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People living with long-term conditions are increasingly being cared for in care homes. Prognostication in this population is particularly challenging, and outcomes are often uncertain. This case history highlights some of the difficulties encountered when clinicians give a time-bound prognosis. It also illustrates how education programmes with high facilitation and ongoing support for care home staff can sustain practice development and enable staff to become highly skilled in working with uncertainty. Practice development programmes such as those based on the Six Steps to Success Programme for care homes give care home staff a framework within which to regularly review a resident's clinical status and the confidence to have the ongoing conversations that empower residents to contribute to decision making and focus on their own goals for care.

International Mindedness is an overarching construct related to multilingualism, intercultural understanding and global engagement (Hill, 2012). The concept is central to the International Baccalaureate (IB) and sits at the heart of its education policies and programmes. The aim of this research study was to examine systematically how schools offering International Baccalaureate programmes (so-called IB World Schools) conceptualise, develop, assess and evaluate International Mindedness (IM), and to understand related challenges and problems, with a view to improving practice in schools. Nine case study schools, identified as being strongly engaged with IM, were selected for in-depth scrutiny of their practice and thinking related to IM. Conclusions from this study will also inform on-going debate on other similar global initiatives.

IntroductionThe development of multiple breath washout (MBW) testing in respiratory disease highlights the need for increased awareness amongst respiratory physiotherapists and a potential opportunity for professional development in the use of an important outcome measure for clinical trials.Objectives To rationalise how MBW may be a useful assessment tool for respiratory physiotherapists and to describe a local MBW training and certification programme for physiotherapists. ResultsThe respiratory Multi-Disciplinary Team in the Belfast Health and Social Care Trust (BHSCT) identified a need for MBW testing to be available to facilitate clinical research and assessment. A 2 day training programme consisting of pre-reading preparation, self-directed learning, theory presentations, practical demonstrations and hands-on practice was developed and delivered. All participants underwent a certification process.Conclusion: We have demonstrated the successful training and certification of clinical and research physiotherapists and encourage other respiratory physiotherapists to consider MBW test training.

Summary Background Hyperbaric oxygen has been used as a therapy for patients experiencing chronic intestinal syndromes after pelvic radiotherapy for decades, yet the evidence to support the use of this therapy is based almost exclusively on non-randomised studies. We aimed to provide conclusive results for the clinical benefits of hyperbaric oxygen in patients with chronic bowel dysfunction after radiotherapy for pelvic malignancies. Methods HOT2 was a double-blind, sham-controlled, phase 3 randomised study of patients (≥18 years) with chronic gastrointestinal symptoms for 12 months or more after radiotherapy and which persisted despite at least 3 months of optimal medical therapy and no evidence of cancer recurrence. Participants were stratified by participating hyperbaric centre and randomly assigned (2:1) by a computer-generated list (block size nine or 12) to receive treatment with hyperbaric oxygen therapy or sham. Participants in the active treatment group breathed 100% oxygen at 2·4 atmospheres of absolute pressure (ATA) and the control group breathed 21% oxygen at 1·3 ATA; both treatment groups received 90-min air pressure exposures once daily for 5 days per week for a total of 8 weeks (total of 40 exposures). Staff at the participating hyperbaric medicine facilities knew the allocated treatment, but patients, clinicians, nurse practitioners, and other health-care professionals associated with patients' care were masked to treatment allocation. Primary endpoints were changes in the bowel component of the modified Inflammatory Bowel Disease Questionnaire (IBDQ) score and the IBDQ rectal bleeding score 12 months after start of treatment relative to baseline. The primary outcome was analysed in a modified intention-to-treat population, excluding patients who did not provide IBDQ scores within a predetermined time-frame. All patients have completed 12 months of follow-up and the final analysis is complete. The trial is registered with the ISRCTN registry, number ISRCTN86894066. Findings Between Aug 14, 2009, and Oct 23, 2012, 84 participants were randomly assigned: 55 to hyperbaric oxygen and 29 to sham control. 75 (89%) participants received 40 pressure exposures, all participants returned the IBDQ at baseline, 75 (89%) participants returned the IBDQ at 2 weeks post-treatment, and 79 (94%) participants returned the IBDQ at 12 months post-start of treatment. Patients were excluded from analyses of co-primary endpoints if they had missing IBDQ scores for intestinal function or rectal bleeding at baseline or at 12 months. In an analysis of 46 participants in the active treatment group and 23 participants in the control group, we found no significant differences in the change of IBDQ bowel component score (median change from baseline to 12 months of 4 (IQR −3 to 11) in the treatment group vs 4 (−6 to 9) in the sham group; Mann-Whitney U score 0·67, p=0·50). In an analysis of 29 participants in the active treatment group and 11 participants in the sham group with rectal bleeding at baseline, we also found no significant differences in the change of IBDQ rectal bleeding score (median change from baseline to 12 months of 3 [1 to 3] in the treatment group vs 1 [1 to 2] in the sham group; U score 1·69, p=0·092). Common adverse events in both groups were eye refractive changes (three [11%] of 28 patients in the control group vs 16 [30%] of 53 patients in the treatment group), increased fatigue (three [11%] vs two [4%]), and ear pain (six [21%] vs 15 [28%]). Eight serious adverse events were reported in eight patients: two were reported in two patients in the control group (tonsillitis requiring surgery [grade 3]; recurrent cancer of the vulva [grade 4]) and six serious adverse events were reported in six patients in the treatment group (malignant spinal cord compression requiring surgery [grade 3]; malignant paraortic lymph node involvement requiring surgery [grade 3]; recurrence of vomiting and dehydration [grade 3]; diarrhoea and fever associated with Campylobacter infection [grade 3]; recurrence of abdominal pain, bloating, diarrhoea, and urinary tract infection [grade 3]; aneurysm [grade 4]), none of which were deemed treatment-related. Interpretation We found no evidence that patients with radiation-induced chronic gastrointestinal symptoms, including those patients with rectal bleeding, benefit from hyperbaric oxygen therapy. These findings contrast with evidence used to justify current practices, and more level 1 evidence is urgently needed. Funding Cancer Research UK and National Health Service (NHS) funding to the National Institute of Health Research Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research.

PURPOSE: Obstructive sleep apnea is common in patients with end-stage renal disease, and there is increasing evidence that clinical factors specific to end-stage renal disease contribute pathophysiologically to obstructive sleep apnea. It is not known whether circumstances specific to dialysis modality, in this case peritoneal dialysis, affect obstructive sleep apnea. Our study aimed to investigate the prevalence of obstructive sleep apnea in the peritoneal dialysis population and the relevance of dialysis-specific measures and kidney function in assessing this bidirectional relationship. METHODS: Participants with end-stage renal disease who were treated with nocturnal automated peritoneal dialysis for at least 3 months were recruited from a hospital-based dialysis center. Laboratory measures of dialysis adequacy, peritoneal membrane transporter status, and residual renal function were gathered by chart review. Patients participated in a home sleep apnea test using a level III sleep apnea monitor. RESULTS: Of fifteen participants recruited, 33% had obstructive sleep apnea diagnosed by apnea-hypopnea index ≥ 5 events per hour of sleep. Renal creatinine clearance based upon 24-h urine collection was negatively correlated with apnea-hypopnea index (ρ = – 0.63, p = 0.012). There were no significant associations between anthropometric measures, intra-abdominal dwell volume, or peritoneal membrane transporter status and obstructive sleep apnea measures. CONCLUSIONS: The prevalence of obstructive sleep apnea and sleep disturbances is high in participants receiving peritoneal dialysis. Elevated apnea-hypopnea index is associated with lower residual renal function, whereas dialysis-specific measures such as intra-abdominal dwell volume and peritoneal membrane transporter status do not correlate with severity of obstructive sleep apnea.

‘Effort’ and ‘ability’ (understood as potential, intelligence or achievement) are concepts widely used in the everyday language of schooling in Britain but each term lacks clear definition of its use in the school context. Meanwhile, the assessment of effort, alongside that of achievement, remains widespread. This article reports on an exploratory case study of conceptions of effort among three major actors in an English secondary school. Qualitative and quantitative data from questionnaires and interviews with teachers, students and parents at an English comprehensive school were collected. Analysis reveals that understandings of ‘effort’ are not uniform. Rather, ‘effort’ is a shorthand term, which can be used variably, therefore can be construed as a tool of negotiation, or a form of investment in a set of aims distinctive to each group or individual case. There is a strong case for more sustained research into the operationalizing of such key concepts in schools and other professional and workplace set...

In this article, we describe an Ebola preparedness initiative with implementation across an academic health system. Key stakeholder centers of various disciplines and clinical experts collaborated in the development and design. Subject matter experts in the areas of Centers for Disease Control and Prevention and World Health Organization protocols for personal protective equipment donning and doffing conducted initial train-the-trainer sessions for program instructors. These trainers represented a cross-section of key clinical responders and environmental services. Through a parallel development process, a blended learning curriculum consisting of online modules followed by on-site training sessions was developed and implemented in both the simulation laboratory and the actual clinical care spaces in preparation for a Department of Health inspection. Lessons learned included identification of the need for iterative refinement based on instructor and trainee feedback, the lack of tolerance of practitioners in wearing full-body personal protective equipment for extended periods, and the ability of a large system to mount a rapid response to a potential public health threat through leveraging of expertise of its Simulation Program, Center for Quality, Safety and Innovation as well as a wide variety of clinical departments.

BACKGROUND Fibromyalgia is a chronic pain syndrome that affects about 2% of the U.S. general population, with greater prevalence among women (3.5%) than men (0.5%). Previous research results suggest that the experience of pain (allodynia) upon sphygmomanometry may indicate the presence of fibromyalgia. OBJECTIVE The aim of this study was to confirm these findings in patients with fibromyalgia and other chronic pain conditions and evaluate the use of sphygmomanometry as a potential screening tool for the identification of patients with fibromyalgia. METHODS A total of 150 people participated in this multicenter, cross-sectional observational study. The study included a physician-conducted evaluation to determine if the participant met the American College of Rheumatology (ACR) 1990 diagnostic criteria for fibromyalgia. The presence of sphygmomanometry-evoked allodynia was assessed during a seated cuff pressure inflation that was repeated three times on each arm. Each site was provided a sphygmomanometer to ensure standardization, and the pressure of the cuff at the moment of pain initiation was recorded. If the patient did not indicate pain prior to 180 mmHg, then the inflation was stopped, a notation of no pain was made, and a cuff pressure of 180 mmHg was recorded. The mean of the six cuff pressure measurements was used for the analyses. Logistic regression was performed to analyze the relationship between sphygmomanometry-evoked allodynia and fibromyalgia. RESULTS The evaluable sample was 148 (one participant had too large an arm circumference for the sphygmomanometer and another did not receive the clinician evaluation of ACR-determined fibromyalgia diagnosis). Over half of the participants were determined to have an ACR diagnosis of fibromyalgia. Of these, 71 (91%) were women and had an average age of 54 years. Of the 70 participants with no fibromyalgia diagnosis, 42 (60%) were women and also had an average age of 54 years. Sixty-one (78%) of the fibromyalgia participants, compared with 25 (36%) of those with no fibromyalgia diagnosis, reported sphygmomanometry-evoked allodynia. The participants with fibromyalgia reported pain ata lower cuff pressure compared with those without fibromyalgia (132 mmHg vs. 166 mmHg, p < .01). The logistic regression showed that sphygmomanometry-evoked allodynia predicted an ACR-determined FM diagnosis (χ(2) = 19.4, p < .01). DISCUSSION These findings support previous research suggesting that patients who report pain upon sphygmomanometry may warrant further evaluation for the presence of fibromyalgia.

A Classroom Response System (CRS) is a communication device instructors can use to promote active learning. CRS have been shown to have other benefits including better attendance, increased peer instruction, higher test scores, better grades, and the ability to use contingent teaching methods. Contingent teaching methods allow instructors to gain real-time understanding of what students know and comprehend and make adjustments to lesson plans as needed. This study investigated hospitality students' attitudes regarding CRS technology. The study was conducted over a three-semester period and surveyed hospitality students (n=117) in an introductory foods course in which a CRS was used. Students indicated CRS helped them understand concepts, engage in discussion, and motivated them to attend.

The Equality Act 2010 will be implemented in full in 2011, and schools in the UK will have to provide special aids or services for children with disabilities where this provision is considered reasonable. This paper reports on staff perspectives on the use and usefulness of a parental questionnaire on disability from a sample of 49 schools (mainstream and special) located in 12 local authorities. Most schools found the process of administering the parent questionnaire undemanding; just under half of the sample indicated that they would take some action as a result of the data collected from the parental questionnaire (e.g., to inform plans for targeting or monitoring support for children, and to contact parents and follow-up issues they had mentioned); and about one-third of schools recorded unanticipated findings from the parental questionnaire, that is, the identification of children whose disabilities were not previously known to the school. Implications for schools are discussed.

There is growing recognition that the effects of climate change are likely to lead to more migration, both internally and internationally, in the relatively near future. These climate change-induced migrations are likely to pose new challenges to the international system, ranging from an increase in irregular migration, to strains on existing asylum systems, to protection gaps for certain migrants affected. Yet the legal and normative framework, and institutional roles and responsibilities, relating to climate change-induced migration remain poorly developed. This article provides an overview of the interactions between climate change and migration, outlines the current international response, and considers new approaches to the global governance framework. KEYWORDS: climate change, migration, asylum. ********** AS EARLY AS 1990, THE INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE (IPCC) warned that significant levels of migration could occur as a result of changing climatic conditions. (1) The concept of environmental migration proved to be a controversial one, largely because of the difficulty in measuring the extent to which environmental factors compel people to move. Since the 1980s, when the term environmental refugees was coined, experts within the environmental and migration fields have differed in their characterization of the phenomenon. Oli Brown puts those concerned with the interconnections in two groups--alarmists and skeptics. (2) The alarmists see the environment as a principal cause of population movements, emphasize the forced nature of the migration (thus, using the term "refugee"), and often project that hundreds of millions of persons will be affected, frequently without differentiating between those who will move short distances to safer ground versus those who will move thousands of miles to new countries. The skeptics, by contrast, raise questions about the models used to generate estimates of those who will be forced to migrate and emphasize that pull factors in destination locations are often more important than push factors at home in determining whether, where, and in what volume people will migrate. Perhaps not surprisingly, some environmentalists have been particularly alarmist, often using the threat of mass migration as a reason that immediate action should be taken to address climate change and other environmental problems. Migration experts, concerned about a potential backlash against migrants and misuse of terms like "refugee," which is carefully defined in international law, have tended to join the camp of the skeptics. Recognizing the complexity in determining causality, and the broader context in which the environment affects population movements, the International Organization for Migration (IOM) has offered the following broad definition of environmental migrants: "Environmental migrants are persons or groups of persons who, for compelling reasons of sudden or progressive change in the environment that adversely affects their lives or living conditions, are obliged to leave their habitual homes, or choose to do so, either temporarily or permanently, and who move either within their country or abroad." (3) Policymakers have been slow, however, to develop national, regional, or international laws, policies, or organizational responsibilities--that is, a system of governance--to manage environmentally induced migration. This situation derives in part from uncertainties about the actual impacts of the environment, particularly as exacerbated by climate change, on migration. But even where there is a recognition that some form of migration related to environmental change is likely to occur, addressing these movements is hampered by the paucity of policy or institutional responses that are deemed appropriate to these forms of migration. This article begins with a brief discussion of the potential impact of climate change on migration patterns. I continue with an examination of existing capacities to address these forms of movement, discussing gaps in governance. …

Little information has been published about the suitability of candidates for living organ donation who have a past or current psychiatric diagnosis. A retrospective review of 445 living donor kidney transplants performed at Barnes-Jewish Hospital's transplant center from 1995 to 2005 disclosed 42 donor candidates with such a history, prompting detailed psychological evaluation. Although 41 candidates (10% of the donor pool) met criteria for 1 or more psychiatric diagnoses, none were considered psychologically unfit for donation. Of these, 22 candidates underwent kidney donation without medical or surgical complications and without development of subsequent active psychological problems. Several donors maintained long-term contact up to 12 years to report good health and a high degree of satisfaction with the decision to donate. This experience suggests that for donor candidates with a psychiatric diagnosis, formal psychiatric evaluation to evaluate current mental health stability is warranted. Stable individuals, on or off therapy, can be considered fit to donate with expected short- and long-term outcome prognoses similar to those for the general population.

PURPOSE: Restless legs syndrome (RLS) is a commonly occurring neurologic disorder that affects up to one third of women during pregnancy. RLS has been associated with increased sympathetic tone in the nonpregnant population. We examined whether a RLS surrogate is associated with a higher prevalence of pregnancy and neonatal outcomes. METHODS: Data were analyzed from a cross-sectional survey of 1000 women interviewed soon after delivery by using an RLS surrogate question. Women were asked how frequently (0 = none, 1 = rarely [

This study suggests that yoga can be of benefit to patients (and carers) in palliative care settings. Complementary therapies have been employed in our day care unit for several years – aromatherapy, reflexology and massage – and have grown in popularity, enabling relaxation and a feeling of wellbeing. For patients striving to remain physically fit and, in consultation with our physiotherapist, we felt there may be a role for a gentle form of yoga. A study of the literature yielded information on yoga and cancer but little evidence of its use in palliative care. Having identified a form of yoga that could be adapted for those with physical frailties – Dru yoga – a 12-week pilot project was introduced into the day care unit. This proved to be highly successful and has now been incorporated as part of our therapeutic service.

The UK Government's Key Stage 3 Strategy (KS3S) aims to transform teachers' approaches, including pedagogy, and pupils' expectations in England. It places new demands on specialist subject teachers to undertake cross‐curricular work in the fields of literacy and numeracy development. However, there are insufficient research data concerning trainee teachers' readiness for such a broadening of their responsibilities, and it is also unclear whether, or how, teachers will be trained in the underpinning pedagogies associated with literacy and numeracy. This study, funded by the British Academy, investigated how trainee teachers across a range of disciplines conceive of literacy and numeracy, as such pre‐concepts are likely to frame their approaches to teaching, and, thus, impact on the effectiveness of the cross‐curricular elements within the Strategy. It discovered differences according to subject background and between attitudes to literacy and numeracy. The interview process was found to be helpful in getti...

As an element of high stakes assessment, coursework was originally intended to raise the validity of the assessment process and to enhance the learning of students. In recent years, this purpose has been distorted by the increasing requirements for educational institutions to demonstrate standards and to be accountable. This small, ESRC-funded study used in-depth qualitative approaches to explore the nature and processes of learning from coursework in national examinations undertaken by 16 year-old students. Among other things, it probed the extent to which qualities such as independent learning, critical thinking and creativity were developed through coursework. The research found that, while the practice underpinning coursework had the capacity to support deeper and more independent learning, the pressures of achieving good grades mediated against all pupils reaching the optimum level of higher order thinking.

The paper raises some concerns about the assessment procedures implicit in the new Standards for the award of Qualified Teacher Status (QTS) issued by the Teacher Training Agency (TTA) and, as a consequence, a question mark is raised over the process and purpose of their introduction to initial teacher education (ITE) in England and Wales. What appears to be a technocratic approach to the assessment of teacher trainees in reality straddles a hybrid position in terms of the assessment model on which it is based. Little regard has been given, in the public domain at least, either to the rationale behind the introduction of the Standards or to the process of implementation. Having taken the ITE world more by surprise than storm this paper reflects upon the Standards in the context of assessment. It builds on previous pleas for a relevant assessment paradigm for workplace assessment, that of the judgemental model (Hager & Butler, 1996; Martin, 1997).

An overarching concern of external agencies working in an educational context in developing countries is that of sustainability, that is, the degree to which change is embedded in practice once the agency has left. As consultants working with advisory teachers (ATs) in Lesotho our contention is that to be sustainable, change in ATs' practice should be a product of their thinking rather than an uncritical adoption of western practice. To understand the impact of our work on sustainability we developed an approach to evaluation which we termed ‘envisioning’. It is suggested that the rationale underpinning envisioning explored in this paper will help agencies involved in similar work.

Summary This paper arises from a research project funded by the Joint Council for the GCSE which investigated users' perceptions of the GCSE. User groups comprised teachers, further education lecturers, students, parents, school and college governors and employers. The paper considers the style and philosophy of the GCSE, and discusses perceptions of its value, organization and appropriateness. In particular, it looks at the extent to which users believe the GCSE has achieved its aims of examining a balance of knowledge, understanding and skills; providing a challenge for students of all abilities; and being relevant to life outside school. The paper suggests that the GCSE is regarded as an important qualification, but that it cannot perform concurrently all the functions that users are claiming for it. Areas where tensions exist are discussed.

The increased emphasis on school‐based programmes as part of initial teacher education has resulted in renewed efforts to forge more effective partnerships between higher education institutions and schools. The University of Bath has established a mentor development programme to ensure that subject mentors have an opportunity to examine ways to engage novice teachers in critical reflection about their practice while providing the support and challenge necessary to help them develop as teachers. This study is based on experienced mentors’ and their perspective on their work with novice teachers and it is a follow‐up to earlier research based on Daloz’ model (1986, Effective Teaching and Mentoring, San Francisco, Jossey Bass) of support and challenge. It examines an emerging mentoring pedagogy through which experienced mentors attempt to engage novice teachers in shaping their own vision of teaching. Three mentor profiles are discussed—the laissez‐faire, the collaborative and the imperial mentor.

This paper is supportive of the judgemental model of assessment posited by Hager & Butler (1996) and is a twofold response. First, it examines the underpinning principles of assessment and testing theory on which their paper is based. Whilst the judgemental model of assessment is not based on the traditional notions of validity and reliability, as in classical test theory, it nevertheless does take account of and is built on appropriate conceptions of these two fundamental principles of any instrument of assessment. It is the concomitant and necessary shift in perceptions of these underlying principles that give support for Hager & Butler's justification for a judgemental model of assessment as that which is appropriate for the assessment of workplace performance. Second, it supports the application of the judgemental model to workplace performance by considering a pertinent area, that of a postgraduate certificate in initial teacher education.

Summary Summary Coursework is an integral part of the GCSE framework, valued for its motivational qualities and its curricular validity. It is a common perception, widely reported in the national press and educational media, that coursework can be held at least partly accountable for differential performances at GCSE; coursework, it is argued, advantages girls. This article reports on an analysis of data arising from a project which offered an opportunity to study current and post-GCSE students’ perceptions of coursework. The outcomes indicate that, when categorised by their relative levels of attainment, girls’ and boys’ perceptions show limited evidence of homogeneity. In other words, to suggest that girls’ and boys’ perceptions of coursework are a function of gender is a gross over-simplification. Other factors are at play and further, more specific and tailored research is essential if we are to understand how best to optimise the benefits that are claimed for coursework.

Schools in England (as elsewhere in Europe) have a duty to promote equality for disabled people and make reasonable adjustments for disabled children. There is, however, a degree of uncertainty about how well-placed parents are addressed to use the legislation to ensure their child’s needs. This paper presents data drawn from a national questionnaire designed for schools to use to identify their disabled pupils and examines, in detail, parental responses to a question on the kinds of support their child finds helpful in offsetting any difficulties they experience. It illustrates the complex and varied nature of the ‘reasonable adjustments’ that are required and an overriding sense that need to be underpinned by the values of a responsive child-centred approach, one that recognises that parents’ knowledge and understanding of their child are important. Schools need to have in place the two-way communication process that supports them in ‘knowing’ about the visible and invisible challenges that pupils with difficulties and disabilities face in participating in school life.

Conceptualisations of disability that emphasise the contextual and cultural nature of disability and the embodiment of these within a national system of data collection present a number of challenges especially where this process is devolved to schools. The requirement for measures based on contextual and subjective experiences gives rise to particular difficulties in achieving parity in the way data is analysed and reported. This paper presents an account of the testing of a tool intended for use by schools as they collect data from parents to identify children who meet the criteria of disability established in Disability Discrimination Acts (DDAs). Data were validated through interviews with parents and teachers and observations of children and highlighted the pivotal role of the criterion of impact. The findings are set in the context of schools meeting their legal duties to identify disabled children and their support needs in a way that captures the complexity of disabled children’s school lives and provides useful and useable data.

Mentoring currently plays an important role in the professional development of both trainee and newly qualified teachers. However, despite the prominence given to this in the delivery of programmes of teacher education and the associated literature there is as yet no consensus as to how it is best managed nor, indeed, that it should be done so in a way that can be universally applied to different schemes. In order to give an overview of the current state of the art this paper considers mentoring and its associated dimensions using the literature to inform the various aspects of the mentoring process: selection of mentors; preparation of mentors for the task; mentor‐student interaction; sustaining the mentoring role; assessment and mentoring in context.

This case study examines the impacts on student learning, achievement and satisfaction when year 13 (final year) students at a large UK sixth form college take a GCE A level in one year instead of the usual two years. Data relating to the entry qualifications and final A level grades achieved by 879 students on both accelerated and non-accelerated programmes were obtained over a four-year period. Inferential analysis was carried out using pairwise Z-tests to compare the proportion of students achieving grade C or better on each course. A sample of 89 students completed a written questionnaire, which was used to examine their attitudes and opinions of accelerated and non-accelerated teaching and learning. It was found that students on accelerated programmes who had taken Business Studies at GCSE or who achieved an A* or A grade in English or Maths at GCSE were more likely to get a grade of C or above at A level compared to students on the standard two-year programme. The results of this study suggest that further research is needed to assess whether more students could be successful on accelerated A level courses, or similar post-compulsory courses internationally.

We have developed a microcytotoxicity assay allowing sera to be screened for anti-epithelial cell cytotoxic antibodies. Cells from the epithelial cell line A549 were cultured overnight in Terasaki trays prior to the addition of the sera to be screened. Using this assay, 63 pediatric recipients of 78 renal transplants have been studied retrospectively. Seventeen transplants carried out in 13 patients were found to be associated with the production of antibodies reactive only against epithelial cells (AEC). Eleven of these transplants failed as compared with 19 failures out of 52 transplants not associated with AEC production (Fisher's p = 0.04). We conclude that transplantation in the face of pre-existing AEC should be approached with caution.

Objective Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain and lowered pain threshold. Other prominent symptoms include disordered sleep and fatigue. FMS affects an estimated 2% of the population, predominantly women. This trial was designed to evaluate the efficacy and safety of pregabalin, a novel α2-δ ligand, for treatment of symptoms associated with FMS. Methods This multicenter, double-blind, 8-week, randomized clinical trial compared the effects of placebo with those of 150, 300, and 450 mg/day pregabalin on pain, sleep, fatigue, and health-related quality of life in 529 patients with FMS. The primary outcome variable was the comparison of end point mean pain scores, derived from daily diary ratings of pain intensity, between each of the pregabalin treatment groups and the placebo group. Results Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo (−0.93 on a 0–10 scale) (P ≤ 0.001), and significantly more patients in this group had ≥50% improvement in pain at the end point (29%, versus 13% in the placebo group; P = 0.003). Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality, fatigue, and global measures of change. Pregabalin at 450 mg/day improved several domains of health-related quality of life. Dizziness and somnolence were the most frequent adverse events. Rates of discontinuation due to adverse events were similar across all 4 treatment groups. Conclusion Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo. Pregabalin was well tolerated and improved global measures and health-related quality of life.

Background and purpose : Sleep is an active and highly organized biological process that is an important component of life. Self-report measures of sleep provide information that can be useful for characterizing the quality of sleep in subgroups of the population. A 12-item self-report sleep measure, the Medical Outcomes Study Sleep measure, was developed and evaluated previously in a sample of 3445 individuals with chronic illness. Patients and methods : In this study, we evaluate the psychometric properties of the MOS Sleep measure in a nationally representative sample of 1011 US adults aged 18 and older and in a sample of 173 adults with neuropathic pain participating in a clinical drug trial. Results : The average age of the general population sample was 46; 51% were female and 81% were white. The average age of the sample of adults with neuropathic pain was 72; 53% were female and 95% were white. Internal consistency reliability estimates for the MOS Sleep scales were 0.73 or higher, with the exception of the daytime somnolence scale in the US general population, which was 0.63. At baseline of the clinical trial, the neuropathic pain patients reported significantly more sleep disturbance and daytime somnolence, as well as less quantity and adequacy of sleep than patients in the general US population. The MOS Sleep scales were found to be responsive to change in the clinical trial with statistically significant improvements observed after administration of pregabalin for sleep disturbance (standardized response mean, SRM=−0.76, P =0.0007), shortness of breath (SRM=−0.20, P =0.0302), sleep adequacy (SRM=0.57, P =0.0014), sleep quantity (SRM=0.55, P =0.0086), and sleep problems (SRM=−0.62, P =0.0036). Conclusions . This study provides further support for the reliability and validity of the MOS Sleep measure. The instrument can be used to assess important aspects of sleep perceived by adults in the general population or participating in clinical studies.

Background Lone mothers and their children are known to suffer disproportionate levels of poor physical and mental health, connected to poverty and worklessness. Many high income countries have introduced employment requirements and restrictions on benefits eligibility for lone parents. There is evidence to support the protective effect of employment on health among the general population. However, little is known about the impact of such ‘welfare to work’ interventions on the health of lone parents and their children. In this international policy context it is crucial to understand how these interventions might affect health. Methods We conducted a Cochrane systematic review of randomised controlled trials which reported the impact of welfare to work interventions on physical and mental health, employment and income for lone parents and their children. Seventeen bibliographic databases were searched, in addition to extensive handsearching. Risk of bias was independently assessed by two reviewers. Data were meta-analysed using random effects models. Results A total of 15,481 references were identified by the searches. 154 full text articles were screened and 12 large RCTs were included in the review. Although all studies were assessed as at high risk of bias on at least one domain, these were large and well-conducted trials. Across all studies and outcomes, few impacts were large or statistically significant. At 60–72 months post-intervention meta-analysis of three studies showed a statistically significant positive impact on maternal mental health (standardised mean difference [SMD] -0.11; 95% CI -0.17 to -0.04); however, two further studies showed a statistically non-significant effect. At this time point, there were no other statistically significant effects on physical or mental health for parents or children. There was a small increase in employment (RR 1.05; 95% CI 1.01 to 1.10) and income (SMD 0.05; 95% CI 0.01 to 0.10). Conclusion This review found 12 RCTs of complex social interventions and as such represents an unusual body of evidence in this field. These welfare to work interventions for lone parents appear to have very small effects on employment, income and adult or child health. Further research on the employment and health impacts of increasing employment requirements for this group is required to establish whether policy makers’ expectations are likely to be fulfilled.

Trafficking of people within countries has been relatively neglected. Should those who are internally trafficked be regarded as IDPs?

Background Sleep is an important element of functioning and well-being. The Medical Outcomes Study Sleep Scale (MOS-Sleep) includes 12 items assessing sleep disturbance, sleep adequacy, somnolence, quantity of sleep, snoring, and awakening short of breath or with a headache. A sleep problems index, grouping items from each of the former domains, is also available. This study evaluates the psychometric properties of MOS-Sleep Scale in a painful diabetic peripheral neuropathic population based on a clinical trial conducted in six countries. Methods Clinical data and health-related quality of life data were collected at baseline and after 12 weeks of follow-up. Overall, 396 patients were included in the analysis. Psychometric properties of the MOS-Sleep were assessed in the overall population and per country when the sample size was sufficient. Internal consistency reliability was assessed by Cronbach's alpha; the structure of the instrument was assessed by verifying item convergent and discriminant criteria; construct validity was evaluated by examining the relationships between MOS-Sleep scores and sleep interference and pain scores, and SF-36 scores; effect-sizes were used to assess the MOS-Sleep responsiveness. The study was conducted in compliance with United States Food and Drug Administration regulations for informed consent and protection of patient rights. Results Cronbach's alpha ranged from 0.71 to 0.81 for the multi-item dimensions and the sleep problems index. Item convergent and discriminant criteria were satisfied with item-scale correlations for hypothesized dimensions higher than 0.40 and tending to exceed the correlations of items with other dimensions, respectively. Taken individually, German, Polish and English language versions had good internal consistency reliability and dimension structure. Construct validity was supported with lower sleep adequacy score and greater sleep problems index scores associated with measures of sleep interference and pain scores. In addition, correlations between the SF-36 scores and the MOS-Sleep scores were low to moderate, ranging from -0.28 to -0.53. Responsiveness was supported by effect sizes > 0.80 for patients who improved according to the mean sleep interference and pain scores and clinician and patient global impression of change (p < 0.0001). Conclusion The MOS-Sleep had good psychometric properties in this painful diabetic peripheral neuropathic population. Trial registration As this study was conducted from 2000 to 2002 (i.e., before the filing requirement came out), no trial registration number is available.

Mentally handicapped children's use of two-word sentence rules was examined in three different contexts (involving pictorial and object material) and on two separate occasions (4 weeks apart). 'Action + Object' sentences were the most frequently given throughout and were elicited more often with objects than with pictures. However the children showed little consistency in their sentence usage across the three contexts and over the two sessions. Hence this study highlights the need for language assessments to be done within a range of contexts and on a repeated basis in order to obtain accurate information on which to base teaching programmes and to evaluate their effectiveness.

The situations in Rwanda-Burundi and Igbo and Ibibio states of south-eastern Nigeria are compared as examples of resorting to multiple cropping and crop diversification as a technological solution to high population density. The Boserup postulation is that population growth leads to improved agricultural technology while the Allan theory is that favorable climate and soil prompts population growth overuse of the land and ultimately out-migration and urbanization. Little is known about the population and agriculture of Rwanda and Burundi until 1914 since the indigenous people excluded intruders. Their populations were estimated at 2 and 1.5 million in 1914 densities of 76 and 54/sq. km. The climate was cool with reliable rainfall the soil fertile supporting eleusine and sorghum as staples and later maize sweet potatoes and beans. Newly introduced crops were cultivated by women to fill in the previous "hungary times." As population grew yams were grown in marshes in the dry season and bananas were added then the Belgian government required all taxpayers to cultivate cassava plots. The population tripled between 1948-1978 to 249/sq. km. in Rwanda. Subsistence economy and poverty became entrenched. In Igbo and Ibibio areas of the Niger delta a similar crop diversification occurred after initial contact with Europeans from palm kernels and yams to maize plantains tomatoes and later cassava. Women cultivated the newer varieties and people exported cassava meal (gari) to the cities for convenience food. Palm oil had almost become profitable because of the invention of small presses when the world prices bottomed out. Currently soil depletion is resulting due to multiple cropping in this previously productive part of Nigeria.

A study of faculty was conducted at a state university to investigate response rates to a request for information relevant to faculty salaries. Faculty members were asked to sign an authorization form to release information from their personnel file and to submit a current resume that included professional activities. Only 25.5% of all 707 full-time faculty members agreed to release information from their personnel files, 14% refused, and 60.5% did not respond to two separate requests sent through a campus mail system. A higher refusal rate and lower consent rate was found among non-tenured instructors with fewer years of service who were not eligible to teach graduate courses. Faculty members who belonged to the organization which sponsored the salary study had a higher consent rate.