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BackgroundA step change in the night environment is taking place, with the large-scale installation of bright, broad-spectrum road lighting such as white light-emitting diodes (LEDs). One justification for this is a reduction in road traffic collisions (RTCs). This study aimed to estimate the effect of new lighting on personal injury RTCs within a large UK city.MethodsWe analysed a 9-year time series of weekly RTC personal injury counts in 132 areas of the city using multilevel modelling. The RTC rate over a full 24-hour period was the primary outcome; darkness and daylight RTC rates were secondary. The background change in RTC rate was separated from the change associated with the number of newly installed bright lamps by including a polynomial underlying time trend for the logarithm of the mean number of collisions per week for each area. The study was based on a rigorous, predesigned and archived protocol.ResultsWithin-area coefficients for the broad lighting effect were positive; as the number of bright lamps in an area increased, so did the RTC rate. The estimate for the increase in the within-area 24-hour RTC rate is 11% (95% CI 2% to 20%). The estimate of darkness-only RTCs is 16% (95% CI 2% to 32%). If the effect of lighting on darkness RTC rate is adjusted by that for daylight, one obtains 4% (95% CI −12% to +23%).ConclusionNo evidence was found for bright lamps leading to an improvement in road safety in any of the analyses. For this city, introducing brighter road lighting may have compromised safety rather than reducing harm.

Would a billion-dollar investment in improved street lighting make Australian roads safer at night? Paul Marchant finds the evidence wanting

Background: Amputee pain may present in a body part that has been amputated (phantom pain) and/or at the site of amputation (stump pain). Mainstay treatments are pharmacological although the need for non-pharmacological management strategies has been recognized. Transcutaneous electrical nerve stimulation (TENS) is recommended as a treatment option. Objective: The aim of this systematic review was to inform TENS technique and dosages by undertaking an extended descriptive analysis of findings from case reports, non-randomized studies, and uncontrolled studies excluded from our previous Cochrane Review. Methods: A search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, AMED, CINAHL, PEDro, and SPORTDiscus was performed for randomized controlled trials (RCTs) using any surface electrical nerve stimulation for amputee pain. Two review authors screened potential studies for inclusion. Results: Of the 72 articles identified by the searches, 14 were considered relevant. A ...

Set within B. J. Zimmerman’s (1989, A social cognitive view of self-regulated academic learning, Journal of Educational Psychology, Vol. 81, pp. 329–339; and B. J. Zimmerman, 2000, Attaining self-r...

It has been suggested that childhood obesity is inversely associated with deprivation, such that the prevalence is higher in more deprived groups. However, comparatively few studies actually use an area-level measure of deprivation, limiting the scope to assess trends in the association with obesity for this indicator. Furthermore, most assume a linear relationship. Therefore, the aim of this study was to investigate associations between area-level deprivation and three measures of adiposity in children: body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). This is a cross-sectional study in which data were collected on three occasions a year apart (2005–2007). Data were available for 13 333 children, typically aged 11–12 years, from 37 schools and 542 lower super-output areas (LSOAs). Stature, mass and WC. Obesity was defined as a BMI and WC exceeding the 95th centile according to British reference data. WHtR exceeding 0.5 defined obesity. The Index of Multiple Deprivation affecting children (IDACI) was used to determine area-level deprivation. Considerable differences in the prevalence of obesity exist between the three different measures. However, for all measures of adiposity the highest probability of being classified as obese is in the middle of the IDACI range. This relationship is more marked in girls, such that the probability of being obese for girls living in areas at the two extremes of deprivation is around half that at the peak, occurring in the middle. These data confirm the high prevalence of obesity in children and suggest that the relationship between obesity and residential area-level deprivation is not linear. This is contrary to the ‘deprivation theory’ and questions the current understanding and interpretation of the relationship between obesity and deprivation in children. These results could help make informed decisions at the local level.

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients.Interventions to promote self-care in frequent users of primary care services have had mixed results. This paper reports an evaluation of a self-care initiative that aimed to develop a practice-based strategy to support self-care.A 12-month longitudinal-matched comparison study was carried out in seven intervention and four comparison practices. The intervention was a multidisciplinary training package delivered to Primary Care Trusts (PCTs) and practice staff in three workshops, over a three- to six-month period. Twenty-one managers, health professionals and other staff from participating practices and PCTs and 1454 patients were involved in the study. 'Frequently attending' patients were defined as having visited the practice more than eight times in the previous year, and were identified from practice registers and recruited by letter. Three sets of data were obtained: psychometric scores and other data from structured questionnaires; routinely collected data on use of healthcare services; and self-care beliefs and behaviour from qualitative interviews. Findings Study recruitment rate was 20% and retention rate 75%. Of those recruited 66% were female and the majority (94.8%) were White. There was poor uptake of the training programme within the participating practices, with few changes agreed or implemented. Few healthcare professionals consented to take part in the evaluation. No significant changes were seen in patients' use of health services, psychometric scores or self-care beliefs or behaviour.The initiative did not show any effects during its pilot phase. Uptake and implementation were adversely affected by competing pressures for time and resources in primary care, coupled with a lack of engagement from primary health care professionals.

To determine the effects of a community-based training programme in self-care on the lay population.Self Care is recognised as being a cornerstone of the populations health, but to date there have been few large-scale studies of its effectiveness on the general public. This paper reports on an evaluation of a self-care skills training course delivered in small group sessions within workplace and parent and toddler group settings to a lay population.A quasi-experimental longitudinal study of 12-month duration was conducted in three intervention primary care trusts (PCTs) and two similar comparison PCTs in England. The sample comprised 1568 self-selecting participants: 868 received the intervention and 700 did not.No changes were seen in usage of General Practitioner services, the primary outcome, however, statistical analysis suggested that being in the intervention group may be associated with increased use of out-of-hours and secondary care services. At six months' follow-up small but statistically significant positive effects of being in the intervention group were seen on self-esteem, well-being and anxiety scores. At 12 months' follow-up small but statistically significant positive effects of being in the intervention group were also seen on recovery locus of control, health literacy and self-esteem scores, and on knowledge of adult cough. The clinical significance of these very small changes is unclear. The training programme had a small but positive effect, which was still evident at 12 months, on individuals' knowledge and confidence levels with regard to managing their own health, but did not lead to reductions in health service use.

TENS can be administered in conventional (high frequency, low intensity) or acupuncture-like (AL-TENS: low frequency, high intensity) formats. It is claimed that AL-TENS produces stronger and longer-lasting hypoalgesia than conventional TENS, although evidence is lacking. This randomised controlled parallel group study compared the effects of 30 minutes of AL-TENS, conventional TENS, and placebo (no current) TENS, on cold-pressor pain threshold (CPT), in 43 healthy participants. Results showed a greater increase in mean log(e) cold-pressor pain threshold relative to baseline for both AL-TENS and conventional TENS vs. placebo TENS, and for AL-TENS vs. placebo 5 and 15 minutes after TENS was switched off. There were no statistically significant differences between conventional TENS vs. placebo or between AL-TENS vs. conventional TENS at 5 or 15 minutes after TENS was switched off. In conclusion, AL-TENS but not conventional TENS prolonged post-stimulation hypoalgesia compared to placebo TENS. However, no differences between AL-TENS and conventional TENS were detected in head-to-head comparisons.

Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.

Summary Objectives: To compare the hypoalgesic effects of conventional transcutaneous electrical nerve stimulation (TENS) (high frequency, low intensity) and acupuncture-like TENS (AL-TENS, low frequency, high intensity) on cold-induced pain. Design: Randomized controlled parallel group study comparing the effects of strong non-painful AL-TENS, conventional TENS and placebo (no current) TENS on cold-pressor pain threshold (CPT) and pain intensity. Two baseline (pre-intervention) measures and three during intervention measures of CPT and cold pain intensity (four point category scale) were recorded. Setting: Physiology laboratory in Leeds Metropolitan University. Participants: One hundred and twenty-one healthy participants. Interventions: Each participant received one of three TENS interventions over their flexor digitorum profundus: (i) high pulse rate TENS with a strong non-painful paraesthesia (conventional), (ii) low-rate burst mode TENS that caused strong non-painful phasic muscle twitching (acupuncture like) or (iii) no current (placebo) TENS. Main outcome measure: Difference between conventional TENS and AL-TENS in cold pain threshold relative to pre-TENS baseline after 25 min of stimulation. Results: No differences were detected for CPT or cold pain intensity during conventional TENS compared with AL-TENS. When compared with placebo TENS, the confidence intervals for the ratio of intervention CPT to baseline CPT, for both AL-TENS (0·966, 1·424) and conventional TENS (0·948, 1·401), were close to the positive side of one, although neither reached statistical significance. Conclusions: Unlike some previous studies, the present study detected no differences in hypoalgesia between AL-TENS, conventional TENS and placebo (no current) TENS during stimulation.

Non-randomized trials can give a biased impression of the effectiveness of any intervention. We consider trials in which incidence rates are compared in two areas over two periods. Typically, one area receives an intervention, whereas the other does not. We outline and illustrate a method to estimate the bias in such trials under two different bivariate models. The illustrations use data in which no particular intervention is operating. The purpose is to illustrate the size of the bias that could be observed purely due to regression towards the mean (RTM). The illustrations show that the bias can be appreciably different from zero, and even when centred on zero, the variance of the bias can be large. We conclude that the results of non-randomized trials should be treated with caution, as interventions which show small effects could be explained as artefacts of RTM.

Comer CM, Johnson MI, Marchant PR, Redmond AC, Bird HA, Conaghan PG. The effectiveness of walking stick use for neurogenic claudication: results from a randomized trial and the effects on walking tolerance and posture. Objectives To determine the immediate effects of using a stick on walking tolerance and on the potential explanatory variable of posture, and to provide a preliminary evaluation of the effects of daily walking stick use on symptoms and function for people with neurogenic claudication. Design A 2-phase study of neurogenic claudication patients comprising a randomized trial of 2 weeks of home use of a walking stick and a crossover study comparing walking tolerance and posture with and without a walking stick. Setting A primary care–based musculoskeletal service. Participants Patients aged 50 years or older with neurogenic claudication symptoms (N=46; 24 women, 22 men, mean age=71.26y) were recruited. Intervention Walking stick. Main Outcome Measures Phase 1 of the trial used the Zurich Claudication Questionnaire symptom severity and physical function scores to measure outcome. The total walking distance during a shuttle walking test and the mean lumbar spinal posture (measured by using electronic goniometry) were used as the primary outcome measurements in the second phase. Results Forty of the participants completed phase 1 of the trial, and 40 completed phase 2. No significant differences in symptom severity or physical function were shown in score improvements for walking stick users (stick user scores − control scores) in the 2-week trial (95% confidence interval [CI], −.24 to .28 and −.10 to .26, respectively). In the second phase of the trial, the ratio of the shuttle walking distance with a stick to without a stick showed no significance (95% CI, .959–1.096) between the groups. Furthermore, the use of a walking stick did not systematically promote spinal flexion; no significant difference was shown for mean lumbar spinal flexion for stick use versus no stick (95% CI, .351°–.836°). Conclusions The prescription of a walking stick does not improve walking tolerance or systematically alter the postural mechanisms associated with symptoms in neurogenic claudication.

Objective To investigate the hypoalgesic effects of massage on experimental pain. Design A cross-over intervention study separated by a 24-hour washout period. During each experiment, participants completed five cold-induced pain tests, two before the intervention and three during the intervention. During each test, participants immersed their hand in iced water and reported the first sensation of pain and pain intensity after a further 30 seconds. Setting Laboratory setting. Participants A volunteer sample of 30 university staff and students without known pathology, recruited from noticeboard advertisements. Interventions Participants received massage in one experiment and static touch in the other experiment. Interventions were administered to the ipsilateral arm for 4 minutes immediately before the hand was immersed in iced water. Main outcome measures Time to pain threshold and the odds of a reduction in pain intensity and an increase in pain relief. Results A mixed model analysis was used to establish how measures varied, according to baseline, during static touch and during massage. Massage increased the pain threshold by a factor of 1.08 (95% confidence interval 0.99–1.17) compared with static touch, but this failed to reach statistical significance ( P = 0.088). Massage was more likely to result in a report of low pain intensity than static touch (odds ratio 0.26, 95% confidence interval 0.10–0.71, P = 0.007). Massage was more likely to result in a state of high pain relief than static touch (odds ratio 7.7, 95% confidence interval 3.0–19.8, P Conclusion Massage produced hypoalgesic effects on experimental pain in healthy volunteers.

This paper compares the incidence of the diagnosis of Autistic Spectrum Disorders (ASD) among White and Asian children with reference to data obtained from thirteen local education authorities (LEAs) in England. It begins by outlining some of the theoretical debates associated with the definition, diagnosis and prevalence of ASD. The empirical component underpinning this work uses logistic modelling to ascertain whether the proportion of children with a statement of special educational need (SEN) for ASD is different for Asian and for White children and whether the proportion of children with a statement of SEN for ASD varies between LEAs. The discussion speculates as to possible reasons for the differences found and identifies areas for further research.

Background: The impact of change in communication, life participation, and psychological well‐being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited. We are grateful to Leeds Health Authority, the Leeds Speech and Language Therapy Service, Leeds Social Services, Leeds Metropolitan University and the Leeds Modernisation Team ‐ Disability for funding and other resources for the group and the research. Our thanks in particular are conveyed to the group participants. Additionally we thank the reviewers for their guidance. Aims: To explore the experience of aphasia within the context of communication, life participation and psychological well‐being and evaluate the outcomes of these phenomena in people with chronic aphasia following participation in a group intervention involving a ...

Many social, scientific and political debates are conducted using numerical information to support an argument. The question is: “does the evidence stand up?” Certainly the question ‘does a crime reduction method work?” is one which must ultimately be settled using numbers, because if the method does work, crimes will be fewer, on average. This brings in the discipline of statistics, simply because we need to be convinced that any reduction observed is more than might reasonably be expected to have occurred anyway; i.e. due to the many other factors which can affect the number of crimes committed and counted.

When we look around an imperfect world, we feel an understandable impulse to improve matters. We may therefore decide to intervene by prescribing medical treatment or by introducing crime reduction measures. But how do we know that what we do is likely to work? In medicine the standard answer is to do a trial; not surprisingly the same is true in crime reduction. But, says Paul Marchant, the lessons learned from medical trials have not been implemented in the latter field.

This article discusses the important differences between evaluating area-based crime reduction interventions through comparison of areas, and evaluating treatment effectiveness by a classic randomised controlled trial (RCT). The differences must be respected in the analysis of data. Wrong results will be given for a comparative area- based crime reduction trial if it is thought of as an RCT. The problem with evaluations which compare areas, one with an intervention and one without, is that such studies are neither randomised nor controlled, and the crime events being counted are correlated rather than statistically independent. Wrongly using those methods which are appropriate for an RCT will give misleading results. Statistical uncertainties will tend to be large and poorly determined, and statistical biases problematic because of the lack of equivalence between areas at the outset. Crime studies need to be appropriately designed to avoid such problems if costly mistakes are to be avoided.

The major systematic review on street lighting and crime, Home Office Research Study 251, suggests that claims for the effectiveness of lighting against crime are justified. The review at first sight appears to be an appropriate statistical synthesis of all studies on street lighting and crime across the world. However on close examination, the statistical claims and methods are unfounded. In three cases examined there is a clear conflict between the evidence and the reviewers' interpretation of this. One of the principal problems is easily seen. The time-series of the original data from the Bristol study shows no good evidence for the crime reduction benefit of lighting. However the review gives the result for the same data as being extremely statistically significant. It is suggested that such a difference between the newly lit and the control areas occurring purely by chance is less than one in a billion, but this is manifestly wrong. Two other component studies, Birmingham and Dudley, are examined.

Research suggests that there has been a leveling off in obesity prevalence occurring in the child population. However, a concern with the evidence base is that all of the studies have relied upon the use of BMI. The purpose of this study was to compare waist circumference (WC), BMI, and waist-to-height ratio (WHtR) data in three different sample of children (total number: 14,697) typically aged 11-12 years. Obesity prevalence defined by BMI did not change significantly between measurement years (2005 boys 20.6%, girls 18.0%; 2006 boys 19.3%, girls 17.3%; 2007 boys 19.8%, girls 16.4%). Obesity prevalence defined by WC was considerably higher especially, in girls (2005 boys 26.3%, girls 35.6%; 2006 boys 20.3%, girls 28.2%; 2007 boys 22.1%, girls 30.1%). The prevalence of children defined as "at risk" according to WHtR (2005 boys 23.3%, girls 21.1%; 2006 boys 16.7%, girls 15.6%; 2007 boys 17.6%, girls 17.2%) was found to be between obesity prevalence, estimated using BMI and WC. This data are the most up to date collection that includes BMI and WC in three large samples of children and clearly demonstrates inconsistencies between different measurements based on current classification systems. There is a need to understand the relationship between BMI and WC, with growth and health risk to establish a consistent public health message that is easily understood by the public.

SUMMARY This paper examines and compares some aspects of the academic and social experiences of first-year teacher education students at two colleges, one in England and the other in the Republic of Ireland. It describes the transition from second level (and, for some, the transition from further education) to third level education and offers an account of the integration of first-year students into the academic and social system of their institution. In comparing the experiences of students in both colleges, we use inferential statistics, thus assuming the legitimacy of inferring differences in the populations from which the samples come. Although we have no reason to believe that the students and colleges in our study are untypical of teacher education students and their respective colleges more generally in England and Ireland, we acknowledge the need for tentativeness in making the leap to the broader population and for further research to explore the national and international comparisons using a wid...

Objective The purpose of this study was to examine the prevalence of obesity over time in the same individuals comparing body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR). Study design Five year longitudinal repeated measures study (2005–2010). Children were aged 11–12 (Y7) years at baseline and measurements were repeated at age 13–14 (Y9) years and 15–16 (Y11) years. Methods WC and BMI measurements were carried out by the same person over the five years and raw values were expressed as standard deviation scores (sBMI and sWC) against the growth reference used for British children. Results Mean sWC measurements were higher than mean sBMI measurements for both sexes and at all assessment occasions and sWC measurements were consistently high in girls compared to boys. Y7 sWC = 0.792 [95% confidence interval (CI) 0.675–0.908], Y9 sWC = 0.818 (95%CI 0.709–0.928), Y11 sWC = 0.943 (95%CI 0.827–1.06) for boys; Y7 sWC = 0.843 (0.697–0.989), Y9 sWC = 1.52 (95%CI 1.38–0.67), Y11 sWC = 1.89 (95%CI 1.79–2.04) for girls. Y7 sBMI = 0.445 (95%CI 0.315–0.575), Y9 sBMI = 0.314 (95%CI 0.189–0.438), Y11 sBMI = 0.196 (95%CI 0.054–0.337) for boys; Y7 sBMI = 0.353 (0.227–0.479), Y9 sBMI = 0.343 (95%CI 0.208–0.478), Y11 sBMI = 0.256 (95%CI 0.102–0.409) for girls. The estimated prevalence of obesity defined by BMI decreased in boys (18%, 12% and 10% in Y 7, 9 and 11 respectively) and girls (14%, 15% and 11% in Y 7, 9 and 11). In contrast, the prevalence estimated by WC increased sharply (boys; 13%, 19% and 23%; girls, 20%, 46% and 60%). Conclusion Central adiposity, measured by WC is increasing alongside a stabilization in BMI. Children appear to be getting fatter and the additional adiposity is being stored centrally which is not detected by BMI. These substantial increases in WC are a serious concern, especially in girls.

Response to ‘Area-level deprivation and adiposity in children: is the relationship linear?’

BACKGROUND: Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. This Cochrane Review is an update of a review last updated in 2012. OBJECTIVES: To evaluate the effectiveness of localised cooling treatments compared with no treatment, placebo, or other cooling treatments applied to the perineum for pain relief following perineal trauma sustained during childbirth. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019) and reference lists of retrieved studies. SELECTION CRITERIA: Published and unpublished randomised and quasi‐randomised trials (RCTs) that compared a localised cooling treatment applied to the perineum with no treatment, placebo, or another cooling treatment applied to relieve pain related to perineal trauma sustained during childbirth. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were double checked for accuracy. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS: We included 10 RCTs that enrolled 1233 women randomised to the use of one cooling treatment (ice, cold gel pad, cooling plus compression, cooling plus compression plus (being) horizontal) compared with another cooling treatment, no treatment, or placebo (water pack, compression). The included trials were at low or uncertain risk of bias overall, with the exception that the inability to blind participants and personnel to group allocation meant that we rated all trials at unclear or high risk for this domain. We undertook a number of comparisons to evaluate the different treatments. Cooling treatment (ice pack or cold gel pad) versus no treatment There was limited very low‐certainty evidence that cooling treatment may reduce women's self‐reported perineal pain within four to six hours (mean difference (MD) −4.46, 95% confidence interval (CI) −5.07 to −3.85 on a 10‐point scale; 1 study, 100 participants) or between 24 and 48 hours of giving birth (risk ratio (RR) 0.73, 95% CI 0.57 to 0.94; 1 study, 316 participants). The evidence is very uncertain about the various measures of wound healing, for example, wound edges gaping when inspected five days after giving birth (RR 2.56, 95% CI 0.58 to 11.33; 1 study, 315 participants). Women generally rated their satisfaction with perineal care similarly following cooling or no treatment. The potential exception was that there may be a trivially lower mean difference of −0.1 on a five‐point scale of psychospiritual comfort with cooling treatment, that is unlikely to be of clinical importance. Cooling treatment (cold gel pad) + compression versus placebo (gel pad + compression) There was limited low‐certainty evidence that there may be a trivial MD of −0.43 in pain on a 10‐point scale at 24 to 48 hours after giving birth (95% CI −0.73 to −0.13; 1 study, 250 participants) when a cooling treatment plus compression from a well‐secured perineal pad was compared with the placebo. Levels of perineal oedema may be similar for the two groups (low‐certainty evidence) and perineal bruising was not observed. There was low‐certainty evidence that women may rate their satisfaction as being slightly higher with perineal care in the cold gel pad and compression group (MD 0.88, 95% CI 0.38 to 1.38; 1 trial, 250 participants). Cooling treatment (ice pack) versus placebo (water pack) One study reported that no women reported pain after using an ice pack or a water pack when asked within 24 hours of giving birth. There was low‐certainty evidence that oedema may be similar for the two groups when assessed at four to six hours (RR 0.96, 95% CI 0.50 to 1.86; 1 study, 63 participants) or within 24 hours of giving birth (RR 0.36, 95% CI 0.08 to 1.59). No women were observed to have perineal bruising at these times. The trialists reported that no women in either group experienced any adverse effects on wound healing. There was very low‐certainty evidence that women may rate their views and experiences with the treatments similarly (for example, satisfied with treatment: RR 0.91, 95% CI 0.77 to 1.08; 63 participants). Cooling treatment (ice pack) versus cooling treatment (cold gel pad) The evidence is very uncertain about the effects of using ice packs or cold gel pads on women’s self‐rated perineal pain, on perineal bruising, or on perineal oedema at four to six hours or within 24 hours of giving birth. Perineal oedema may persist 24 to 48 hours after giving birth in women using the ice packs (RR 1.69, 95% CI 1.03 to 2.7; 2 trials, 264 participants; very low‐certainty). The risk of gaping wound edges five days after giving birth may be decreased in women who had used ice packs (RR 0.22, 95% CI 0.05 to 1.01; 215 participants; very low‐certainty). However, this did not appear to persist to day 10 (RR 3.06, 95% CI 0.63 to 14.81; 214 participants). Women may rate their opinion of treatment less favourably following the use of ice packs five days after giving birth (RR 0.33, 95% CI 0.17 to 0.68; 1 study, 49 participants) and when assessed on day 10 (RR 0.82, 95% CI 0.73 to 0.92; 1 study, 208 participants), both very low‐certainty. AUTHORS' CONCLUSIONS: There is limited very low‐certainty evidence that may support the use of cooling treatments, in the form or ice packs or cold gel pads, for the relief of perineal pain in the first two days following childbirth. It is likely that concurrent use of several treatments is required to adequately address this issue, including prescription and non‐prescription analgesia. Studies included in this review involved the use of cooling treatments for 10 to 20 minutes, and although no adverse effects were noted, these findings came from studies of relatively small numbers of women, or were not reported at all. The continued lack of high‐certainty evidence of the benefits of cooling treatments should be viewed with caution, and further well‐designed trials should be conducted.

To compare the hypoalgesic effects of conventional transcutaneous electrical nerve stimulation (TENS) (high frequency, low intensity) and acupuncture-like TENS (AL-TENS, low frequency, high intensity) on cold-induced pain.Randomized controlled parallel group study comparing the effects of strong non-painful AL-TENS, conventional TENS and placebo (no current) TENS on cold-pressor pain threshold (CPT) and pain intensity. Two baseline (pre-intervention) measures and three during intervention measures of CPT and cold pain intensity (four point category scale) were recorded.Physiology laboratory in Leeds Metropolitan University.One hundred and twenty-one healthy participants.Each participant received one of three TENS interventions over their flexor digitorum profundus: (i) high pulse rate TENS with a strong non-painful paraesthesia (conventional), (ii) low-rate burst mode TENS that caused strong non-painful phasic muscle twitching (acupuncture like) or (iii) no current (placebo) TENS.Difference between conventional TENS and AL-TENS in cold pain threshold relative to pre-TENS baseline after 25 min of stimulation.No differences were detected for CPT or cold pain intensity during conventional TENS compared with AL-TENS. When compared with placebo TENS, the confidence intervals for the ratio of intervention CPT to baseline CPT, for both AL-TENS (0·966, 1·424) and conventional TENS (0·948, 1·401), were close to the positive side of one, although neither reached statistical significance.Unlike some previous studies, the present study detected no differences in hypoalgesia between AL-TENS, conventional TENS and placebo (no current) TENS during stimulation.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, inexpensive analgesic technique used to relieve pain. It has been suggested that caffeine, an adenosine antagonist, may interfere with TENS action. This double-blind controlled pilot study investigated the effect of coffee on response to TENS in healthy human participants experiencing experimentally induced pain. Twelve participants (7 female, age range = 20-41 years) took part in two experiments separated by 24 h. Each experiment lasted 80 min and consisted of 3 x 15 min cycles: pre-TENS, during TENS predrink and during TENS postdrink [coffee (100 mg caffeine) or decaffeinated coffee randomized across experiments]. During each cycle, thresholds for electrical (EPT), mechanical (MPT) and cold pressor (CPT) pain were recorded. The statistical analysis modelled the responses for the coffee and decaffeinated coffee conditions during TENS (i.e. as a standard crossover) and detected no statistically significant effects between coffee and decaffeinated drinks for the natural logarithm (ln) transformed values of electrical pain threshold [ln EPT Coffee-ln EPT Decaffeinated coffee mean (standard error) = 0.0147 (0.2159)], mechanical pain threshold [ln MPT Coffee-ln MPT Decaffeinated coffee mean (standard error) = 0.1296 (0.0816)] and cold pain threshold [ln CPT Coffee-ln CPT Decaffeinated coffee mean (standard error) = 0.0793 (0.1139)]. We conclude that a single cup of coffee (100 mg caffeine) had no detectable effect on TENS outcome. Reasons why coffee did not produce a detectable effect on pain threshold are discussed.

This paper examines the effects of key characteristics on achievement at the end of Key Stage 2 with reference to the results of all KS2 pupils in one LEA in the north of England. It offers new evidence of the relative impact of various pupil characteristics on performance by using generalised regression methods, which take account of the structure of the data. The paper explores simultaneously the impact on achievement of school attended and school cluster (based on groups of feeder schools) and four pupil factors; namely, gender, age, social disadvantage (defined in terms of entitlement to free school meals) and having English as an additional language. It discusses the findings with respect to other recent studies in the field.

Reports on a survey of nearly 700 companies to find out who uses industrial robots in the UK. Outlines how the data was gathered and the investigation into which factors determined robot use: was it size, ownership, region, industry or a combination of these.

We studied the time of onset of chest pain in 1099 patients admitted to a coronary care unit with myocardial infarction using a statistical model. Statistical analysis demonstrated an excess of infarcts with time of onset of chest pain at 0700 hours (14%) and at midnight (11%), with the remaining infarct population (75%) forming a background distribution over the 24 hr.

Objective: to evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). Design: a randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. Setting: a midwifery unit in the north of England and then continued in the women's own homes. Participants: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. Measurements and findings: the ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours ( p =0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema ( p =0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain ( p =0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours ( p p =0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups ( p Key conclusions: this trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.