Bognor Regis War Memorial Hospital

BACKGROUND: The prevalence of chronic daily headache in association with regular use of analgesics is about 2%. Whether regular use of analgesics has a causal or consequential relationship to daily headache has not been established. A causal relationship has been suggested consequent to the observation of improvement or resolution of headache following analgesic withdrawal in patients attending headache clinics, but this observation has not been validated by controlled trials. PURPOSE: The aim of our investigation was to determine whether regular use of analgesics is associated with the development of chronic daily headache de novo and to characterize the clinical phenotype of those headaches by carefully studying chronic daily headache in patients with regular use of analgesics for a nonheadache indication. METHODS: Patients attending a rheumatology-monitoring clinic of second-line agents were interviewed by a training neurologist with regard to their analgesic and headache history. Headache classification was according to the criteria of the International Headache Society. Daily headache characteristics were surveyed via a standardized questionnaire, and headache features were further explored by a trained medical interviewer. RESULTS: Of 110 patients presenting to a rheumatology-monitoring clinic, 73% had a diagnosis of rheumatoid arthritis, 23% had seronegative arthritis, and 4% comprised a miscellaneous group. One hundred three were using one or more analgesics regularly for their arthritis. Of this group, 8 (7.6%) reported a history of chronic daily headache, each of whom reported a history of migraine. The onset of migraine occurred before the onset of chronic daily headache in 7 patients and at about the same time as the chronic daily headache in 1 patient. In those with onset of migraine prior to chronic daily headache, the mean interval before the onset of headache was 30 years (range, 10 to 50 years). Regular use of analgesics preceded the onset of daily headache in 5 patients by a mean of 5.4 years (range, 2 to 10 years). In 1 patient, analgesic use and the development of daily headache occurred at about the same time. In 1 patient, the onset of daily headache preceded regular use of analgesics by almost 30 years. Five of those with regular use of analgesics had been taking an opiate-based preparation in combination with a nonsteroidal anti-inflammatory agent in 4. Two had been on a combination of acetaminophen (paracetamol) and a nonsteroidal anti-inflammatory drug. The minimum number of tablets per week was 7, and the mean was 48 (range, 7 to 87). Of those patients who did not have daily headache, 41% had a history of migraine and 27% reported a history of tension-type headache. CONCLUSION: These findings suggest that individuals with primary headache, specifically migraine, are predisposed to developing chronic daily headache in association with regular use of analgesics.

BACKGROUND: Duchenne muscular dystrophy (DMD), which afflicts 1 in 3500 boys, is one of the most common genetic disorders of children. This fatal degenerative condition is caused by an absence or deficiency of dystrophin in striated muscle. Most affected patients have inherited or spontaneous deletions in the dystrophin gene that disrupt the reading frame resulting in unstable truncated products. For these patients, restoration of the reading frame via antisense oligonucleotide-mediated exon skipping is a promising therapeutic approach. The major DMD deletion "hot spot" is found between exons 45 and 53, and skipping exon 51 in particular is predicted to ameliorate the dystrophic phenotype in the greatest number of patients. Currently the mdx mouse is the most widely used animal model of DMD, although its mild phenotype limits its suitability in clinical trials. The Golden Retriever muscular dystrophy (GRMD) model has a severe phenotype, but due to its large size, is expensive to use. Both these models have mutations in regions of the dystrophin gene distant from the commonly mutated DMD "hot spot". METHODOLOGY/PRINCIPAL FINDINGS: Here we describe the severe phenotype, histopathological findings, and molecular analysis of Cavalier King Charles Spaniels with dystrophin-deficient muscular dystrophy (CKCS-MD). The dogs harbour a missense mutation in the 5' donor splice site of exon 50 that results in deletion of exon 50 in mRNA transcripts and a predicted premature truncation of the translated protein. Antisense oligonucleotide-mediated skipping of exon 51 in cultured myoblasts from an affected dog restored the reading frame and protein expression. CONCLUSIONS/SIGNIFICANCE: Given the small size of the breed, the amiable temperament and the nature of the mutation, we propose that CKCS-MD is a valuable new model for clinical trials of antisense oligonucleotide-induced exon skipping and other therapeutic approaches for DMD.

Psychology and Education provides a user-friendly introduction to educational psychology. The book covers psychological theories and their practical applications in education. Susan Bentham has written an ideal guide to this topic for students studying the OCR A-Level specification. The book will also be relevant to those studying the EdExcel specification and to those with a general interest in education and learning. The book covers the cognitive, behaviourist and humanistic perspectives on learning, including the work of Piaget, Vygotsky, Bruner and others, and describes the practical applications of these theories. The assessment of educational performance is covered and the cultural and developmental factors affecting performance are discussed. Chapters on the special educational needs of the educationally disadvantaged and gifted, and disruptive behaviour in school are included, with sections on ADHD, autism and dyslexia. The book also discusses teaching and learning styles, and the design and layout of educational environments.Psychology and Education requires little or no background knowledge and makes an ideal introduction for students of psychology, trainee teachers, child carers and anyone who is interested in what is happening in today's schools.

OBJECTIVE: To compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP). DESIGN: Systematic review with best evidence synthesis. DATA SOURCES: The Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched. ELIGIBILITY CRITERIA: Two reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement. RESULTS: Thirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12-26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes. CONCLUSION: Corticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016033161.

Abstract Although there have been many claims that technology might enhance university teaching, there are wide variations in how technology is actually used by lecturers. This paper presents a survey of 795 university lecturers’ perceptions of the use of technology in their teaching, showing how their responses were patterned by institutional and subject differences. There were positive attitudes towards technology across institutions and subjects but also large variations between different technologies. Two groups of technology were identified—“core” technologies, such as Powerpoint, that were used frequently, even when lecturers felt that they were not having a positive impact on learning, and “marginal” technologies, such as blogs, that were used much less frequently and only where they fitted the pedagogic approach or context. Rather than there being “leading” universities that were the highest users of all technologies, institutions tended to be heavier users of some technologies than others. Similarly, subjects could be associated with particular technologies rather than being consistent users of technology in general. The study suggests that university technology policy should reflect different disciplines and contexts rather than “one size fits all” directives.

An esterified pillar[5]arene has been incorporated into a PVC electrochemical membrane. The resulting pH-responsive sensor functions in the range of pH 1 to 4 in a non-linear manner.

THIS ARTICLE is a survey of the treatment of the sick poor in the counties of Berkshire, Essex, and Oxfordshire from c. 1720 to 1834 based on parish records.Its general argument is that the sick poor received sympathetic and humane consideration bearing in mind contemporary medical knowledge and the limited facilities available.General medical aid is first considered -broken limbs, midwifery, eye complaints, etc.This is followed by a section on the use of provincial hospitals and those in London.Parishes readily availed themselves of these institutions and it is suggested that they were not as great a menace as has been often maintained.The role of the dispensaries is also considered.A short section follows on the treatment ofthe mentally deranged pauper and the use of private asylums.A brief comment is made on the medical contract system.The problem of smallpox in the parishes is examined.It is argued that the effects of the disease were so serious and the use of inoculation so widespread, particularly in the rural areas -that this treatment might well have had some effect on mortality trends in the second half of the eighteenth century.Vaccination also became very popular in the parishes after the first decade of the nineteenth century.This, it is also maintained, made an important contribution to mortality trends -particularly when local authorities were able to treat the whole of the poor.The action against typhus and cholera is then considered.Examples are cited of progressive authorities who made strenuous attempts to secure a healthier environment and which might, in a small way, have made a contribution towards improving the health of the local communities.A concluding section attempts to compare the achievements in these three counties with findings in other areas and makes some tentative conclusions.Much more work of this nature clearly needs to be carried out at local level before an overall and definitive picture emerges. I. GENERAL MEDICAL CAREThe Elizabethan legislation referred to the care of the "Lame, Impotent, Old and Blind",1 though subsequent statutes made little reference to this aspect of poor relief.The Poor Law Commissioners of 1834 merely refer to doctors' contractual salaries.However, medical treatment became an essential part of the overseers' duties and a fair

ABSTRACT: It is claimed that a conflict may exist between the implicit values underlying English language teaching and the values of Islam. This article describes two parallel pieces of research undertaken in a statefunded religious school in the state of Melaka in Malaysia aimed at investigating this claim. It concludes that the majority of students studying English in this context were well‐motivated towards English language learning and while recognizing the dangers of absorbing alien values through their language learning, felt able to resist these and to deploy English as a tool for the development of themselves and their nation without feeling that their identity as Malay and Muslim was compromised in any serious way.

This paper aims to explore the influence of one cycle of a learning set experience in a postgraduate medical leadership development programme. It does so from two perspectives: first, from the self‐reports of nine senior doctors working in leadership roles in England in the National Health Service; and second from a researcher perspective as we present our research process, findings and perceptions on the use of action learning (AL) and critical action learning (CAL) for leadership development in the complex and unpredictable context of that service. The paper affirms other study findings that CAL in the development of participants’ collective reflexivity has the potential to deal with emotions and power relations in organizational life. An original contribution lies in advancing the idea that CAL can help build resilience in doctor leaders and groups in uncertain conditions such that they are able to challenge current care delivery and effect change in organizational performance.

Background: The need to support carers of stroke survivors is widely recognised. However, research on which to base recommendations is scarce. Little research has focused on carers of stroke survivors with aphasia, and that which exists suffers from problems with sample size and methodology. More information is needed about methods used by carers to manage communication difficulties and about coping strategies that promote emotional wellbeing. Aims: To assess the coping strategies used by informal carers of stroke survivors with aphasia to manage communication problems, and their association with depressive symptoms. To assess whether a problem-specific coping inventory offers an advantage over a generic coping questionnaire for this purpose. Methods & Procedures: Questionnaires were completed by 150 informal caregivers of stroke survivors with aphasia. The Centre for Epidemiologic Studies Depression Scale measured depressive symptoms. Coping was assessed with the Brief COPE and a problem-specific questionnaire on coping with communication difficulties. Level of social support was also assessed. Multiple regression analysis explored associations between coping and depressive symptoms. Mediation analysis assessed the significance of the indirect effect of coping between the level of communication impairment in the stroke survivor and the degree of depressive symptoms in the carer. Outcomes & Results: Participants reported a wide range of coping strategies. Avoidant styles of coping were associated with increased depressive symptomatology. Coping by use of positive reframing was linked with fewer symptoms of depression. Anticipated level of social support was also associated with less depressive symptomology. The level of communication impairment of the stroke survivor was not predictive of depressive symptoms in carers after controlling for coping and social support. Limited support was found for a mediating model of coping. Inclusion of one subscale from the problem-specific questionnaire improved the amount of variance accounted for in depressive symptoms, above that explained by the Brief COPE. Conclusions: The results verify that the impairment of the stroke survivor has less effect on carers' psychosocial functioning compared to coping. Assessment of coping can help to identify carers presenting with increased risk of depression. A traditional coping inventory provides an adequate assessment of the coping strategies used to manage communication problems, and can be supplemented by specific questions about avoidance. Interventions that develop some emotion-focused coping strategies in carers may support adaptation. Interventions should also aim to decrease the use of unhelpful coping strategies rather than solely focusing on increasing problem-focused forms of coping.

Abstract Purpose – The purpose of the study described in this paper was to explore with property and facilities managers to what degree they are able to achieve a good return for their organisations on PFM, and what might facilitate or inhibit that. Design/methodology/approach – Semi‐structured interviews were held with 12 managers with significant experience of property and facilities management (PFM). A variety of industry sectors, and the public sector, were represented in the sample. Within these interviews, the researchers were able to explore the opinions of respondents and the qualitative data gathered provided interesting insight on the research topic. Findings – This research identifies that in practice it is extremely difficult for companies to achieve a wide spectrum of added value from property and facilities. Property management may have a lower profile in organisations than it deserves, with a concentration on cost rather than opportunity. A sense of resignation may be created by long leases, which are still "the norm" in the UK. The literature review and primary research show dissatisfaction with long leases and a strong preference for more flexible arrangements with landlords. Flexibility is inextricably linked to the expectation of better return on property investment. The demand for flexibility is felt most acutely in economic recession, which causes organisations to consolidate space and manage property and facilities at a micro level. Research limitations/implications – This research was based on a relatively small sample size (12), collected from volunteer respondents in the south of the UK. On the basis of the findings, there is scope for further research on a larger scale, perhaps involving structured samples, quantitative data collection methods, and comparisons of the UK with a country where PFM choice is wider, such as the USA or Australia. Development of an economic model of the impact of flexibility on return on investment might be possible. Practical implications – This paper provides a comprehensive discussion of how PFM is typically managed in the UK and how property and facilities managers would like to see it improve in the future. Originality/value – This paper has identified an apparent suppressed demand for more flexibility in the property market in the UK. This could be of use to PFM suppliers in designing future offerings, and to the companies who use PFM services in articulating their requirements to suppliers.

The most common source of shoulder pain is thought to involve the tendons of the rotator cuff and associated structures around the subacromial space. A generic diagnostic term has been suggested, rotator cuff-related shoulder pain (RCRSP), which is an overarching clinical term that includes a number of conditions, such as subacromial impingement syndrome, subacromial pain syndrome, and rotator cuff tendinopathy. The management of RCRSP may include exercise, surgery, or injection therapy. Those who perform or recommend injection therapy for RCRSP have a duty of care to provide advice on the expected benefits and outcomes, as well as the potential risks and associated harms. Clinicians also need to consider what medication to inject, where to inject it, and how to inject it. The aim of this Viewpoint is to discuss these issues. J Orthop Sports Phys Ther 2019;49(5):289–293. doi:10.2519/jospt.2019.0607

Payments for Ecosystem Services (PES) schemes are an increasingly popular form of catchment management for improving surface water and groundwater quality. In these schemes, downstream water users who are impacted by agricultural diffuse pollution incentivise upstream farmers to adopt better practices. However, this type of scheme will not be successful in all situations, in part, due to a lack of potential for agriculture to improve the suuply of good water quality and/or a lack in demand from downstream users for good water quality. As such, this study aims to present a flexible approach to mapping the potential for PES schemes to improve water quality in agricultural catchments. The approach is based on multi-criteria analysis, with supply and demand as key criteria. It uses expert judgement or current guidance on PES to select supply and demand sub-criteria, expert judgement to weight all criteria through pairwise comparisons and readily available, national datasets to indicate criteria. Once indicator data are normalized, it combines them in a weighted sums analysis and presents results spatially at the national scale, all within a geographical information system. The approach can easily be applied to the country or region of interest by using locally relevant criteria, expert judgement and data. For example, when applied to the situation for river waterbodies in England, supply sub-criteria were the contribution of agriculture to loads of the major pollutants (nitrogen, phosphorus and sediments) and demand sub-criteria were the different downstream water users present (water companies and, tourist and local recreational users). Experts assigned equal weight to supply and demand criteria and the highest weights to sediments and water companies for sub-criteria, respectively. When national scale datasets to indicate these criteria were combined in a weighted sums analysis, it was possible to identify areas of high potential for PES. This would hopefully motivate more detailed research at the individual catchment level into the constraints in linking supply and demand. Three case-study schemes were also examined to show how some of these constraints are being identified and overcome. As such, the approach forms the first tier in a two-tier framework for establishing PES schemes to improve water quality in agricultural catchments.

Calcific tendinopathy of the shoulder is a relatively common condition, characterized by the presence of calcium deposits in the shoulder tendons, which may be associated with shoulder pain and dysfunction. To help guide the most appropriate treatment and future research in the area, a thorough review of the best available research was conducted. Overall, it was found that there is a lack of high-quality research in this area. Based on the current research, high-energy shockwave therapy and ultrasoundguided needling appear to be the best treatment options available for reducing shoulder pain, improving shoulder function and reducing the size of calcium deposits in the shoulder tendons. However, with out further high-quality research in this area, it is not possible to inform people seeking care which is the best management option. Objective: To evaluate the effectiveness of nonsurgical interventions for rotator cuff calcific tendinopathy. Data sources: Medline, EMBASE, CINAHL, Cochrane Register of Clinical Trials, PEDro and SPORTDiscus from inception to March 2018, and accompanying reference lists. Peer-reviewed randomized clinical trials of non-surgical interventions for adults with rotator cuff calcific tendinopathy were included. Data extraction: The same 2 reviewers independently evaluated eligibility, extracted data and evaluated risk of bias of the included randomized clinical trials. A system to resolve any disagreements was established a priori. Short-term, medium-term and long-term outcomes for pain, shoulder function and calcific morphology related to rotator cuff calcific tendinopathy were extracted. Due to diversity in outcome measures a meta-analyses was not conducted. Data synthesis: Of the 2,085 articles identified, 18 met the inclusion criteria, all of which had high risk of bias. Five non-surgical interventions were identified (extracorporeal shockwave therapy, ultrasound-guided percutaneous intervention, pulsed ultrasound, acetic acid iontophoresis, and transcutaneous electrical nerve stimulation).

Abstract The hormone adrenomedullin has both physiological and pathological roles in biology. As a potent vasodilator, adrenomedullin is critically important in the regulation of blood pressure, but it also has several roles in disease, of which its actions in cancer are becoming recognized to have clinical importance. Reduced circulating adrenomedullin causes increased blood pressure but also reduces tumor progression, so drugs blocking all effects of adrenomedullin would be unacceptable clinically. However, there are two distinct receptors for adrenomedullin, each comprising the same G protein-coupled receptor (GPCR), the calcitonin receptor-like receptor (CLR), together with a different accessory protein known as a receptor activity-modifying protein (RAMP). The CLR with RAMP2 forms an adrenomedullin-1 receptor, and the CLR with RAMP3 forms an adrenomedullin-2 receptor. Recent research suggests that a selective blockade of adrenomedullin-2 receptors would be therapeutically valuable. Here we describe the design, synthesis, and characterization of potent small-molecule adrenomedullin-2 receptor antagonists with 1000-fold selectivity over the adrenomedullin-1 receptor, although retaining activity against the CGRP receptor. These molecules have clear effects on markers of pancreatic cancer progression in vitro, drug-like pharmacokinetic properties, and inhibit xenograft tumor growth and extend life in a mouse model of pancreatic cancer. Taken together, our data support the promise of a new class of anticancer therapeutics as well as improved understanding of the pharmacology of the adrenomedullin receptors and other GPCR/RAMP heteromers.

Abstract At the time of writing, primary English education is, once again, at a crossroads. Within the context of a continuing focus on underachievement in writing for key groups of learners and a large body of research, which suggests that classroom talk is a powerful means of improving children's success in all areas of the curriculum including writing, this article considers two current approaches to talk in the primary curriculum – Talk for Writing and Towards Dialogic Teaching . In doing so, it critically analyses these texts through the theoretical lens of education as social reproduction with a view to identifying their ideological assumptions about the purpose of talk in the curriculum. Discussion considers how such assumptions may influence classroom practice and contribute to the teachers’ understanding of the role of oracy within the primary classroom. The article concludes that whilst both texts might suggest a socially reproductive approach to education, both have the potential to empower the learner through the skilful implementation of oracy as the foundation of teaching and learning.

Experiments are reported on the germination of over 6, 000 seeds of a large strain of Plantago major. The freshly ripened seeds are shown to exhibit varying degrees of natural dormancy that is gradually lost in contact with the soil and more quickly in air. Germination is naturally intermittent, the germination flushes being associated with the more-marked fluctuations of temperature. Seeds stored for five months germinated in a quasi-simultaneous manner. The results emphasize the importance of sowing freshly ripened seed from individual plants when assessing biological behaviour.

Abstract Plants release carbon‐based exudates from their roots into the rhizosphere to increase phosphorus (P) supply to the soil solution. However, if more P than required is brought into solution, additional P could be available for leaching from riparian soils. To investigate this further, soil columns containing a riparian arable and buffer strip soil, which differed in organic matter contents, were sown with three common agricultural and riparian grass species. The P loads in leachate were measured and compared with those from unplanted columns, which were 0.17 ± 0.01 and 0.89 ± 0.04 mg kg −1 for the arable and buffer strip soil, respectively. A mixture of ryegrass and red fescue significantly ( p ≤ .05) increased dissolved inorganic P loads in leachate from the arable (0.23 ± 0.01 mg kg −1 ) and buffer strip soil (1.06 ± 0.05 mg kg −1 ), whereas barley significantly reduced P leaching from the buffer strip soil (0.53 ± 0.08 mg kg −1 ). This was dependent on the dissolved organic C released under different plant species and on interactions with soil management history and biogeochemical conditions, rather than on plant uptake of P and accumulation into biomass. This suggested that the amount and forms of P present in the soil and the ability of the plants to mobilize them could be key factors in determining how plants affect leaching of soil P. Selecting grass species for different stages of buffer strip development, basing species selection on root physiological traits, and correcting soil nutrient stoichiometry in riparian soils through vegetative mining could help to lower this contribution.

During a period of 28 years 6 clinical observations concerning humans and a dog indicated that micro-calculi can form and acquire laminated growth at the base of the papillae in the renal medulla. In the subsequent research, plastic casts were made of the distal tubules of human post mortem kidneys. Study of these showed that acute angle and Z-bends were more prevalent at the bases of the papillae in the lower calices. Macro-photographs revealed that kinks in the wall of the tubule can reduce the lumen at these points. The combined evidence suggests that crystals and cellular debris may become impacted at these sites and form the nucleus of a stone.

Geographers from a variety of institutions in the UK set out brief practical accounts of successful attempts to hold onto quality while teaching larger classes and more students. An introduction sets these accounts in the context of change in the British higher education system and suggests their relevance to other geographers in mass education systems who are long accustomed to teaching large classes. The accounts are then presented using a common format and set of subheadings.