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A series of large-scale acquisitions suggests the big players are thriving, but what will this mean for the coming year? Mary Evans takes a look.

Early years specialists are upbeat about this Level 3 qualification which has been designed in consultation with the big nursery chains to provide skills employers say they need.

Early Years Professional Status is gearing up for a much welcomed revamp. Mary Evans finds out why it remains the gold standard.

Reviews are rife in the early years sector. Here Mary Evans provides an indispensable guide to what's under scrutiny and when change on the ground is expected to kick in.

With the aim to extend the free entitlement to 40 per cent of all two-year-olds by 2015, nurseries are having to think long and hard about how they can equip themselves to deliver this, as it will require many changes, says Mary Evans.

The Look AHEAD (Action for Health in Diabetes) Study is a long-term clinical trial that aims to determine the cardiovascular disease (CVD) benefits of an intensive lifestyle intervention (ILI) in obese adults with type 2 diabetes. The study was designed to have 90% statistical power to detect an 18% reduction in the CVD event rate in the ILI Group compared to the Diabetes Support and Education (DSE) Group over 10.5 years of follow-up. The original power calculations were based on an expected CVD rate of 3.125% per year in the DSE group; however, a much lower-than-expected rate in the first 2 years of follow-up prompted the Data and Safety Monitoring Board (DSMB) to recommend that the Steering Committee undertake a formal blinded evaluation of these design considerations. The Steering Committee created an Endpoint Working Group (EPWG) that consisted of individuals masked to study data to examine relevant issues. The EPWG considered two primary options: (1) expanding the definition of the primary endpoint and (2) extending follow-up of participants. Ultimately, the EPWG recommended that the Look AHEAD Steering Committee approve both strategies. The DSMB accepted these modifications, rather than recommending that the trial continue with inadequate statistical power. Trialists sometimes need to modify endpoints after launch. This decision should be well justified and should be made by individuals who are fully masked to interim results that could introduce bias. This article describes this process in the Look AHEAD study and places it in the context of recent articles on endpoint modification and recent trials that reported endpoint modification.

The NDNA's online quality assurance scheme aims to maximise the potential of every individual to energise practice and keep it moving forward, as Mary Evans hears at the start of a new series.

As nurseries are having to tighten their belts like everyone else, Mary Evans outlines some ways that managers can take firmer control of their business finances while keeping the staff happy

Background Patients who receive highly variable doses of warfarin may be at risk for poor anticoagulation control and adverse events. However, we lack a system to identify patients with the highest dose variability. Our objectives were to develop a scoring system to identify patients with high dose variability, and to validate this new measure by demonstrating that patients so identified have poor anticoagulation control and higher rates of adverse events (criterion validity). Methods We used a database of over 4, 000 patients who received oral anticoagulation in community practice between 2000-2002. We reviewed the charts of 168 patients with large warfarin dose variation and agreed on 18 risk factor definitions for high dose variability. We identified 109 patients with the highest dose variability (cases), as measured by coefficient of variation (CoV, SD/mean). We matched each case to two controls with low dose variability. Then, we examined all 327 charts, blinded to case/control status, to identify the presence or absence of the 18 risk factors for dose variability. We performed a multivariable analysis to identify independent predictors of high CoV. We also compared anticoagulation control, as measured by percent time in therapeutic range (TTR), and rates of adverse events between groups. Results CoV corresponded with other measures of anticoagulation control. TTR was 53% among cases and 79% among controls (p < 0.001). CoV also predicted adverse events. Six cases experienced a major hemorrhage versus 1 control (p < 0.001) and 3 cases had a thromboembolic event versus 0 control patients (p = 0.04). Independent predictors of high dose variability included hospitalization (OR = 21.3), decreased oral intake (OR = 12.2), use of systemic steroids (OR = 6.1), acetaminophen (OR = 4.0) and antibiotics (OR = 2.7; p < 0.05 for all). Conclusion CoV can be used to identify patients at risk for poor anticoagulation control and adverse events. This new measure has the potential to identify patients at high risk before they suffer adverse events.

Understanding child development acts as a springboard for students to examine their practice in greater depth. Mary Evans explains how this unit supports underpinning knowledge

In tough times nurseries are having to be creative and resourceful in their drive to build their business. Mary Evans hears how they are succeeding.

Providers fear they may not be able to support all the aims of the Government's reforms for early years education. Mary Evans hears about the balancing act they struggle with.

Financial experts tell Mary Evans about what makes a nursery's business plan worth more than the paper it's written on.

This report describes recruitment of minority cancer survivors for a randomized trial of I Can Cope, a support program of the American Cancer Society. Survivor Education and Evaluation (SURE), was designed to recruit patients, age 19 and older, with a primary cancer diagnosis. Recruitment was primarily carried out in a public hospital in Birmingham, Alabama. Of 373 patients approached, 226 were eligible for the study, 175 consented, and 140 were randomized during the 20-month recruitment period. Only 43 declined participation. This resulted in a 61.9% recruitment yield. The mean age of participants was 54.2 years (SD=10.9), 92 (65.7%) were female, and 111 (79.3%) were African American. Twenty-three different cancers were represented including breast (37.1%), colorectal (12.1%), hematologic (12.9%), and lung (7.1%). Over half (63%) had been diagnosed within 12 months. The experience of the SURE project provides evidence for optimism in recruiting racial minorities to cancer research studies.

The challenges and benefits of reflective practice for early years practitioners are explored in depth in this unit, says Mary Evans.

Sure Start has achieved a lot in the deprived area of Great Yarmouth - and despite drastic funding cuts, it is hoped that this good work will continue. Mary Evans reports.

The recession has arrested the decline in childminder numbers as more families choose them over more expensive nurseries, but the support they receive has reduced, writes Mary Evans.

Two comparatively small units aim to provide vital skills when it comes to working with colleagues, parents and professionals, says Mary Evans.

Integrated working and family support are Birmingham's priority amid Sure Start cuts and re-organisation. Mary Evans reports.

This is a challenging unit, but one that is fundamental to providing high-quality care for young children, says Mary Evans.

Creative play and learning come more naturally when the resources are ‘open-ended’, lending themselves to a variety of uses and constantly holding attention, says Mary Evans.

Nurseries should echo society's diversity and combat biased attitudes. Mary Evans explains how.

A unit that can help prepare new practitioners for dealing with parents and multi-agency working is examined by Mary Evans.

The rules on exposing children to risk outside the classroom may soon be relaxed. Mary Evans looks at how nurseries will respond

The largest study unit in the Level 3 Diploma sounds daunting, but is highly valuable in theory and practice, says Mary Evans.

Nurseries are learning to deliver the free entitlement while remaining financially viable, says Mary Evans.

Understanding and promoting children's communication skills is a compulsory part of the new Level 3 diploma, says Mary Evans

There's a skill in sharing something you've learned with your colleagues, and it's more in demand than ever, says Mary Evans.

Aim. This paper reviews literature that draws on models of mental health care for older adults. Background. It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population. Results. The paucity of research in this area is demonstrated. Conclusion. The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.

Children need time to think and lead. This important concept requires training, says Mary Evans.

Young children are learning empathy by caring for even younger babies. Mary Evans finds out how.

Looking after young children's welfare embraces not just secure entry systems to nursery buildings, but everyday products for hygiene, reports Mary Evans.

Is there a long-term future for the new Level 2 - and can Level 3 become a bridge to a degree? These questions on early years qualifications urgently need answers, says Mary Evans.

Although Early Years Capital Grant funding is winding down, nurseries can take a tip from settings that have used it on how best to make improvements, says Mary Evans.

Staff training, if chosen carefully, can provide value for money in keeping and promoting the best people, says Mary Evans.

Cuts will fall harder on some areas, but even in the toughest cases there are innovative ideas that nurseries can use to win through, says Mary Evans.

Working co-operatively takes complex skills. Mary Evans outlines the key areas of joined up working and how to overcome barriers to communication

The influences on today's childcare practice by the work of a pioneering European educator are explained by Mary Evans.

Sleep, a key indicator of health, has been linked to a variety of indicators of well-being such that people who get an adequate amount generally experience greater well-being. Further, a lack of sleep has been linked to a wide range of negative developmental outcomes, yet sleep has been largely overlooked among researchers interested in adolescent delinquency. The purpose of this study was to explore the relationship between hours of sleep and delinquent behavior among adolescents by using data from Wave 1 of the National Longitudinal Study of Adolescent Health (n = 14,382; 50.2% female, 63.5% white). A series of negative binomial regressions showed that youth who typically sleep seven or fewer hours per night reported significantly more property delinquency than youth who sleep the recommended 8–10 h. Further, youth who reported sleeping 5 or fewer hours per night reported significantly more violent delinquency than youth who reported sleeping the recommended number of hours per night. The findings suggest that sleep is an important, and overlooked, dimension of delinquent behavior and studies that focus on adolescent health should further investigate the effects of insufficient sleep. Finally, the authors recommend that sleep and other relevant health behaviors be considered in the context of more comprehensive approaches to delinquency prevention and intervention.

Grandpont Nursery, an outstanding nursery school with a children's centre, wowed the inspector with its strong teamwork ethos, says Mary Evans.

A successful nursery for children with autism makes the most of their visual skills to motivate development. Mary Evans hears how.