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The physical and chemical environment of a floodplain needs to be assessed to define conservation targets for restoring it to species-rich meadows from agricultural land. A straightforward technique, widely applicable by site managers for assessing the suitability of the hydrological and hydro-chemical regime of a floodplain for wet grassland restoration, has been tested by examining the feasibility of restoring plants characteristic of NVC MG4 and MG8 communities to the Castle Meadows, Wallingford (Oxfordshire, UK). Hydro-chemical suitability has been assessed by comparing phosphorus concentrations with species-rich meadows nearby. The flooding regime was estimated based on a rating curve and a digital elevation model and groundwater levels were measured monthly in dipwells and piezometers. The hydrological regime was then compared with published reference guidelines for communities of conservation interest. For the Castle Meadows, the maximum duration of flood events in autumn and winter exceeded MG4 and MG8 species requirements across half of the site, while the depth of the groundwater table in summer exceeded species requirements in the other half. It was shown that, depending on topography, MG5 or MG13 may be more realistic vegetation targets. [ABSTRACT FROM AUTHOR]

(1) Sodium chloride is used as the standard de-icing agent on motorways in England at annual application rates varying from 2 to 20 tonnes per lane km. (2) The severity of winter weather strongly influences the application rate, which varied from about 4 to about 13 t lane-km-1, as a mean over the whole country, between 1974 and 1979. (3) Similar variations in application rate occurred between southern and northern regions, averaged over a period of several years. (4) Sodium concentration in the 0-50 mm layer of the soil of central reserves fluctuated considerably. Maximum values, usually in January-March, were often several times the minima found in September or October. (5) Soil sodium concentrations in April were correlated with salt usage rates during the previous winter and showed similar regional and altitudinal variability. In the 0-50 mm layer of soil, sodium levels varied from <500 µg-1 to several thousand µg-1. (6) Sodium was more persistent in the soil than chloride. (7) In April the highest concentration of sodium, and often also of chloride, was found in the 0-50 mm layer of the soil profile. By October much of the sodium had been transported to greater depth, and much of the chloride had disappeared from the soil. (8) Observations extending over 6 years suggested that there was no consistent annual increase in the salinity of the soil's of central reserves. [ABSTRACT FROM AUTHOR]

Purpose: To study the associations between eleven lens features graded according to the Oxford Clinical Cataract Classification and Grading System (OCCCGS)., Method: 560 subjects taking part in the Melton Eye Study had their lenses graded according to the OCCCGS by one of two examiners. Associations between features were examined using log-linear models for categorised grades. Adjustment was made for age, sex and grader., Results: Within subjects, the two nuclear features, white nuclear scatter and brunescence, are closely related with one another, as are coronary flakes and focal-dots, but these two groupings are negatively associated. Cortical spoke, fibrefolds and waterclefts are all associated with one another and this group is positively associated with coronary flakes and focal-dots. Posterior subcapsular and anterior subcapsular opacity are associated with one another and with cortical spokes. A within-eye analysis gives similar results., Conclusion: These associations may be important in defining cataract subtypes and in identifying minor features that indicate early cataract development.

We calculated the rates for perioperative mortality and fatal pulmonary embolism (PE) after primary total hip replacement in a single UK health region, using a regional arthroplasty register and the tracing service of the Office of National Statistics. During 1990, there were 2111 consecutive primary replacements in 2090 separate procedures. Within 42 days of operation a total of 19 patients had died (0.91%, 95% CI 0.55 to 1.42). Postmortem examination showed that four deaths (0.19%, 95% CI 0.05 to 0.49) were definitely due to PE. The overall perioperative mortality and fatal PE rates are low and in our study did not appear to be altered by the use of chemical thromboprophylaxis (perioperative mortality rate: one-tailed Fisher's exact test, p = 0.39; fatal PE rate: one-tailed Fisher's exact test, p = 0.56). The routine use of chemical thromboprophylaxis for primary THR is still controversial. The issue should be addressed by an appropriate randomised, prospective study using overall mortality and fatal PE rate as the main outcome measures, but the feasibility of such a study is questioned.

Unlabelled: As the demography of Western society changes, the population prevalence of diseases such as age-related macular degeneration (AMD) is expected to rise. Despite this, there remains a paucity of quality data concerning the population prevalence of AMD, the commonest cause of blindness in the elderly., Purpose: To report the prevalence of AMD at two points in time in an elderly population., Method: A geographically defined random population sample of elderly people was defined in 1980, and studied in 1982-4. In 1990, a cohort of survivors was identified. Participants underwent full ophthalmic examination with fundus photography using the same camera on each occasion. Photographs were randomly encoded and graded by two independent masked observers using the Wisconsin Age-related Maculopathy Grading System. Disagreements were resolved by consensus., Results: Eighty-eight survivors participated in the follow-up examinations. Of these, 82 subjects had gradable retinal photographs for both examination points in at least one eye. There were 158 pairs of images (initial and subsequent) available for analysis. The mean age was 80 years (range 77-90 years) at the initial examination, and 87 years (range 84-97 years) at the subsequent examination; 70.7% of subjects were female. Prevalence rates for the initial examination were: drusen 72.8%, drusen confluence 37.3%, degeneration of the retinal pigment epithelium (RPE) 51.3%, increased pigment 22.2%, exudative AMD 1.9% and geographic atrophy 1.9%. Rates at second examination were: drusen 62.7% drusen confluence 41.8%, RPE degeneration 72.8%, increased pigment 16.5%, exudative AMD 3.8% and geographic atrophy 3.2%., Conclusion: This 'double' prevalence study provides detailed data on AMD lesions at two points in time in a population-based group of elderly people.

Unlabelled: Despite age-related macular degeneration (AMD) being the commonest cause of blindness amongst the elderly in Western society, the incidence of new lesions is poorly documented and the natural history of existing disease remains ill understood., Purpose: To document in an elderly population the incidence of new AMD lesions and the progression of pre-existing AMD over time., Method: Baseline ophthalmic examinations were performed on a geographically defined random population sample of elderly people in 1982-4, and retinal photographs taken. The present study re-examined and re-photographed survivors after approximately 7 years using the same fundus camera. Photographs were randomly encoded, and independently graded for AMD features by two masked observers using the Wisconsin AMD grading system. Disagreements were resolved by review to reach a consensus., Results: Eighty-two of the 88 participating survivors had photographs of gradable quality on both occasions in at least one eye. Mean age at follow-up was 87 years (range 84-97 years) and 70.7% of subjects were female. Paired photographs were available on 158 eyes, and showed important differences in drusen type, drusen area and characteristics of the retinal pigment epithelium (RPE) between initial and subsequent examinations. The 7 year incidence (and regression) of lesions was: drusen 30.6% (20.0%), RPE degeneration 54.5% (8.8%), increased pigment 11.6% (64.7%), subretinal haemorrhage 1.3%, subretinal scar/fibrin 1.3% and geographic study 1.3%., Conclusion: These unique population-based results provide new insight into the natural history of AMD in an elderly population.

Study Objective: To investigate the relationship between age at presentation of amblyopia and social deprivation before and after the introduction of changes to a vision screening service., Design: Two cohorts of children treated for amblyopia in 1983 and 1992., Setting: THe orthoptic department of Leicester Royal Infirmary., Participants: The 209 patients treated for amblyopia who first attended the orthoptic department in 1983, and 203 who first attended in 1992., Measurements: Age at presentation to the orthoptic department was the main outcome measure. Social deprivation was measured by Townsend deprivation score for the electoral ward in which the child lived, using 1981 and 1991 census data., Main Results: After the introduction of changes in the screening programme, the mean at presentation of amblyopia associated with microtropia or no strabismus was reduced from 6.6 years to 5.0 years. In 1983 there was a significant relationship between deprivation and age at presentation (p = 0.0001), with those from more deprived areas presenting later. No similar association was found in children referred in 1992 (p = 0.17). There was no change in mean age of presentation of amblyopia associated with a large angle of strabismus (3.3 years in 1983 and 1992) and no relationship between deprivation and age at presentation 1983 or 1992 (p = 0.24 and p = 0.39 respectively)., Conclusion: Since the introduction of changes to vision screening, the relationship between social deprivation and the age of presentation of asymptomatic amblyopia seems to have disappeared. Children are now referred earlier and those from deprived areas are not being overlooked.

Background: Amblyopia is the most common visual disability in children. Early treatment is thought to be more effective, and therefore factors affecting the age at presentation are important. A relationship between social deprivation and access to health care and screening services is well known. We hypothesized that social deprivation might be associated with later presentation of amblyopia, particularly of anisometropic amblyopia which depends on vision screening for referral., Methods: Data from a historical cohort of 897 children with amblyopia, from seven UK orthoptic clinics, were used to test this hypothesis. Social deprivation was measured by the Townsend score of the ward in which the child lived., Results: A relationship between social deprivation and age at presentation was found in children with anisometropic amblyopia even after adjusting for differences between clinics (p = 0.01) but no similar association was evident in children with amblyopia associated with strabismus. There was a difference of 22 months in the average age at presentation between children with anisometropic amblyopia in the most deprived and least deprived areas of the study., Conclusions: If screening for anisometropic amblyopia is to be undertaken, priority should be given to screening children from areas of social deprivation.

Random samples of people aged 40 years and over were drawn from lists of patients registered with two neighbouring inner-city general practices: one predominantly with Asian patients and the other predominantly with European patients. The people selected were invited to attend specially arranged eye clinics for examination by an ophthalmologist and an optician. We examined 377 people and found that, compared to people of European descent, Asians had a significantly higher prevalence of age-related cataract: 30% compared to 3% in people aged under 60 years and 78% compared to 54% in those aged 60 years and over. The age of onset of cataract seems to be earlier in Asians. After adjustment for age, there were no statistically significant ethnic differences in the prevalences of open-angle glaucoma, macular degeneration or diabetic retinopathy.

The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.8/10(5) and that of ulcerative colitis 90.8/10(5). The prevalence of Crohn's disease among South Asians was 33.2/10(5) and that of ulcerative colitis 135/10(5). The prevalence of Crohn's disease in Europeans was significantly greater than that in Hindus (chi 2 = 16, p < 0.001), while the prevalence of ulcerative colitis was significantly lower in Europeans than Hindus (chi 2 = 27, p < 0.001) and Sikhs (chi 2 = 4.4, p < 0.05). The comparative risk of developing ulcerative colitis in first degree relatives of Europeans patients with ulcerative colitis was increased by approximately 15, but the risk of Crohn's disease was not increased. The comparative risk of developing Crohn's disease among first degree relatives of patients with Crohn's disease was increased by up to 35, the comparative risk of ulcerative colitis was approximately 3. The risk among relatives of South Asian patients with Crohn's disease was not increased, but the risk of ulcerative colitis to relatives of patients with ulcerative colitis was. This study supports the view that Crohn's disease and ulcerative colitis arise in people with a genetic predisposition and exposed to some, as yet unknown, environmental factor.

Follow-up ranging between 6 and 8 years of the survival of a cohort of 473 elderly nondiabetic subjects randomly selected from a small English town showed an age- and sex-adjusted association between nuclear cataract at the time of baseline examination and decreased survival (P = .002). Comparing those with and without nuclear cataract, the adjusted relative hazard for death was 1.52 (95% confidence interval, 1.15 to 1.99). This effect remained virtually unchanged when also adjusted for whether the subject reported ever having been a smoker.

We present incidence estimates for amblyopia using data from a study of a cohort of 364 children from a single English county who were referred during 1983 for occlusion therapy. Using a criterion of a visual acuity of 6/12 or worse to define amblyopia, we estimate that 3.0% of the county's children develop the condition. Successful treatment of some of these children means that 1.9% will remain amblyopic as adults.

One hundred and forty-one patients with multiple myeloma, diagnosed at the City Hospital, Nottingham between January 1975 and October 1986, were followed until death or for at least two years in a retrospective study. Overall median survival was 25 months, with no significant improvement occurring during the study period; increasing age, ESR and serum creatinine concentration at diagnosis were independent predictors of shortened survival. Renal impairment developed in 56 per cent of patients but only 7 per cent died of renal failure. At least one episode of infection occurred in 55 per cent of patients, most commonly in the first month. There was a significant rise in the overall incidence of infection and in the proportion caused by Gram-negative bacteria during the study period. Raised serum urea and low haemoglobin concentrations at diagnosis were independent risk factors for subsequent infection. Infection was associated with 2.75-fold increased risk of death, independent of other risk factors. Prevention of infection is an important aim for improvements in the survival of patients in multiple myeloma.

A community based ophthalmic survey has been carried out in the city of Leicester. Samples of Asians and Caucasians aged 40 years and over were randomly selected from the patients of four general practitioners and invited to have an ophthalmic examination. After adjustment for age, the prevalence rate of age-related cataract was significantly higher in the Asians when compared to the Caucasians. Age-related cataract was found to develop earlier in the Asians. A strict vegetarian diet was found to be a significant risk factor for age-related cataract in the Asian Community in Leicester.

A prospective incidence study into wound infection after caesarean section was carried out. Thirty-one centres in England and Wales participated and 2370 patients were entered into the study. One-hundred-and-forty-one patients (6.0 per cent) acquired wound infections, according to the definitions used (i.e. with both clinical and microbiological evidence of infection). If all inflamed wounds has been cultured, the infection rate would have been considerably higher, (calculated at 14.0 per cent). Patients with infected wounds spent an extra 2.4 days in hospital. Factors associated with wound infection included size of hospital, obesity, time in labour, number of vaginal examinations and various operative procedures.

Cataract is known to be more common in India than it is in the industrialised world, but there is little evidence to show whether people emigrating from India will continue to have a high incidence of the disease. Data have been collected from the outpatient clinics of a hospital in Leicester, England, that suggest that for people aged over 45 the demand incidence of cataract is more than five times higher in people of Indian descent than it is in the indigenous population. As well as measuring the demand incidence of cataract in Leicester's two main racial groups the data are used to investigate other risk factors. For both communities the demand incidence of cataract is significantly higher in women than in men, and it is significantly higher in people of Indian descent who emigrated directly from India than in those who emigrated from East Africa. Religious subgroups within the immigrant community also show small differences in their demand incidence. The possibility that these differences are linked to diet is considered.

A study is reported of all new registrations for blindness and partial sight in the county of Leicestershire, England, for the years 1965, 1975, and 1985. The number of new registrations for blindness has risen considerably over this period, but the increase is shown to be attributable to changes in the age structure of the population and under-registration in 1965. The number of new registrations for partial sight has also increased over the study period but by significantly more than would be expected, even after changes in the population structure are allowed for. The registration rates for Leicestershire when analysed by age, sex, and cause are shown to be broadly in line with available national figures. Registration rates for macular degeneration and glaucoma are increasing in both males and females, and rates for cataract are at a significantly higher level for women than for men.

A population-based survey of the insulin-requiring diabetics of a representative population was carried out. The overall prevalence of diabetes was 10.9/1000, that of insulin-requiring diabetes 4.1/1000. No retinopathy was found in 59%, background retinopathy was found in 33% and proliferative and advanced disease in 8%, diabetic maculopathy was present in 6.8% and the prevalence of potentially treatable disease undetected was 7.6%. Significant risk factors identified for retinopathy were increased duration of diabetes and elevated diastolic blood pressure, those for maculopathy an increased age at examination and onset of diabetes and an elevated systolic blood pressure.