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To analyse the effects of prevalence and incidence screening on uptake and detection of cancer in an ongoing, dynamic programme for colorectal screening using faecal occult blood testing.Analysis of prevalence and incidence screening.Three rounds of biennial colorectal screening using the guaiac faecal occult blood test in east and north east Scotland, March 2000 to May 2007.Adults aged 50-69.Uptake of screening, test positivity (percentage of those invited who returned a test that was positive and triggered an invitation for colonoscopy), positive predictive value, and stage of cancer.Of 510 990 screening episodes in all three rounds, 248 998 (48.7%) were for prevalence, 163 483 (32.0%) were for first incidence, and 98 509 (19.3%) were for second incidence. Uptake of a first invitation for prevalence screening was 53% and for a second and third invitation was 15% and 12%. In the cohort invited for the first round, uptake of prevalence screening rose from 55% in the first round to 63% in the third. The uptake of first incidence screening on a first invitation was 54% and on a second invitation was 86% and on a first invitation for second incidence screening was 46%. The positivity rate in prevalence screening was 1.9% and the uptake of colonoscopy was 87%. The corresponding values for a first incidence screen were 1.7% and 90% and for a second incidence screen were 1.1% and 94.5%. The positive predictive value of a positive faecal occult blood test result for cancer was 11.0% for prevalence screening, 6.5% for the first incidence screen, and 7.5% for the second incidence screen. The corresponding values for the positive predictive value for adenoma were 35.5%, 29.4%, and 26.7%. The proportion of cancers at stage I dropped from 46.5% for prevalence screening to 41% for first incidence screening and 35% for second incidence screening.Repeat invitations to those who do not take up the offer of screening increases the number of those who accept, for both prevalence screening and incidence screening. Although the positive predictive value for both cancer and adenomas fell between the prevalence screen and the first incidence screen, they did not fall between the first and second incidence screens. The deterioration in cancer stage from prevalence to incidence screening suggests that some cancers picked up at incidence screening may have been missed on prevalence screening, but the stage distribution is still favourable. These data vindicate the policies of continuing to offer screening to those who fail to participate and continuing to offer biennial screening to those who have accepted previous offers.

Delays and suboptimal investigations mean there is much room for improvement Earlier diagnosis of colorectal cancer, a common malignancy in the United Kingdom, improves survival. International interest in developing strategies for improving diagnosis and reducing delay is growing. The best chance of improving symptom based diagnosis resides in primary care, where most patients with cancer first present.1 In the linked systematic review (doi:10.1136/bmj.c1269), Jellema and colleagues assess the diagnostic performance of tests for colorectal cancer, either alone or in combination with symptoms.2 Despite intensive efforts and comprehensive national cancer frameworks,3 the UK lags behind other European countries in terms of stage of presentation and survival for common cancers, including colorectal cancer.4 It has been estimated that more than 4000, or 9% of all deaths from colon cancer, could be avoided if the UK’s survival figures were in line with mean European rates.5 This has, in part, prompted a renewed emphasis on …

The study investigated popular election results regarding the relationship between the variables of county board member defeat or re‐election and the reappointment or dismissal of county school superintendents, in the state of North Carolina, within a one, two, three or four year time frame. All 100 county school districts were studied over a 12‐year period of time in which an ex post facto quasi‐experimental research design was used to determine the relationship between incumbent board member defeat and superintendent turnover following six general elections. Results of the study show there was stability in both superintendent reappointment and incumbent school board member re‐election. These findings do not support previous research regarding the dissatisfaction theory in that previous studies found significant differences between superintendent turnover and incumbent school board member defeat. This study, unlike others, focused on county public superintendent turnover and county board member election results as opposed to city or state superintendent and school board member elections.

In this chapter: You have a contribution to make Preparation, including agendas and minutes Arriving at the meeting Being a member of the meeting the conduct of the meeting your body language making your point personalities some tricks of the trade group decisions After the meeting Formal presentations at meetings

In this chapter: Formal instruction Job breakdown, preparation and use Giving instruction: prepare instruct put to work check

In this chapter: Who is ‘the boss’? Assertive, not aggressive Simple requests More complicated requirements Knowing the boss Timing Presenting your case The outcome

In this chapter: Why is it important? Approaching other people who are: on their own in a group Other people approaching you who are: angry in a hurry senior to you on your level junior to you strangers

In this chapter: Who are customers or clients? Your image — first impressions Your body language Questioning Listening Language Tone of voice Last impressions

In this chapter: Preparation of material Presentation area seating lighting heating and ventilation noise Presentation Poise Pace Pitch Feedback After sales service Discussion Visual aids Post mortem

In this chapter: Job interviews First impressions Attitude Clear thinking Speech Body language Mannerisms Conversation piece Last impressions

In this chapter: You as group leader Preparation Introduction Controlling the discussion: listening, observing, thinking summaries handling people the silent person, the dominant personality, the ‘expert’, the ‘happy wanderer’, the ‘bee keeper’

Objectives: To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference. Design: Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes. Setting: 31 general practices in Trent region. Participants: Patients aged 18–70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms. Main outcome measures: Difference in mean Beck depression inventory score; time to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria. Results: At 12 months there was no difference between the mean Beck scores in the randomised arms. Combining the randomised and patient preference groups, the difference in Beck scores was 0.4 (95% confidence interval −2.7 to 3.5). Patients choosing counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference in the psychiatrist9s overall assessment of outcome between any of the groups. 221/265 (83%) of participants with a known outcome had a remission. Median time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months v 3 months). 33/221 (15%) patients had a relapse. Conclusions: Generic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiving antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment. What is already known on this topic Antidepressants and specific psychological interventions are effective in major depression. Generic counselling has not previously been compared with antidepressants in primary care What this study adds 12 months after starting treatment, generic counselling is as effective as antidepressants Patients treated with antidepressants may recover more quickly Given a choice, more patients opt for counselling Patients who choose counselling may benefit more than those with no strong preference

The purpose of this study was to identify the fields of population health covered by General Practice Evaluation Program (GPEP) research and to evaluate the population health findings and implications of this research. The research method was to conduct a review of 150 GPEP project reports completed between 1992-1998, using a framework developed to identify research with population health content and/or relevance. A total of 65 projects were identified in the following areas: health promotion; disease prevention and screening; systematic illness care; integration of health services; data collection; and research on specific populations. The majority of the research was descriptive in nature (53 out of 65 projects). Strengths of the existent research lie in documenting the use of interventions to improve systematic illness care, and in GP activities directed towards disease prevention and screening. However, the analysis identified a number of problem areas. Recording and collection of information about GP activities is variable, in part due to a lack of consensus about the kind of information that should be collected. Our analysis highlights the need for a national approach to the assessment, adoption, dissemination and implementation of guidelines, and for critical evaluation of this process. There is a lack of evidence for the efficacy of many GP interventions for improving population health. The research demonstrated examples of collaboration between GPs and other health care providers, and of general practice research using a population health approach. It was concluded that GPEP is an innovative funding program which has the potential to make substantial contributions to population health and to strengthen the links between general practice and population health. To date it has focussed on systematic illness care with current practice providing models for future development. However, there is a need for systematic approaches to data set definition, data collection and guideline use.

Supporting academic achievenlent of students who poorly has long been a concern (1) . Traditional programs, however, present scheduling problems, loss of time, and labeling of sti~dents (4) . Hayes ( 3 ) Found traditional programs for low-achieving students provide less than expected cognitive gains and recommended the use of computer-assisted instruction. Also, computer-assisted instruction contributes to mouvation and higher level thinking skills for students by providing immediate feedback, a variety of learning modes, and self-paced exercises (2) . A study was conducted in one school system to assess the achievement gains of low-achievers using computer-assisted versus traditional instruction. O n e school used compurer-assisted insrruction daily in reading and mathemarics for lowachieving students in Grade 5 (rz=63) while control students, Grade 5 (tz=48), in another school received traditional insrruction. Test scores were analyzed only for studenn wirh both preand posrtesr scores. Students were similar in race, sex, and age. The reading comprehension and mathematics sections of the Iowa Test of Basic Slulls were administered to both computer-assisted and control students as a pretest (M 1995 scores) and posrtest (M 1996 scores). Mean scores were analyzed by analysis of covariance with pretest scores controlling for initial differences between groups. Means of the computer-assisted group increased from preto posttest in reading from 30.2 to 39.0 (SD: 10.2 to 4.4) and in mathematics from 33.9 to 40.0 (SD: 11.2 to 3.7). Control students' preand posttest means increased from 30.2 to 31.4 (SD: 9.9 to 8.7) in reading and from 33.7 to 38.3 (SD: 11.1 to 5.8) in mathematics. Analysis of covariance indicated the computer-assisted group means were significantly higher in reading (F2,61 = 12.40, p< .001), with the higher scores attributed to rhe daily computer-assisted instruction.

Two school systems randomly assigned two classes each of Grades 3 to 12 students to learn the principles and tools. Taught students ( n = 1220) evidenced statistically significantly higher posttest scores than control students ( n = 4480) for Grades 3–12 after a year's instruction. Higher posttest scores for one system on the application of the principles and tools were attributed to time spent on instruction.

A peer-group feedback model of classroom supervision was used to facilitate 48 teachers' acquisition of questioning skills for use with discussion lessons. Teachers in 6 groups of 24 who received feedback through the feedback made significant gains on 10 of the 13 questioning skills. A control group of teachers made significant gains on four skills.

The model described here will enable principals to help teachers develop computer skills and overcome their hesitancy to use them in the classroom.

If teachers are to perform at their best, reasons this author, they need a favorable school climate. He believes Maslow's construct of needs provides a model that princi pals can use to pro vide such a climate.

Summ.a~y.49 principals and 73 teachers responded to a survey of' 39 institutions of higher education. Significant-differences were noted in 6 of 9 competencies needed by secondary teachers in adapting regular curricula for exceptional students. Using this information workshops were developed and attended by 59 secondary teachers and 30 administrators. Significant differences in attitudes were noted but cognitive gains were similar whether workshops were personnel-assisted or not. A comprehensive training program for regular, secondary classroom teachers designed to meet the needs of exceptional children in a regular sec- ondary classroom has long been needed (2, 4) because mainstreaming involves daily interaction between regular classroom teachers and students who are physically or mentally impaired. A concern is the ability of regular classioom teachers to diagnose, prescribe, and implement instructional strategies needed by exceptional students in science, mathematics, social science, and language arts. Teachers' educational programs have primarily focused on providing special education courses for students majoring in elementary education; little attention has been given to training secondary school teachers in these proce- dures (1, 5). These findings are reinforced by Sabatino (6) who reported that only a few colleges and universities currently give classes in special educa- tion to undergraduates with majors in secondary education. According to Schubert and Landers (7), these findings are not too surprising considering the traditional role of the secondary teacher is that of a subject-matter special- ist. Consequently, secondary teachers often lack the necessary skills and com- petencies to work effectively with special students. At best, these teachers tend to provide remedial work which often focuses only on mathematics and lan- guage arts (3). The purpose of this study was twofold, to ascertain the number of colleges and universities within the state of Texas which offered a'course on salient competencies and skills necessary to teach exceptional children in the classroom and to develop a comprehensive program to assist secondary teachers in adapting regular classroom curricula in mathematics, language arts, social studies, and science for special education students. The findings are presented in two parts, reflecting the two purposes.

(1983). Discrepancy Analysis: A Quantitative Technique for Curriculum Development. The Clearing House: A Journal of Educational Strategies, Issues and Ideas: Vol. 56, No. 5, pp. 223-229.

Strmmmy.-This srudy examined the professional aspects of teaching and assessed differences in the attitudes of 1,436 Georgia public school teachers in 88 rural and 55 urban schools at the elementary (K-5), middle (6-8), and secondary (9-12) levels. Significant differences in attitude were noted by school level but not location. Whether teaching can be considered a profession has been of concern to educators for decades. Corwin (1965) defined a profession from a structural perspective as a vocacion which (1) has a legal monopoly over the application of theoretical knowledge to the solution of social problems and (2) has legal control over its membership including control of the licensing standards and code of ethics sanctioned by law. Greenwood and Soar (1969) agreed with Corwin but assett that the professional brings to the organization specialized knowledge or skills acquired through years of formal training which are needed to practice the profession. Carbino, cited by Gerwin ( 1974), on the other hand, emphasized the distinguishing characteristic of professionalism as a uadition of explicit recognition of obligations to the clientele. However, Cotwin (1965) emphasized that, while certain criteria do exist, it may be less important to decide whether teaching is a profession on the basis of objective standards than to decide whether teachers actually think of themselves as professionals. Studies over the last several years have concerned teachers' relation to teaching. Raenholrz (1985) stated thar "che greatest obstacle to the professional development of teachers is the isolated nature of their work (p. 350). Corwin ( 1965 ) noted that role conflict between the teacher's obligations as a professional and those as an employee lead to job dissatisfaction. Concurrently, Sergiovanni (1967) reported that while achievement and recognition were satisfying, interpersonal relationships with suhrdinates and peers were unsatisfying. Looking at professional and social integration of teachers, Chapman ( 1983) noted that the higher the involvement in professional aspects of teaching and the more social ties teachers had in schools, the more likely they would remain in the profession. In a similar srudy, Morgan (1979) contended that "when the subject of professional life of teachers is raised, a common area of

In any retail outlet there are two broad categories of tickets; price and descriptive. Sometimes the two are combined to provide a ticket which tells customers what the item is, how much it costs and why they should buy it.

Information technology is an important and expanding part of the retail scene. Perhaps you are already a part of the exciting IT revolution; perhaps your own retail outlet has not quite got there yet. In either case you need to know what IT is doing for retailing and its advantages and disadvantages.