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Aim: The British Isles have been worked for millennia to extract metal ores to feed industrial development, leaving a legacy of mine water pollution that continues to impact freshwater communities in many regions. Brown trout (Salmo trutta L.) have long been observed to persist in these metal‐impacted systems as apex predators, with previous studies showing a small number of impacted populations to be highly genetically divergent. We sought to understand the scale of genetic diversity across regions and the repeatability of genetic divergence in trout populations affected by metal pollution. Location: We examined four mine water‐impacted regions across the British Isles: west Wales, northeast England, southwest England and southeast Ireland. Methods: We employed a panel of 95 SNP loci to screen 1236 individuals from 71 sites representing paired metal‐impacted and clean sites from across the four regions. From these, we obtained diversity statistics, assessed genetic structuring of populations and modelled historical demographic scenarios to understand which factors most credibly explain genetic variation in divergent populations. Results: We evidenced hierarchical population structure in the regions studied, in line with expectations from phylogeographic history. However, in a hierarchical analysis of genetic structuring the first level of differentiation was driven by the divergence of the metal‐impacted trout of Cornwall in southwest England. Within regions we observed reduced genetic diversity and repeated patterns of local genetic sub‐structuring between paired samples from metal‐impacted and relatively clean sites. Demographic history analyses suggested the timing of these splits to be relatively recent and to be associated with periods of peak mining activity. Main conclusions: Our findings demonstrate distinct patterns of genetic isolation and reduced diversity arising from legacy pollution in freshwater ecosystems, with impacts being most apparent where both chemical pollution and physical barriers are present. Management should focus on the amelioration of mine water wash‐out and the removal of barriers to fish movement to safeguard genetic diversity in impacted populations. [ABSTRACT FROM AUTHOR]

Effective management of Atlantic salmon requires a suite of metrics that are fed into stock assessment models to assess stock compliance within individual rivers in relation to estimated conservation limits. Key among metrics required to assess compliance are the number of adult female spawners within each adult sea age class and their corresponding egg deposition rates. Owing to the current need to conserve salmon stocks, adult sex ratios used to calculate egg deposition estimates often depend on data derived from historic lethal sampling. Using non‐invasive sampling and an accurate genetic sex test, we determined the proportion of female fish in two adult life history stages (one sea winter and two sea winter) of Atlantic salmon from the River Tamar, an Environment Agency (England) Monitored River. Our results suggested that phenotypic‐based sexing of Tamar salmon was unreliable, especially for early run fish and that the proportion of female salmon has been under‐estimated, thereby leading to consistent under‐estimation of egg deposition rates. [ABSTRACT FROM AUTHOR]

We used microsatellite markers to investigate levels and structuring of genetic diversity in trout (Salmo trutta L.) sampled from 16 rivers along the south coast of Cornwall in southwest England. This region is characterized by many small coastal streams with a few larger catchments. At a regional level, genetic structuring of contemporary populations has been influenced by a combination of events, including the last Ice Age and also more recent human activities over the last millennium. All populations are shown to have gone through strong genetic bottlenecks, coinciding with increased exploitation of mineral resources within catchments, beginning during the Medieval period. At more local levels, contemporary human‐induced habitat fragmentation, such as weir and culvert construction, has disproportionally affected trout populations in the smaller catchments within the study area. However, where small catchments are relatively unaffected by such activities, they can host trout populations with diversity levels comparable to those found in larger rivers in the region. We also predict significant future loses of diversity and heterozygosity in the trout populations inhabiting small, isolated catchments. Our study highlights how multiple factors, especially the activity of humans, have and continue to affect the levels and structuring of genetic diversity in trout over long timescales. [ABSTRACT FROM AUTHOR]

Objectives: To assess how nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) are managed and treated across primary and secondary care. Design: Population‐based pregnancy cohort. Setting: Medical records (CPRD‐GOLD) from England. Population: 417 028 pregnancies during 1998–2014. Methods: Proportions of pregnancies with recorded NVP/HG diagnoses, primary care treatment, and hospital admissions were calculated. Multinomial logistic regression was employed to estimate adjusted relative risk ratios (aRRRs) with 99% confidence intervals (CIs) for the association between NVP/HG management paths and maternal characteristics. Main outcome measures: NVP/HG diagnoses, treatments, and hospital admissions. Results: Overall prevalence of clinically recorded NVP/HG was 9.1%: 2.1% had hospital admissions, 3.4% were treated with antiemetics in primary care only, and 3.6% had only recorded diagnoses. Hospital admissions and antiemetic prescribing increased continuously during 1998–2013 (trend P < 0.001). Younger age, deprivation, Black/Asian/mixed ethnicity, and multiple pregnancy were associated with NVP/HG generally across all levels, but associations were strongest for hospital admissions. Most comorbidities had patterns of association with NVP/HG levels. Among women with NVP/HG who had no hospital admissions, 49% were prescribed antiemetics, mainly from first‐line treatment (21% prochlorperazine, 15% promethazine, 13% cyclizine) and metoclopramide (10%). Of those admitted, 38% had prior antiemetic prescriptions (34% first‐line, 9% second‐line, 1% third‐line treatment). Conclusion: Previous focus on hospital admissions has greatly underestimated the NVP/HG burden. Although primary care prescribing has increased, most women admitted to hospital have no antiemetics prescribed before this. An urgent call is made to assess whether admissions could be prevented with better primary care recognition and timely treatment. The NVP/HG burden is increasing over time and management optimisation should be high priority to help reduce hospital admissions. The NVP/HG burden is increasing over time and management optimisation should be high priority to help reduce hospital admissions. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of university employees on the development and implementation of the nursing associate programme., Background: As part of wider policy initiatives to address workforce shortages, provide progression for healthcare assistants and offer alternative routes into nursing, England recently introduced the nursing associate level of practice. Little research has yet considered university perspectives on this new programme., Methods: An exploratory qualitative study reported following COREQ criteria. Twenty-seven university staff working with trainee nursing associates in five universities across England were recruited. Data, collected via semi-structured interviews from June to September 2021, were analysed through a combined framework and thematic analysis., Results: Three themes developed: 'Centrality of partnerships' considered partnerships between employers and universities and changing power dynamics. 'Adapting for support' included responding to new requirements and changing pedagogical approaches. 'Negotiating identity' highlighted the university's role in advocacy and helping trainees develop a student identity., Conclusions: Nursing associate training in England has changed the dynamics between universities and healthcare employers, shifting learners' identity more to 'employee' rather than 'student'. Universities have adapted to support trainees in meeting academic and professional standards whilst also meeting employer expectations. While challenges remain, the ability of nurse educators to make adjustments, alongside their commitment to quality educational delivery, is helping establish this new training programme and thereby meet government policy initiatives., Implications for Nursing Policy: The international movement of apprenticeship models in universities has the potential to change the status of the learner in nursing educational contexts. National policies that encourage this model should ensure that the implications and challenges this change of status brings to learners, employers and education institutions are fully considered prior to their implementation., (© 2023 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Aim: The aim of this study was to understand the factors that contribute to the development of the nursing associate professional identity., Design: A 3-year longitudinal qualitative study of trainee nursing associates., Methods: Trainee nursing associates in England were interviewed remotely annually in February 2020, March 2021 and March 2022. They also provided diary entries. Data were anonymised, transcribed and analysed thematically., Results: Nursing associate professional identity was developed through: increased knowledge, skills and responsibility; and self-perceptions of identity alongside responses to the role by colleagues. Tensions arose when the scope of practice expected by organisations differed from that expected by the nursing associates. Frustrations occurred when nursing associates were perceived as substitutes for Registered Nurses in the context of nursing workforce shortages., Conclusion: Nursing associates in this study clearly valued their new knowledge, skills and responsibility, enabling them to provide enhanced patient care. Increased clarity of role boundaries is necessary in enhancing the professional identity of nursing associates and reducing inter-professional tensions arising from role ambiguity within health and social care organisations., Implications for the Profession: National guidance and employers should provide clarity on the boundaries of the nursing associate role which will strengthen their professional identity and mitigate role ambiguity within health and social care organisations., Reporting Method: The Consolidated Criteria for Reporting Qualitative Research has been used to guide reporting., Patient of Public Contribution: A patient and public involvement group was consulted during the initial study design stage., Impact: This study aimed to understand the factors which contribute to the development of a nursing associate professional identity. Nursing associate professional identity is developed through increased knowledge, skills and responsibility, and the perceptions of identity by participants themselves and their colleagues. The findings should inform the implementation of initiatives to clarify nursing associate role boundaries and the development of similar roles internationally., (© 2024 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care., Aim: To explore the experiences and career development opportunities for trainee nursing associates based in primary care., Methods: This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically., Findings: Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a 'valuable opportunity for career progression'. Trainees were frustrated by the 'emphasis on secondary care' in both academic content and placement portfolio requirements. They also experienced 'inconsistency in support' from their managers and assessors and noted a number of 'constraints to their learning opportunities', including the opportunity to progress to become registered nurses., Conclusion: This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.

Aim: To understand how advanced nurse practitioners use knowledge to inform their discharge decision-making in the emergency department., Background: Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department., Design: An ethnographic study was undertaken in an emergency department in the North of England., Method: Data were collected by observation (n = 5) and semi-structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes., Findings: In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision-making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge., Discussion: Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring., Conclusion: Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision-making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department., Impact: The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision-making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence-based discharge decision-making., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: The nursing associate role was developed in England in response to the 'Shape of Caring' review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of workforce shortages. Other high income countries deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who have embarked on the new nursing associate training course and their experiences of the role., Methods: An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations. Three focus groups (n = 15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was analysed thematically., Results: This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity., Conclusions: The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The results increase our understanding of this emerging role, and have informed the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.

The 10-year drug strategy for England and Wales was published in February 2008. It dropped drugs-related deaths (DRDs) as a key performance indicator. Scotland retained a necessary strong focus on DRDs. Scotland's DRDs numbered 1006 in 2000-02 and 1009 in 2003-05. The previous Scottish administration's claim that its number of current injectors had decreased substantially between 2000 and 2003 implied, paradoxically, that their DRD rate would have to have increased. Worse was to come: Scotland's DRDs had increased to 876 in 2006+2007. We analyse UK's DRDs by sex and age-group to reveal temporal trends (2000-02 versus 2003-05 versus 2006+2007) with different public health and epidemiological implications. We also address the above Scottish paradox and assess, by age-group, how consistent Scotland's 876 DRDs in 2006+2007 are with Scottish injectors' DRD rate in 2003-05 of around 1 per 100 injector-years. Public health success in the UK in reducing DRDs at younger ages should not be overshadowed by the late consequence in terms of older-age DRDs of UK's injector epidemics; in the early 1980s in Scotland, and late 1980s in England and Wales. Targets for reducing DRDs should pay heed to UK's injector epidemics., (Copyright 2009 Elsevier B.V. All rights reserved.)

Context: The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings., Methods: A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques., Results: Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive., Conclusion: Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Focally folded myelin has been recognized as a distinctive feature in some individuals with severe inherited demyelinating neuropathy, with an onset in childhood. Such cases have been shown to be genetically heterogeneous. Alterations in the myotubularin-related protein 2 (MTMR2) gene on chromosome 11q22 have recently been shown to give rise to this phenotype. Mutations have been identified in the 3' region of the MTMR2 gene in four unrelated families, in two of whom the disorder had been mapped to chromosome 11q22 by genetic linkage analysis. We have sequenced the entire coding region and flanking intronic regions of the MTMR2 gene in eight families with early onset autosomal recessive neuropathies. Two novel mutations were identified in exon 4 at the 5' end of the MTMR2 gene in an English and an Indian family. The clinical phenotype and sural nerve pathology in these two families differs in severity, with the proband in the English family having an earlier onset and more severe neuropathy with prominent cranial nerve involvement. This is probably due to mutation type and possible involvement of small nucleotide polymorphisms in phenotype modulation. Detailed sural nerve pathology is presented in both cases. Mutations in the MTMR2 gene are thus an important cause of autosomal recessive demyelinating neuropathy. Identifying further mutations and defining their phenotype will help to clarify the genetic classification of this group of disorders.

Data are presented for particulate organic carbon (POC) and particulate nitrogen (PN) concentrations in the Humber Estuary and tidal River Ouse Estuary. The POC data were derived from approximately monthly surveys and are consistent with data reported for suspended particulate matter (SPM) in the non-tidal River Ouse (the freshwater river) and with SPM, or bed sediments, in estuarine ecosystems such as the Mississippi, Delaware, San Francisco Bay, Tolo Harbour, the Vellar Estuary and Cochin Backwater, as well as the Loire, Gironde, Ems and Tamar Estuaries. Relative to the dry weight of SPM, the Humber-averaged organic carbon and nitrogen percentages during the year February 1995-March 1996 were 2.6 +/- 0.6% (mean and S.D.) and 0.21 +/- 0.04%, respectively. The ratio of Humber-averaged POC to Humber-averaged PN was 13 +/- 3. Higher POC levels were observed near the Humber's mouth and in the adjacent coastal zone during 'bloom' conditions, and in the upper estuarine reaches during large, winter and springtime freshwater inflows. At these times of high runoff, the POC content of SPM increased progressively up-estuary from the coastal zone to the tidal River Ouse. When inflows became very low, during late spring to early autumn of 1995, both the freshwater-saltwater interface (FSI) and the strengthening turbidity maximum (TM) moved further up-estuary and the POC content of SPM in the upper reaches of the Ouse became lower compared with that immediately down-estuary. This led to a poorly defined POC maximum near the confluence of the Humber, Ouse and Trent, before POC eventually decreased again towards the coastal zone. The lower POC contents in the upper estuarine reaches of the tidal Ouse may have been partly due to POC respiration by heterotrophic bacteria attached to SPM within the TM, consistent with the severe oxygen depletion observed there during high turbidity, summertime spring tides.

Objective: To determine whether reliable birth cohort prevalence rates of disabling conditions in early childhood can be obtained from child health information systems., Design: Comparison of two sources of information on motor and sensory disabilities: from child health information systems held by health authorities, and a population register that uses multiple sources of ascertainment., Setting: The counties of Oxfordshire, Buckinghamshire, and Northamptonshire., Participants: Children born to residents of the three counties between 1984 and 1989., Results: Eight hundred and twenty children (6.0/1000 live births) were identified from the child health system as having one or more of the conditions, and 580 (4.2/1000 live births) were identified from the population register; however, only 284 children were identified by both sources., Conclusions: It is currently impossible to monitor trends in the prevalence rate of disabling disorders in childhood using the child health information systems. Agreement about ways of collecting, recording, and collating information on disability would be a useful step towards realising the full potential of these systems.

Aims: To report on the epidemiology of cerebral palsy in England and Scotland, to provide information on the prevalence of cerebral palsy and the severity of the disability or any co-morbidity., Methods: Cerebral palsy registers were compiled from multiple sources of ascertainment covering all of Scotland and the counties of Merseyside, Cheshire, Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire in England. All cases of cerebral palsy born in 1984 to 1989, to mothers resident in the area, were included. Denominator number of live births and neonatal deaths for determining birthweight specific prevalence were obtained from birth and death registrations. Learning, manual, and ambulatory disabilities were graded for severity. Any co-existing sensory (hearing or visual) morbidity was also graded for severity., Results: There were 789,411 live births in 1984-9, with 3651 neonatal deaths (neonatal mortality 4.6 per 1000 live births) and 1649 cases of cerebral palsy--a cerebral palsy prevalence of 2.1 per 1000 neonatal survivors. The birthweight specific cerebral palsy prevalence ranged from 1.1 per 1000 neonatal survivors in infants weighting > or = 2500 g to 78.1 in infants weighing < 1000 g. There was no significant time trend in prevalence of cerebral palsy in any of the birthweight groups, in contrast to the fall in neonatal mortality observed in all birthweight groups. Of the 1649 cases of cerebral palsy, 550 (33.4%) had severe ambulatory disability (no independent walking), 390 (23.7%) had severe manual disability (incapable of feeding or dressing unaided), 381 (23.1%) had severe learning disability (IQ < 50), 146 (8.9%) had severe visual disability (vision < 6/60 in the better eye) and 12 had severe hearing disability (> 70 dB loss)., Conclusions: Registers fill an important gap left by the lack of routine data on the prevalence of disability in children. The ability to record trends in the prevalence and the severity of the disability should inform those who have responsibility for providing services for children with disabilities.

Aims: To describe the birthweight specific rate of severe vision loss among babies born between 1 January 1984 and 31 December 1987 to mothers resident in a geographically defined area, to classify the causes of vision loss by time of origin, and to describe the associated sensory and motor impairments and disabilities., Methods: Cases were identified from a population register of children with early childhood impairment, which uses multiple sources of ascertainment. Further clinical information was retrieved from hospital records and by asking ophthalmologists caring for the children., Results: 166 (1.25/1000 live births) children with severe vision loss diagnosed by the age of 5 years were identified. The rate among babies born weighing less than 1500 g at birth was 26 times higher than the rate for babies between 2500 g and 3499 g. These very low birthweight babies contribute 17.5% of all severely visually impaired children. Almost two thirds of children with severe vision loss have a lesion of prenatal origin. Other sensory or motor deficits are present in 69% of the children. Retinopathy of prematurity accounted for 5.4% of all visually impaired children and seven of the 166 children met the criteria for perinatal asphyxia., Conclusions: Although the contribution made by babies with a low birth weight to overall severe vision loss in the community is small, many of these children have additional impairments and probably place considerable demands on health and educational services and families. Reduction in the frequency of vision problems in the preschool population as a whole is unlikely to occur until there are major advances in the understanding of the aetiology and prevention of eye conditions of genetic, prenatal, and developmental origin.

The objective of this study was to assess the prevalence of different shoulder disorders likely to be experienced by a rheumatologist in a community-based rheumatology clinic. We assessed patients with shoulder pain presenting to a large general practice at a community-based rheumatology clinic. It was found that the more common conditions seen were rotator cuff lesions (65%), pericapsular soft tissue pain (11%), acromioclavicular joint pain (10%) and referred pain from cervical spine (5%). In conclusion this study has established the spectrum of shoulder disorders referred from general practice to a highly accessible community-based rheumatology clinic. The diagnostic processes to distinguish the different conditions rely chiefly on an accurate history and directed examination.

We have looked at the effect of open radiological access on patient management during a 2-year prospective study in the radiology department of a teaching hospital and two general practices. Five hundred and thirty consecutive requests for radiological examination were studied. Chest radiographs (29.8%) and barium meals (17.4%) were the investigations most commonly requested. At the time of referral general practitioners indicated that if open radiological access had not been available, 78% of the patients would have been referred to specialist clinics. They also indicated that with a normal initial radiological examination only 12% would need referral to a specialist department. Open access appears to save outpatient consultations.

In a two-partner practice with 5,000 patients where oestrogens had never been prescribed during pregnancy, it was found on examining the records, that at least eight girls had been exposed to oestrogens in utero, two of them to stilboestrol. Three of them have since been examined with negative results. In a quarter of cases no information was available from the records.

"This paper analyses the residential behaviour of Cypriots in Greater London over the last 30 years. First, patterns of settlement and movement at a borough level are described and some explanations offered for the changes observed. Second, the authors look in more detail at the actual process of residential relocation with the aid of the results of a questionnaire survey [of] Greek Cypriots in the borough of Haringey." (summary in FRE), (excerpt)

Aspects of teaching and learning at senior house officer level in South East Thames region were investigated by analysis of the responses of consultants, senior registrars, registrars, and senior house officers to a postal questionnaire. Responses to sections about who teaches senior house officers, how senior house officers learn, and the relation between the service and training elements of these posts varied significantly, according to the status of the respondents; certain grades commonly overestimated their own contribution when compared with the estimates of the other grades. Although the replies of senior house officers showed that they were taught by various grades, 47% of this group did not regard the consultant as their main teacher. Senior registrars and registrars rather than consultants were regarded by senior house officers as best at teaching (63% v 48% respectively). Consultants and registrars were considered to require more commitment to training, personal educational training, and to be more approachable. Inquiry about teaching methods used most by senior house officers showed absence of a systematic approach to training. Only about half of senior house officers cited ward rounds with consultants. Views on the relation between training and service were significantly different among grades, but there was general dissatisfaction. Overall, the findings disclosed the ineffectiveness of senior house officer training posts. This arises from lack of a clear distinction between training and service elements, of educational training for teachers, of a clear contractual obligation to teach im the consultant grade, and of allotted time for training and study for the teachers and senior house officers respectively. Reversal of these current trends is needed for senior house officer posts to fulfil their main training function.

A regional register of preschool children with cerebral palsy, severe vision loss and sensorineural deafness has been complied. Case definition, the threshold for including or excluding a case and a standard method for describing a case have been predefined. In order to achieve complete ascertainment, multiple sources of information were used and account was taken of population movement, and loss of cases through death. The optimal age of case ascertainment poses a particular problem and counting of definite cases was delayed until age three years with a further review at age five years. The register can be used to estimate prevalence of impairment, as a basis for aetiological and interventive studies and for service planning. It fills an important gap in the information currently available on childhood morbidity.

Problems arising from the present rate of failure of vocational trainees in the MRCGP examination are outlined; and the role of formative assessment during training in reducing this rate is considered. A study is described in which trainees in a number of centres were assessed by a method designed to measure specified cognitive abilities and areas of knowledge. The method, based on written papers, provides each candidate with a profile of performance and generates comparative standards. Reliability of marking, the distribution of candidate-scores within and between areas of assessment and techniques for monitoring the effectiveness of questions are reported. Use of the method by College as an educational service to trainees is considered, along with its potential as a Part I MRCGP examination.