 1 month and 6% of the women after 9 months (odds ratio per month, 0.87; 95% confidence interval, 0.53-1.44). After miscarriage, proportions after 9 months were 16% for posttraumatic stress, 17% for anxiety, and 5% for depression. Corresponding figures after ectopic pregnancy were 21%, 23%, and 11%, respectively. In contrast, among control women with viable pregnancies, 13% reported moderate-to-severe anxiety (odds ratio loss at 1 month vs controls: 2.14; 95% confidence interval, 1.14-4.36), and 2% reported moderate-to-severe depression (odds ratio loss at 1 month vs control subjects: 3.88; 95% confidence interval, 1.27-19.2).Conclusion: Women experience high levels of posttraumatic stress, anxiety, and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at 9 months. [ABSTRACT FROM AUTHOR]

Presents a collaborative audit of the effect of subarachnoid haemorrhage among residents treated at the Newcastle neurosurgery units and the Nottingham unit in the United Kingdom. Description of the study and its results; Comment that the observed difference in outcomes between the units does not necessarily reflect the quality of care given, but rather it can be explained by case mix and the impact of the availability of resources on admission criteria.

The article presents an outline of the Primary Science Day at the Association for Science Education's 2006 Annual Conference in Reading, England. Steve Marshall will explore the role of speaking and listening in science lessons. Professor Wynne Harlen will present the Primary Science Teaching awards who will then present the primary keynote lecture entitled "Assessment for Learning in Science: The Role of Dialogue."

Aims: Violence involving the use of firearms has increased in the UK over the past decade. This study assesses the implications of such injuries for service provision and training by reviewing the experience at one inner city hospital. Methods: Accident and Emergency (A & E) triage data were searched for patients presenting with gunshot wounds (GSW) over a 54-month period. Case notes were reviewed and patterns of care established. The resources required for clinical management were ascertained, and the financial consequences determined at contemporary full cost. Results: There were 187 attendances with 247 wounds. Mean age was 21 years (range 8–63). 69 per cent attended out of normal working hours. 97 patients were admitted to one hospital, 83 of whom required surgery. 10 patients were transferred to other hospitals. Of the remaining 80, 4 died in A & E, the rest were either airgun wounds or relatively simple higher calibre injuries. A wide range of surgical specialities was involved (limb injury 80, thoraco-abdominal and vascular 35, head and neck eight, orbit four), and combinations of injuries transgressed speciality and subspecialty boundaries. The total cost of patient care was over £1/4 million, 98 per cent of which was in patient costs (mean in patient cost £2700, range £140–£40 k). Conclusions: GSW present a heavy demand on the clinical and financial resources of the receiving hospital, and surgeons responsible for unselected acute admissions in ‘General Surgery’ should be capable of dealing with theses indiscriminate injuries. Current training and service trends towards increasing subspecialization may militate against them achieving or retaining this capability. [ABSTRACT FROM AUTHOR]

Background: People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision., Objectives: To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes., Design: The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible., Setting: Nursing homes in England providing care for people with dementia., Participants: Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff., Intervention: Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement., Main Outcome Measures: The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity., Results: Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia ( n  = 32) were recruited in intervention ( n  = 18) and control ( n  = 14) homes. Informal carers (total, n  = 12: intervention, n  = 5; control, n  = 7) and 97 staff from eight sites (intervention, n  = 75; control, n  = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported., Conclusions: A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification., Future Work: In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context., Trial Registration: Current Controlled Trials ISRCTN14948133., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 6. See the NIHR Journals Library website for further project information., Competing Interests: Joanna Coast reports grants from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme during the conduct of the study; and she led the development of the ICECAP (ICEpop CAPability) instruments. Claire Goodman is a NIHR Senior Investigator. Ben Hardwick reports grants from the NIHR HTA programme during the conduct of the study. Catherine Walshe reports that she was a member of the NIHR Health Services and Delivery Research programme Researcher Led Committee during the conduct of the study.

Introduction: The two-week wait (2WW) referral guideline for suspected central nervous system (CNS) tumours was implemented more than a decade ago to facilitate early cancer diagnosis with the aim of improving tumour survival rates. Short-term studies have shown poor compliance and low detection rates of the guideline. This study aimed to provide a decade analysis of referral patterns, and compliance and detection rates of the guideline., Methods: All patients referred via the 2WW pathway for suspected CNS tumour to the Newcastle Department of Neurosurgery from 1st January 2002 to 31st December 2011 were retrospectively identified from the local cancer registry. Data from referral letters, case notes, radiographic images and final outcomes were recorded. Trends in waiting time, time to diagnosis, compliance and detection rate of the guideline in identifying CNS tumours were analysed., Results: Over the last decade, there were no significant changes in trends in waiting time, time to diagnosis and compliance and detection rates of the guideline. Of 85 2WW referrals, 41.2% were non-compliant and 21.2% identified CNS tumours. The detection rate was higher in referrals that complied with the guideline compared to those that did not (32.0% vs 5.2%, p < 0.05). The non-compliant referrals which identified CNS tumours consisted of patients with cognitive decline. The guideline sensitivity and specificity were 88.8% (63.9%-98.1%, 95% CI) and 49.3% (40.0%-61.6%), respectively. Most of CNS tumour diagnoses were made independent of the 2WW pathway (N = 1093, 98.4%)., Conclusion: There have not been any major changes in terms of waiting time, time to diagnosis, compliance and detection rates of the 2WW guideline during the last decade. The 2WW pathway generated very few referrals but among these, the positive detection rate was high and the addition of time-based cognitive decline onto the current guideline may further improve the detection rate.

Aims: On-call referrals are a considerable part of the neurosurgical workload. Many neurosurgical centres in the UK have now adopted the practice of maintenance of electronic databases to keep records of on-call activity. We analysed the neurosurgical on-call referrals database maintained at the Newcastle General Hospital (NGH)/Royal Victoria Infirmary (RVI) to assess any trends in the nature of referrals., Methods: Retrospective review and statistical analysis of a contemporaneously populated referrals database, maintained at the Regional Neurosciences Unit in Newcastle. Data were analysed from August 2008 to April 2011. A three point moving average was used to depict trend in the number of referrals. Descriptive statistics were used to display other trends. Analysis was conducted using JMP 8.0.2 (SAS Institute, Cary, NC, USA)., Results: Our analysis reveals that the number of emergency referrals to neurosurgery in the North East of England is increasing year-on-year. Mean number of referrals per day has increased by almost 5 over the study period (9.06 in 2008 compared to 13.93 in 2011). The major diagnoses that account for this increase are lumbar degenerative conditions, intracerebral haematomas, spinal trauma and subarachnoid haemorrhage. 50% of the patients are referred out of hours and approximately one-third are admitted. In contrast, 47% of all referrals to rule out a cauda equina syndrome, need admission for scanning. General practitioners (GP) are the single biggest source of referral outside of the parent NHS trust and 47% of the GP referrals are regarding lumbar degenerative conditions and cauda equina syndrome., Conclusions: Continuously increasing referrals have implications on cost, staffing and sustainability of the service. Alternative referral pathways, especially for referrals from primary care, must be considered to restore the on-call workload to 'true' neurosurgical emergencies.

Purpose: With a constant debate on working hours and improved patient outcomes, time studies are crucial to obtain and analyse timelines and work components. This includes time spent on communication. The aim of this study was to assess the magnitude and patterns of telephone call episodes in the work schedule of neurosurgery trainees., Methods: Logs of handheld telephone sets assigned to neurosurgery specialty trainees in a British regional neurosurgical centre were obtained from the hospital switchboard for a 6-month period. This formed the primary data. Ringtime was added to the talktime for outgoing calls. Monday to Friday, 8 am-5 pm was considered as regular hours and the rest as other hours. The outcome measures used were number and duration of telephone episodes (individual and collective) and the timing of these episodes., Results: During the study period of 6 months, there were 12071 incoming calls and 10712 outgoing calls (total calls-22783). The maximum number of incoming calls/ day/ trainee was in the range of 39-78 while the range for outgoing calls was 36-102. On an average, the on-call trainee made and received 33 and 36 calls respectively in a 24-hour period (mean call duration was 1.7 minutes) which meant that a telephone call intruded into the schedule almost once every 21 minutes. Typically, the on-call trainee spent 138 minutes on the telephone (69 calls) in 24 hours, while on an off-call day it was significantly less at 25 minutes (18 calls). Of the calls, 67% happened out of regular hours., Conclusions: Time spent on the telephone is a significant work component and would have a bearing on timelines.

Background: Lymph node examination in colorectal cancer is of vital importance for accurate staging. Patients who have fewer nodes examined may be understaged and not offered adjuvant chemotherapy. The national institute of clinical excellence and the association of coloproctology of Great Britain and Ireland both recommend that 12 nodes should be examined for accurate staging. The aim of this study was to assess lymph node harvest at five hospitals in the northwest of England in respect to these guidelines., Materials and Methods: This study is a retrospective review of all colorectal cancer resections over a 1-year period at five hospitals., Results: Two hospitals met the national guidelines of a median of 12 or more nodes. Overall, over 50% of colorectal cancers contained fewer than 12 nodes. Fifty-three point seven percent (53.7%) of Dukes B patients did not have 12 nodes in their specimens and may therefore be understaged. There was a significant variation between hospitals in terms of the number of cancers with 12 or more nodes (P < 0.0001) and the number of Dukes B cancers with 12 or more nodes (P < 0.008)., Conclusion: Over 50% of all colorectal cancer specimens contain fewer than 12 lymph nodes despite clear national guidelines. This is of particular importance to Dukes B cancers where over 53% of cases may be understaged and not offered adjuvant therapy. Significant variation exists between hospitals within the same region.

Objective: To describe the school dental screening process in Community Dental Services across England and Wales., Basic Research Design: Cross-sectional study using a postal questionnaire., Clinical Setting: Community Dental Services., Participants: Clinical Directors of Community Dental Services in England and Wales., Main Outcome Measures: Respondents answers about the objectives of school dental screening, criteria used for referring a child, methods of informing parents of screening results, and methods used to confirm subsequent dental attendance., Results: The response rate for this study was 92.1%. Respondents identified dental registration (75.2%) and attendance at a dentist (82.9%) as objectives of school dental screening. Less than one third (29.5%) saw the activity as having a preventive role. Caries in the primary and secondary dentitions and soft tissue lesions were reported as key criteria for referral. Methods of follow-up of screened positive children differed and were often inadequate; approximately one third of respondents used a letter carried home by the child that did not allow parents to inform the CDS of action taken. Half of the respondents routinely collected data on the number of screened positive children who subsequently visit a dentist., Conclusions: School dental screening is delivered in a similar fashion throughout England and Wales but methods of informing parents of a positive screen and follow-up mechanisms for children with positive screens vary. Most school dental screening programmes do not collect sufficient data to evaluate the impact of their programmes on children's oral health.

A total of 153 children (excluding those who erred on control questions), mainly 5 and 7 years of age, participated in two experiments that involved tests of false belief. In the task, the sought entity was first at Location 1 and then, unknown to the searching protagonist, it moved to Location 2. In Experiment 1, performance was well below ceiling in 5-year-olds when the sought entity was a person, and this contrasted with a task in which the sought entity was a physical object. Performance was especially inaccurate when the sought person moved of his or her own volition rather than when the sought person was requested to move by a third party. Interestingly, 5-year-olds were more likely to nominate Location 1 when asked where the searching protagonist would look first than when asked what he or she would do next. In Experiment 2, however, 5-year-olds also tended to nominate Location 1 following a question that included the word "first" even in a test of true belief--a patently incorrect response. Altogether, the results suggest that 5-year-old children have considerable difficulty with a test of false belief when the sought entity is a person acting under his or her own volition. This suggests that 5-year-olds' handle on states of belief is surprisingly fragile in this kind of task.

Background: Violence involving the use of firearms has increased in the UK over the past decade. This study assesses the implications of such injuries for service provision and training by reviewing the experience at one hospital., Methods: Accident and emergency triage data were searched for patients presenting with gunshot wounds over a 54-month period. Case notes were reviewed and patterns of care established. The resources required for clinical management were ascertained, and the financial consequences determined at contemporary full cost., Results: There were 187 attendances with 247 wounds. Mean age was 21 years (range, 8-63 years). Of the attendances, 69% were out of normal working hours. Of the 187 cases, 97 patients were admitted to one hospital (83 of whom required surgery) and 10 patients were transferred to other hospitals (6 for plastic surgery not available at the Manchester Royal Infirmary and 4 due to lack of beds). Of the 80 patients who were not admitted, 4 died in accident and emergency, the rest were either air gun wounds or relatively simple higher calibre injuries. A wide range of surgical specialties was involved (limb injury, 53; thoraco-abdominal and vascular, 28; head and neck, 5; and orbit, 2), and combinations of injuries transgressed specialty and sub-specialty boundaries. The total cost of patient care was pound 267,000., Conclusions: Gunshot wounds present a heavy demand on the clinical and financial resources of the receiving hospital, and surgeons responsible for unselected acute admissions in "general surgery" should be capable of dealing with these indiscriminate injuries. Current training and service trends towards increasing sub-specialisation may mitigate against them achieving or retaining this capability.

Objective: To describe the care and resultant outcomes of the carious primary teeth of children who regularly attend the General Dental Service (GDS)., Setting: Four districts in the North West of England, Subjects and Materials: A retrospective study of the case notes of 677 children who received their dental care from 50 general dental practitioners (GDPs). Each dentist must have had a minimum of 10 patients and a maximum of 20 patients whose care had been provided by the same dentist from or before the age of five to the age of 14. All of the children included in the study had a history of approximal caries. The outcomes of interest were extraction due to pain or sepsis, or exfoliation and whether or not a tooth had given rise to the prescription of a course of antibiotics. Teeth that did not have a history of extraction were assumed to have exfoliated naturally. Logistic regression models, taking into account the clustering of the teeth within patients, were fitted to compare the outcomes for restored and unrestored teeth according to size of lesion (one or two surface), age caries was first recorded and by tooth type., Results: A total of 4,056 teeth had been either recorded as carious or had received an intervention of some kind. Some 44.1% (N=1,789) of these teeth were extracted, however only 475 (11.7%) were extracted due to pain or sepsis. Of the teeth with a documented history of caries or restoration and for which an outcome was recorded (N=3,145), most first (81.1%) and second (84.3%) carious primary molars were filled during their lifetime, but only 40.5% of primary carious anterior teeth were filled. The majority of carious primary teeth exfoliated naturally. There was no difference in the proportions of teeth extracted due to pain or sepsis whether a carious tooth was restored or left unrestored, either by cavity type or by tooth type, after controlling for age when caries was first recorded. There was also no difference in the number of filled or unfilled carious teeth that caused a course of antibiotics to be prescribed., Conclusions: Treatment by extraction was common, but GDPs restored the majority of carious primary molar teeth of their regularly attending child patients. The bulk of carious teeth exfoliated naturally irrespective of whether they were filled or not. The reasons for these findings require further investigation.

Of 1774 patients with breast cancer given mitoxantrone (MTZ) with methotrexate (n = 492) or with methotrexate and mitomycin C (n = 1282), nine developed MDS/AML after a median of 2.5 years. Median duration of survival from diagnosis of MDS/AML was 10 months and six patients died. The crude incidence of developing MDS/AML after MMM or MM chemotherapy was 15 per 100,000 patient years follow-up, while the actuarial risk was 1.1% and 1.6% at 5 and 10 years respectively. MTZ-based regimens carry a 10 x higher risk of subsequent MDS/AML compared to that seen in the general population.

The study was designed to determine the prevalence of large bowel symptoms in an adult working population and to assess their value in screening for large bowel neoplasms. A symptom questionnaire was sent to workers in two large organizations and the results were compared with faecal occult blood testing in the same individuals using Haemoccult (Eaton Laboratories). Completed symptom questionnaires and Haemoccult test kits were returned by 916 out of a total of 1805 employees over the age of 40 (compliance 50.7 per cent). Twenty-eight (3.1 per cent) were Haemoccult positive and 114 (12.4 per cent) had one or more symptoms. All positives (129 persons) were examined by flexible sigmoidoscopy and barium enema. No cancer was found but 7 patients with adenomas greater than 10 mm diameter were discovered. Each of the 7 patients reported at least one symptom (dark red bleeding in 4, bright red bleeding in 2 and diarrhoea in 1) and 6 were Haemoccult positive. There was no individual with a Haemoccult positive adenoma without symptoms. Predictive values for adenomas over 10 mm for Haemoccult positive tests (21 per cent), self-reported dark bleeding (16 per cent) and diarrhoea (17 per cent), were significantly higher than for other symptoms. The predictive value rose significantly to 46 per cent for Haemoccult-positive patients who in addition had at least one symptom (P less than 0.05) and to 57 per cent for Haemoccult positive with dark bleeding. These combinations of Haemoccult- and symptom-positive results increased the specificity of 97.6 per cent for Haemoccult alone to values over 99 per cent without reducing sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)