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The study was funded by the UK National Institute for Health Research (NIHR, PHR 10/3000/07). Objectives. Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. Study design. Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. Methods. Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. Results. Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. Conclusions. POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays. Publisher PDF

Several countries have increased their legal minimum age for work in line with international conventions on child labor. We evaluated the effect of increasing the legal minimum age for work on school attendance in 3 low- and middle-income countries using difference-in-differences analyses. Increasing the legal minimum age for work increased school attendance by 3.0 (0.2, 5.8) percentage-points in Malawi, and 2.0 (0.2, 3.6) percentage-points in Colombia. In Malawi, we found a greater policy effect among girls compared to boys. In Colombia, the poorest tercile experienced the greatest improvement in educational outcomes. We found no evidence of an impact of increasing the legal minimum age for work on school attendance in Burkina Faso. Our findings suggest that increasing the legal minimum age for work has had a positive effect on educational outcomes in some low and middle income countries., Highlights • Many countries increased legal minimum age for work (LMAW) in line with ILO conventions on child labor. • Increasing LMAW increased school attendance by 3.0 percentage-points in Malawi, and 2.0 percentage-points in Colombia. • In Malawi, we found a greater policy effect among girls compared to boys. • In Colombia, the poorest tercile experienced the greatest improvement in educational outcomes. • We found no evidence for a policy effect in Burkina Faso.

ObjectivesThe purpose of this study was to assess the relationship between carotid artery disease by ultrasound and coronary artery disease by coronary computed tomography angiography (CTA) and to identify carotid ultrasound parameters predictive of coronary artery disease.BackgroundCarotid ultrasound and CTA are noninvasive modalities used to image atherosclerosis. Studies examining the relationship between the 2 tests, however, are lacking.MethodsWe performed carotid ultrasound on predominantly nondiabetic subjects referred for CTA. Carotid intima media thickness (IMT) and plaque were assessed and compared with coronary artery calcification and the number of coronary arteries with any evidence of atherosclerosis on CTA.ResultsA total of 150 subjects underwent both CTA and carotid ultrasound on the same day. Carotid plaque was present in 71.3% (n = 107), whereas the presence of at least 1 coronary artery with disease on CTA was present in 57.1% (n = 84). Carotid plaque was present in 47.6% (30 of 63) of subjects with a calcium score of 0 and 88.5% (77 of 87) of subjects with a calcium score >0 (p = 0.0001). Similarly carotid plaque was present in 52.4% (33 of 63) of subjects with no CTA evidence of atherosclerosis versus 85.7% (72 of 84) of subjects with any CTA evidence of atherosclerosis (p < 0.0001). Carotid plaque, IMT ≥1.5 mm, or averaged mean IMT >0.75 mm were associated with a calcium score >0 (odds ratio: 5.4, p < 0.0001, 2.7, p < 0.001; 2.9, p = 0.011, respectively) and disease in at least 1 vessel on CTA (odds ratio: 2.8, p = 0.03, 2.19, p = 0.073; 2.22, p = 0.058, respectively) independent of age and sex.ConclusionsCarotid plaque and increased carotid IMT are associated with the presence and severity of coronary calcification and disease on CTA in ambulatory subjects.

Purpose Misclassification of gestational age based on the last menstrual period (LMP) in routinely collected data creates bias in newborn birthweight and gestational age-related indicators. Common correction methods have not been evaluated. We developed a normal mixture model for use with SAS software to correct misclassification of gestational age and compare its performance with other available correction methods and estimates of gestational age. Methods Using the 2007 United States natality file from the National Center for Health Statistics, we compared LMP preterm and postterm birth rates and gestational age-specific birthweight percentiles against a reference subset of births, where the likelihood of misclassification in gestational age was minimized, before and after correction by a normal mixture model, two truncation methods, and the clinical/obstetric estimate of gestational age. Results The mixture model corrected preterm and postterm birth rates by 90% and 41% respectively, but previous methods performed poorly. The mixture model was also superior in correcting birthweight percentiles 50 and 90 with error reductions in the range of 68% to 85% between 28 and 36 weeks of gestation, where most misclassification occurred. Conclusions The mixture model behaved consistently better than truncation methods, particularly between weeks 28 and 36 of gestation.

Objectives Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland. Methods A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland. Results : Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems. Conclusions Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development.

Research on the health status of international migrants to industrialised countries in general, and on perinatal outcomes in particular, has assumed an interpretative model based on primary migration, characterised by one permanent cross-border movement from the migrant's country of birth. However, many migrants experience more complex migration patterns that may also be associated with human health. Secondary migration, defined as a migration from a country of residence other than the country where the immigrant was born, has been growing during the last two decades, favoured by globalisation. The purpose of this study was to examine the association between secondary migration and preterm birth (PTB) and infant birthweight at term (BW) using a Canadian official immigration database to build a cohort of immigrants to Ontario, Canada, who obtained their permanent residence in the years 1985-2000. The study population comprised 320,398 singleton live infants born to immigrant women during 1988-2007. Primary and secondary migrants were categorised according to whether they were born in an industrialised country or not. Secondary migrants were further subdivided according to whether the country from which they migrated to Canada was industrialised or not. We found that compared to primary migrants, secondary migrants to Canada born in non-industrialised countries had lower odds of PTB and higher mean BW at term. However, such a protective effect was not observed among secondary migrants born in industrialised countries. In a cross-classified multilevel model restricted to secondary migrants, 5.2% of the variation in birthweight was explained by migrants' countries of birth and 0.8% by migrants' countries of last permanent residence. These findings are consistent with the so-called healthy migrant effect, implying that selective migration from non-industrialised countries is associated with protective individual characteristics.

Epinephrine is indicated for various medical emergencies, including cardiac arrest and anaphylaxis, but the dose and route of administration are different for each indication. For anaphylaxis, it is given intramuscularly at a low dose, whereas for cardiac arrest a higher dose is required intravenously. We encountered a patient with suspected anaphylaxis who developed transient severe systolic dysfunction because of inappropriately received cardiac arrest dose, ie, larger dose given as an intravenous push. Three additional patients who experienced potentially lethal cardiac complications after receiving inappropriately higher doses intravenously were also identified. These iatrogenic errors resulted from underlying confusion by physicians about proper dosing of epinephrine for anaphylaxis. The risk of error was amplified by the need for rapid decision making in critically ill anaphylactic patients. An e-mail survey of local hospitals in southeast Michigan revealed that 6 of 7 hospitals did not stock prefilled intramuscular dose syringes for emergency use in anaphylaxis. At our institution, we have introduced prefilled and appropriately labeled intramuscularly dosed epinephrine syringes in crash carts, which are easily distinguished from intravenously dosed epinephrine syringes. In this Concepts article, we describe the clinical problem of inadvertent epinephrine overdose and propose a potential solution. Epinephrine must be clearly packaged and labeled to avoid inappropriate usage and unnecessary, potentially lethal complications in patients with anaphylaxis.

Counseling programs for adolescents living with human immunodeficiency virus (HIV) encourage abstinence from sex and relationships. This Uganda study, however, found that many of these adolescents are sexually active or desire to be in relationships but engage in poor preventive practices. Programs for HIV and acquired immunodeficiency syndrome (AIDS) programs therefore need to strengthen preventive services to this group.

Objective Genetic testing for adult-onset, common diseases is becoming more commonplace in clinical medicine. We modeled the proportions of hypothetic populations that would potentially benefit or suffer harm from widespread predisposition testing. Methods Using the traditional two-by-two table from the discipline of epidemiology, we modeled three hypothetic populations using the example of genetic testing for hereditary colorectal cancer in three groups: the general population, a genetically increased-risk population, and a population at increased risk due to nongenetic factors. Results We demonstrate that the potential benefits are increased and risks are reduced when testing is limited to those at increased genetic risk when compared with testing in the general population. Where disease incidence is increased due to nongenetic factors, genetic testing has the potential to detract from the detection and reduction of other potentially important risk factors. Conclusion While targeted testing can benefit those truly at increased risk, broadly applied genetic testing can do more harm than good.

It has been recently reported that both dynamic movement characteristics, as well as the duration of postures adopted during work, are important in the development of low back pain (LBP). This paper presents a video-based posture assessment method capable of measuring trunk angles and angular velocities in industrial workplaces. The interobserver reliability, system accuracy, and the relationship of the measured exposures to the reporting of low back pain are reported. The video analysis workstation consisted of a desktop computer equipped with digital video capture and playback technology, a VCR, and a computer game type joystick. The operator could then use a joystick to track trunk flexion and lateral bending during computer-controlled video playback. The joystick buttons were used for binary input of twisting. The inter-observer reliability for peak flexion and percentage of time spent in posture category variables were excellent (ICC>0.8). Lower reliability levels were observed for peak and average velocity and movement related variables. The video analysis system time series data showed very high correlation to the criterion optoelectronic imaging system (r ¼ 0:92). Root mean square errors averaged 5.81 for the amplitude probability distribution function data. Trunk flexion variables including peak level, peak velocity, average velocity indicators, and percent time in flexion category indicators all showed significant differences between cases and controls in the epidemiological study. A model consisting of the measures peak trunk flexion, percent time in lateral bend and average lateral bending velocity emerged after multivariable analysis for relationship to low back pain. Relevance to industry Risk of injury for the low back is multifactorial. The trunk position and movement velocity are emerging as important parameters. This analysis confirms the importance of these factors and demonstrates the utility of a videobased method to measure them in industrial settings. r 2001 Elsevier Science B.V. All rights reserved.

Objectives: To demonstrate an important limitation of empirical tests of the proposition that medical care has contributed to long-term declines in mortality. Quasi-experiments cannot detect the effect of care that sustain, rather than change, a downward trajectory. We demonstrate this limitation by testing two hypotheses. One is that isolation of patients and antibiotic treatment coincided with declines in tuberculosis (TB) mortality in Massachusetts between 1850 and 1950. Another is that the introduction of Medicare in the 1960s increased life expectancy at age 65. Results: The first hypothesis is supported, for both patient isolation and streptomycin. The second is not. The circumstances that could yield such results are explored. Conclusions: Epidemiologists and historians should cooperate to devise methods that can resolve the issue of whether medical care has sustained the steady downward trend in mortality witnessed over the last century-and-a-half.

Objectives To explore the views of chiropractors about timely return-to-work in treating patients with musculoskeletal injuries, to identify the approaches used by chiropractors when treating injured workers with musculoskeletal disorders, and to learn about chiropractors' perspectives on the barriers and facilitators of successful return-to-work. Design Qualitative study of 3 focus groups of chiropractors. Methods Focus groups of 8 to 11 chiropractors were conducted in 3 large Canadian cities. The selected participants were experienced in treating patients with occupational musculoskeletal injuries. Standard questions were used to collect data. The data from each focus group were coded and analyzed separately and then considered in relation to each other. Results The participants indicated that timely return-to-work depends on patients' characteristics, severity of injury, clinical progress, the availability of work accommodation, and clinical judgment. The chiropractors commented that their treatment of injured workers rests on their strength in diagnosis and treatment and on providing patient-centered care. Positive human relations within workplaces and the ability to accommodate the work of an injured worker were described as important in return-to-work programs. The participants believed that a bias against chiropractic is present within the medical profession and workers' compensation boards. They viewed this bias as an important barrier when assisting their patients to successfully return to work. Conclusion The broad approaches described by the participating chiropractors to return injured workers to work are consistent with those proposed in evidence-based practice guidelines. Better communication among chiropractors, medical doctors, and workers' compensation boards would likely decrease interprofessional tensions and improve the recovery of workers with musculoskeletal injuries.

Background context: Back pain is the single most costly work-related injury. Chiropractors and physicians are the main primary care providers for occupational low back pain (OLBP), but there is no consensus regarding the relative cost-effectiveness of these two modes of care. Purpose: To critically appraise and synthesize recent literature on the cost-effectiveness of medi- cal and chiropractic care for OLBP, and to propose a cost-effectiveness methodology that inte- grates epidemiologic and economic methods for future studies. Study design: Literature review. MEDLINE was searched from 1990 through 1999. Nine articles that met the inclusion criteria were reviewed. The methodological quality of the articles was criti- cally appraised independently by two epidemiologists using standardized review criteria. Two health economists reviewed the studies on cost-effectiveness. Results: The current literature suggests that chiropractors and physicians provide equally effective care for OLBP but that chiropractic patients are more satisfied with their care. Evidence on the relative costs of medical and chiropractic care is conflicting. Several methodological deficiencies limit the validity of the reviewed studies. No studies combine high-quality cost data with adequate sample sizes and controls for confounding factors. Conclusion: Existing studies fail to clarify whether medical or chiropractic care is more cost effec- tive. We suggest that future studies must combine epidemiologic and economic methods to answer the question adequately. © 2001 Elsevier Science Inc. All rights reserved.

A posture and load sampling approach to measure physical exposures was implemented within a case-control study of low-back pain reporting. The purpose of this paper was to determine how well this method was able to identify known low-back pain risk factors. Subjects, including both cyclic production and non-cyclic support workers, were studied while working in an automotive assembly facility. The study included 104 (with 20 proxies) cases, workers who reported low-back pain at work, and 129 randomly selected controls. Results indicate significant associations between low-back pain reporting and peak spinal loads (OR=2.0 for compression), shift-average spinal loading (OR=1.7 for compression), percent of time with loads in the hand (OR=1.5), maximum flexion angle (OR=2.2), and percent of time spent forward flexed beyond 458(OR=1.3). Posture and hand load variables, considered to be intermediate exposure variables, were handled separately in multivariable regression analyses from variables of peak and average spine force which directly estimate tissue loading. The work and posture sampling approach is particularly useful for heterogeneous work situations where traditional task analysis is diAcult and can provide information on work and tissue load parameters which have been directly associated with risk of reporting low-back pain. Relevance to industry

OBJECTIVE: To determine the relative importance of modelled peak spine loads, hand loads, trunk kinematics and cumulative spine loads as predictors of reported low back pain (LBP). BACKGROUND: The authors have recently shown that both biomechemical and psychosocial variables are important in the reporting of LBP. In previous studies, peak spinal load risk factors have been identified and while there is in vitro evidence for adverse effects of excessive cumulative load on tissue, there is little epidemiological evidence. METHODS: Physical exposures to peak and cumulative lumbar spine moment, compression and shear forces, trunk kinematics, and forces on hands were analyzed on 130 randomly selected controls and 104 cases. Univariable and multivariable odds ratios of the risk of reporting were calculated from a backwards logistic regression analysis. Interrelationships among variables were examined by factor analysis. RESULTS: Cases showed significantly higher loading on all biomechanical variables. Four independent risk factors were identified: integrated lumbar moment (over a shift), 'usual' hand force, peak shear force at the level of L(4)/L(5) and peak trunk velocity. Substituting lumbar compression or moment for shear did not appreciably alter odds ratios because of high correlations among these variables. CONCLUSIONS: Cumulative biomechanical variables are important risk factors in the reporting of LBP. Spinal tissue loading estimates from a biomechanical model provide information not included in the trunk kinematics and hand force inputs to the model alone. Workers in the top 25% of loading exposure on all risk factors are at about six times the risk of reporting LBP when compared with those in the bottom 25%. RELEVANCE: Primary prevention, treatment, and return to work efforts for individuals reporting LBP all require understanding of risk factors. The results suggest that cumulative loading of the low back is important etiologically and highlight the need for better information on the response of spinal tissues to cumulative loading.

Scholarly productivity is an important issue for all academic disciplines. Empirical examinations of career research productivity have not been conducted in the marketing discipline, however. This study reports the analysis and classification of total and career research publication activity for a cohort of 374 marketing academicians over a 20-year period. The analysis revealed seven different career patterns as well as substantial differences in overall levels of career research productivity. Patterns of productivity included those where academicians reached a peak productivity early or midway in their careers as well as those who produced at an increasing level over the course of their careers. Productivity levels were identified based on four groupings that included nonproducers, low producers (one to four articles), medium producers (five to nine articles), and high producers (10 or more articles). Approximately one-third of the cohort were nonproducers, one-third were low producers, and one-third were medium to high producers.

The causes of reported occupational back pain are controversial. Many observers appear to believe that job insecurity increases back pain compensation claims during recessions. The purpose of this study was to formally examine the impact of macro-economic forces-the business cycle-on the incidence of lost-time back pain claim rates in order to elicit clues to both its aetiology and reporting patterns. For Ontario between 1975 and 1993, age- and sex-adjusted lost-time back pain claim rates, stratified by industry sector (construction, manufacturing and trade), were regressed on the unemployment rate of the industry sector using time series methods. As a comparison group, the association between "acute" claim (fractures, lacerations, etc.) and the business cycle was also tested. Both back pain claim rates and acute claim rates increased during boom periods and decreased during recessionary periods. Time series analyses confirmed that these associations were statistically significant. The elasticities between claim rates and the unemployment rate were similar for back pain claims and acute claims. In addition, these associations were consistent in direction across all three industrial sectors tested. These results rebut the view that back pain claims increase during recessionary times.

Total geometry optimizations, at the RHF/3-21G level of theory, for all relevant and computable minima on the unprotonated and protonated potential energy hypersurfaces (PEHSs) of the ground and low-lying valence excited states (i.e. 1,3 (π → π ∗ ) and 1,3 (n → π ∗ ) ) of HCHNOH were determined, using ab initio molecular orbital methods, for the purpose of modelling their aromatic analogues. Reference to both energetics and nuclear and electronic structure aspects of adiabatic proton transfer was made in terms of proton affinities and diagrammatic representations in which the role of geometry and electronic configuration is expressed qualitatively with the aid of Lewis/resonance structures.

Since each torsional mode (χ1 about the CαCβ and χ2 about the CβO bond) of the side-chain of N-formyl-lserinamide, For-l-Ser-NH2, is expected to have three minima (g+, a, g−), the side chain conformational potential energy surface (PES) E = E(χ1, χ2) is expected to have, in the ideal case, nine legitimate minima. Taking 30 ° intervals along χ1 and χ2 a 12 × 12 grid of points has been generated to examine the side-chain conformational PES using a rigid γL(C7eq) backbone conformation (γL; φ = −75 °, ψ = +75 °). Six out of the nine expected minima have been located on the ab initio PES generated for the γL backbone conformation, at the HF/3-21G level of theory. However, three conformations were missing. The relaxed geometries of the remaining six side-chain conformations have been determined by gradient geometry optimization.

A parallel case study design was used to investigate psychosocial effects in populations exposed to solid waste facilities. Psychosocial effects were defined as a complex of distress, dysfunction and disability, manifested in a range of psychological, social and behavioural outcomes, as a consequence of actual or perceived environmental contamination. This paper presents the results of logistic regression analyses designed to identify determinants of psychosocial effects of exposure. The data come from an epidemiologic survey of residents (N = 696) living within a prescribed radius from each of three solid waste facilities in southern Ontario. The analytical model has three main components: external variables (e.g. individual and exposure-related variables); mediating variables (e.g. social network membership and involvement, general health status measures); and outcome variables (e.g. concern, effects and actions). Results for a series of site specific analyses show that outcome measures can be successfully explained by a combination of external and mediating factors. In general, variables from each of the three main components enter the concern-related models while the action models are clearly dominated by social network variables. Analyses using data from all three sites indicate the explanatory power of site-related characteristics. However, given the number and diversity of variables in the models, there is no support for a simple cause and effect relationship. The implication is that strategies aimed to address and alleviate psychosocial effects need to be specific to the characteristics of the populations in particular settings.

Risk factors for the 12-year incidence of definite coronary heart disease (CHD) among 3440 men who were middle-aged (51 to 59 years old) and 1419 men who were elderly (65 to 74 years old) at baseline examination were examined for differences in predictive values in terms of both relative risk and attributable (excess) risk of the highest versus the lowest quartile or appropriate categories. In multivariate models using Cox life-table regression procedures, serum cholesterol level, cigarette smoking, systolic blood pressure, and history of treatment for diabetes were significant predictors of incident CHD for both age groups. Alcohol consumption when modeled as drinker versus nondrinker showed a protective effect in both younger and older men. There was no dose relationship, however, among elderly drinkers. While the relative risks for the variables studied were similar between the two age groups, the excess risk was typically between 1.5 to 2.0 times higher for the older than the middle-aged men. In contrast, the detrimental effect of adiposity as measured by body mass index appeared to decline after age 65 for both measures of risk. This may partly be attributed to diminished adiposity overall in the older age group. The implications of these results are that serum cholesterol level, smoking, hypertension, diabetes, and possibly alcohol consumption continue to be important predictors for CHD when measured after age 65, and that the public health impact of these risk factors, in terms of excess risk, may be more important in the elderly.

On the basis of multidimensional conformational analysis a two-dimensional Ramachandran map of a single amino acid unit in a peptide is expected to have, under ideal conditions, 3 2 =9 distinct minima according to the following pattern: γ D δ D α L ϵ D β DL ϵ L α D δ L γ L Consequently, a dipeptide unit, which corresponds to a four-dimensional Ramachandran map, is expected to have 3 4 =81 distinctly different minima, under ideal conditions. Some of these minima may be labelled γ L γ L ,γ L δ L ,γ L ϵ L ,γ L α L ,γ L α D etc. It appears that the “unordered” conformations as well as the familiar “ordered” secondary structural elements such as α-helix, β-pleated sheet or the different types of turn in proteins might be related to the above 81 conformations of the dipeptides. This recognition leads to a system of conformational classification that may have far-reaching consequences for our understanding of the secondary and tertiary structures of peptides and proteins.

Background Evidence that early years interventions can reduce inequalities has led to Scottish Government policy recommending that local areas implement initiatives to improve early child development. How best to measure the effects of these interventions is, however, unclear. We conducted a pilot study of the first UK use of the teacher-administered Early Development Instrument (EDI), an internationally validated measure of global child development now used at school entry in all children in Australia and most of Canada. Methods The study, conducted in the primary school setting in 2011–12, was cross-sectional in design and used qualitative and quantitative methods. During phase 1 the EDI was adapted for the Scottish context. 14 teachers assessed 154 pupils, using the instrument. Focus groups and semi-structured questionnaires were used to gather feedback from teacher participants on the instrument and the process. Phase 2 collected and analysed data from 1090 pupil participants, comprising 98% of eligible school-entrants in East Lothian local authority, assessed by 68 teachers. The 104-item EDI questionnaire has five domains of child development: physical, social, emotional, language and cognitive, and communication and general knowledge. Data were analysed with SPSS (version 17.0). The psychometric properties of the EDI were assessed with Cronbach's α. Mean scores in the domains were linked to levels of deprivation and results were mapped using Geographic Information System. Phase 3 monitored subsequent dissemination and use of EDI results. The study was approved by the School of Psychological Sciences and Health Ethics Committee of the University of Strathclyde, Glasgow, UK; the Education Authority of the relevant school district; and the Chief Scientist Office of the Scottish Government. In line with EDI data collection in other countries, opt-out consent was used for parents of pupils. All teachers provided written, informed consent. Findings Children in the most deprived quintile were 2·8 times more likely than the most affluent to be developmentally vulnerable in one or more domains; however, substantial developmental vulnerability was found across all five quintiles, not only in the most deprived. The EDI was found to be user friendly and acceptable to teachers, demonstrating high levels of internal reliability. Dissemination of results created a forum for multidisciplinary discussion and raised awareness about the importance of early child development, domains of development, and how inequalities can be tackled, leading to new initiatives based on EDI data. Interpretation The EDI is a robust instrument able to highlight developmental differences in children between socioeconomic groups and small-scale geographical areas. Its simplicity and usability lend themselves easily to community-wide implementation. Funding Medical Research Council and Chief Scientist Office of the Scottish Government.

Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRP's role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research. Methods Four working groups, including members from research, practice, and policy, were formed to address prioritised topics across the life course. Directed by these groups, structured rapid reviews of the published work were undertaken. Various KTE and collaborative activities were used to strategically disseminate the review findings and to engage with stakeholders in implementation of the recommendations. These activities included events such as workshops, seminars and public meetings, and training courses. Findings SCPHRP commissioned and seed-funded several projects to support intervention development. The pilot studies and review findings contributed to the development of new research across the four topics. The timeliness and extent of convergence with current government priorities and initiatives probably had the greatest effect on policy makers' receptivity. SCPHRP is working with Scottish Government and NHS Health Scotland on several policy relevant projects, including development of an evidence-informed parenting strategy; assessment of alcohol brief interventions; piloting of a measurement instrument to assess early child development at the population level; and obesity management and prevention. Interpretation The extent to which SCPHRP has successfully influenced government public health decision making will be known only in the longer term. However, our experiences suggest that successful KTE relies on the identification, development, and facilitation of networks that bridge the divide between scientific research, policy, and practice. These networks should ideally be developed early and involve stakeholders from policy, research, and practice from the outset. Windows of opportunity for engagement with policy makers on public health priorities should be identified and fully exploited. Funding UK Medical Research Council and Chief Scientist Office of the SCottish Government.

Preventive medical interventions directed at the general population require rigorous evaluation of the associated benefits, risks, and costs. This paper, the first of a three-part series, assesses the current evidence for the effectiveness of occult-blood (Hemoccult) screening for colorectal carcinoma. When judged by explicit methodologic criteria for the effectiveness of screening, that evidence demonstrates no clearcut benefits to patients found to have colorectal cancer through testing for occult blood. In contrast, there may be substantial risks and costs associated with the widespread use of this preventive maneuver. These are considered in two companion papers.

It is argued that women who find asymptomatic benign breast lesions by breast self-examination (BSE) are exposed to unnecessary anxiety, unnecessary medical investigations (including invasive procedures), and potential risks of false reassurance. "False positives" so greatly outnumber patient-detected cancers below age 30 to 35 that the potential for net benefit from BSE in this age group is remote. BSE in younger women, by encouraging invasive and costly medical investigation of many asymptomatic benign breast lumps needing no treatment, could well do more harm than good.

The potential benefits and risks associated with Hemoccult® screening have been reviewed in two companion papers.12 This final article assesses two major determinants of the overall “disease yield” of occult-blood screening, as well as the economic costs entailed by the maneuver. First, asymptomatic polyps detected and treated by such screening are more properly considered “false” positives than “true” positives—the benefits of their aggressive diagnosis and extirpation in the general population being much less established than the risks. Secondly, the ongoing detection rate for colorectal carcinoma on subsequent (e.g., annual) screenings of a population already screened will be substantially less than the initial screening yield; yet, the risks of confirmatory diagnostic procedures remain high. Lastly, there are many hidden costs to occult-blood screening that have generally not been recognized. Therefore, the use of Hemoccult screening as a routine health maintenance maneuver cannot yet be justified for any age-group.

Regular multidimensional screening of the elderly for undetected health problems has the potential for delaying functional deterioration and improving the quality of life, but has not been evaluated rigorously. This pilot study examined the amount and type of unmet health care need discovered by home-based screening of 100 family practice patients aged 75 and over. Although 96 per cent of patients had some health problems, only 71 per cent had problems that needed further intervention. Of these, the majority were problems in the area of psychosocial function, independence, and lifestyle. Age, sex, and frequency of attendance at the practice in the previous year were not found to be useful markers for targeting screening efforts. Although it is potentially beneficial for detecting unmet need, home-based screening is resource-intensive and requires further examination in randomized trials in the North American context.

Total geometry optimizations at the STO-3G and 3-21G basis levels, as well as single point energy determinations using the 6-31G* basis set for all relevant minima and selected first- and second-order critical points on the unprotonated and protonated potential energy surfaces (PES's) of vinyl alcohol, methyl vinyl ether and 1,3-butadien-1-ol were determined. The proton affinities for each minimum isomer on the PES's of these compounds were also determined. These three systems were chosen as initial compounds to model the highly potent mutagenic “fecapentaenes” which are found in the bowel mucosa of people who have a high risk of developing colon cancer. These model compounds were chosen for two reasons: (1) to determine if a simplified glycerol moiety (i.e. a methyl group in methyl vinyl ether) can be further simplified to a hydrogen atom as in vinyl alcohol, and (2) to compare and contrast the differences obtained in the PES when the double bond moiety in vinyl alcohol is extended to a conjugated carbon—carbon double bond system as in 1,3-butadien-1-ol. The calculations reveal that the glycerol moiety of the enol ether type compounds may be simplified to a hydrogen atom using enol aldehyde compounds. In general, the PES's of the model fecapentaene compounds behave as would be predicted by chemical intuition, i.e. secondary carbonium ions are found to be more stable than primary carbonium ions, and the anti or trans configurations for (CCCC), (CCCO) and (HOCC) torsional angles are favored over the syn or cis configurations respectively (unless the cis/syn configurations are part of a ring system formed by H-bond or covalent type bonds). Configurations about carbon—carbon double bonds favor trans over cis , and finally, when three-, five- and six-membered rings can form, the calculations reveal that in all likelihood they will do so. The most important features at each basis level were that the energy barriers for methyl, methoxyl and hydroxyl rotations were very low, corresponding to virtually free rotations, and that the energy differences between conformers of a given isomer were small. The geometries determined by the 3-21G basis set should be superior to those determined with the STO-3G basis set, and some unusual features were present with the STO-3G basis set, especially when the protonation site was oxygen.

The pinning forces in Nb and Pb-In were determined by mechanically sweeping a magnetic field over it and measuring the resulting force. Three different forces due to the interaction between the magnetic field , the trapped flux lines, the Meissner screening current, and the pinning sites of the specimen were identified. The magnitude of the bulk pinning force was in agreement with that calculated from the magnetization via Irie-Yamafuji model; F=αBr. The temperature dependence of the pinning force was found to be given by Fp(T)=Fp(0) (1−T/Tc) and it is suggested that this can be understood in terms of Anderson's flux creep model.

The film transfer rate out of a glass beaker under conditions of strict cleanliness and minimization of vibration can be described by σ (H,T) = 6.5 ϱ s ϱ H − 1 4 10 −5 cm 2 /sec , where H is the height of the beaker rim above the beaker level.