Great Britain

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients' life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ''altered sense of self,'' a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives. A holistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children.

Viral haemorrhagic septicaemia (VHS) was diagnosed in rainbow trout in the UK in May 2006. VHS virus (VHSV) was isolated from fingerlings showing typical histopathological lesions at a single rainbow trout farm site experiencing high mortality. The virus was confirmed as VHSV by serological and molecular biological tests. Phylogenetic analysis based on the complete glycoprotein gene sequence revealed that the isolate was closely related (99% nucleotide identity) to several Danish isolates from 1991 to 2000 and was assigned to VHSV genogroup Ia. The pathogenicity of the isolate was determined in infection experiments using rainbow trout fry. Following waterborne challenge, cumulative mortalities reached 96.67-100% by 12 days post-infection. This represents the first isolation of a pathogenic freshwater VHSV in the UK.

Background: International youth holiday resorts feature many of the key risk factors for violence, including large numbers of bars and nightclubs and high levels of substance use. However, little information currently exists on the extent of violence amongst holidaymakers or factors that increase risks of involvement in fights on holiday. Methods: A cross-sectional comparative survey of 3003 British, German and Spanish holidaymakers aged 16-35 years, undertaken in the departure areas of Ibiza and Majorca (Spain) airports. Results: Nightlife was the most common reason for destination choice in both locations. Overall, more than half of participants reported drinking to drunkenness at least 2 days per week during their holiday (59.3% Majorca, 58.0% Ibiza; significantly lower in Spanish participants in both locations). Levels of illicit drug use were highest in Ibiza and in British and Spanish holidaymakers. Levels of violence were highest in Majorca, where 6.4% of participants reported involvement in a fight, compared with 2.8% in Ibiza. However, after controlling for confounding factors, holiday destination was not a significant predictor of violence. Predictors of fighting were being male, young, British, frequent drunkenness and use of cannabis or cocaine during the holiday. Use of ecstasy on holiday was associated with not being involved in violence. Conclusions: High levels of substance use contribute to violence being a relatively common feature of young people's visits to international holiday resorts. To protect the health and well-being of holidaymakers and local populations in popular resorts, violence and substance use prevention must adapt to an increasingly globalized nightlife.

We apply an autobiographical memory framework to the study of regret. Focusing on the distinction between regrets for specific and general events we argue that the temporal profile of regret, usually explained in terms of the action-inaction distinction, is predicted by models of autobiographical memory. In two studies involving participants in their sixties we demonstrate a reminiscence bump for general, but not for specific regrets. Recent regrets were more likely to be specific than general in nature. Coding regrets as actions/inactions revealed that general regrets were significantly more likely to be due to inaction while specific regrets were as likely to be due to action as to inaction. In Study 2 we also generalised all of these findings to a group of participants in their 40s. We re-interpret existing accounts of the temporal profile of regret within the autobiographical memory framework, and outline the practical and theoretical advantages of our memory-based distinction over traditional decision-making approaches to the study of regret.

The present paper describes a pilot and follow-up study of the preliminary development of a new tool to screen for Asperger Syndrome (AS) and related social and communication conditions (the CAST: Childhood Asperger Syndrome Test) in children aged 4-11 years, in a non-clinical setting. Pilot Study: Parents of 13 children with AS and 37 typically developing children completed the CAST. There were significant differences in mean scores, with the AS sample mean of 21.08 (range 15 -31) and the typical sample mean of 4.73 (range 0 -13). The Pilot was used to establish preliminary cut-off scores for the CAST. Main Study: Parents of 1150 primary-school-age children were sent the CAST, with 199 responders and 174 taking part in the full data analysis. Results suggest that compared to other tools currently available, the CAST may be useful for identifying children at risk for AS and related conditions, in a mainstream non-clinical sample.

The National Health Service Knowledge and Skills Framework has been introduced as part of the Agenda for Change Reforms in the United Kingdom to link pay and career progression to competency. The purpose of this paper is to consider the implications for nurses, their managers and the impact on university departments delivering continuing professional development for nurses. The new system has the potential to increase the human resources management aspect of the clinical nurse managers' role and could have legal implications, for example if practitioners perceive that their needs for continuing professional development have been overlooked to the detriment of their pay and career aspirations. The new system also has implications for providers of continuing professional development in the universities and is likely to demand closer liaison between education providers and trust staff who commission education and training. The Knowledge and Skills Framework is of interest to nurses and nurse educators internationally because the system, if effective, could be introduced elsewhere.

the medical superintendent of the Brookwood Asylum, immediately took upon himself the task of unchaining Catherine from what he clearly considered apparel reminiscent of a pre-Conollyite era ofmechanical restraint. In the first few weeks following her admission to Brookwood, he observed that Catherine had responded well to her new physical liberty, behaving placidly, and eating with a sharp knife. "She acts", he confided in his medical casebook, "without exhibiting any suicidal propensities at present." By early 1872, unfortunately, her behaviour deteriorated. Seemingly unprovoked bouts of aggression aimed at both fellow patients and attendants prompted the superintendent to administer morphine and chloral hydrate. Early in 1875, she attempted to strangle herself but appeared soon to recover and during the next six months her behaviour ranged from the diligent to the destructive before she was again transferred (back) to Wandsworth Asylum. Sadly, her persistent attempts to commit self-murder were ultimately successful. A short time after her arrival, she committed suicide by hanging.5

Background: The United Kingdom (UK), alongside other industrialised countries, is experiencing a shortage of nurses partly due to low retention rates. Job satisfaction has been highlighted as a contributing factor to intent to leave and turnover, yet this is a complex area with many elements affecting its measurement. Aim: The aim of this paper is to explore the impact of job satisfaction components on intent to leave and turnover for hospital-based nurses in order to identify the most influential factors. Methods: To achieve this, a systematic search of the literature was undertaken to identify relevant international research. Three databases (i.e. BNI, CINAHL and PsychInfo) were utilised, resulting in nine articles that met the inclusion criteria. Four recurrent themes were identified in the literature: leadership, educational attainment, pay and stress.

"Words and Phrases, Unchanged for Centuries.

Containing a rich glossary and in excess of 300 words and phrases, the texts demonstrate the strength of the Macedonian language through preservation.

Following is a comparison of sentences between the texts and the Macedonian
dialect of Bitola as spoken today.

16th cent., Kostur dialect
21st cent., Bitola dialect

Gospodine, brate, da si zdrav, da si prost, ostavi ni da spime, ela da jame, i da pieme, dol da pojdime, da rabotime.
Gospodine, brate, da si zdrav, da si prost, ostai ne da spiame, ela da jaime, i da piame, dolu da pojdime, da rabotime.

Imate hljap-o da kupime, imate vino da kupime, ot koja strana da pojdime vo
Bogasko.
Imate lep da kupime, imate vino da kupime, od koja strana da pojdime vo
Bogatsko.

As can be clearly noticed, most of the vocabulary and grammar is identical.
All of the elements that would later be required to rejuvinate the Macedonian people as they were shaking off centuries of subjugation, were present during this period. The language of the people had solidified, a tradition of heraldry and symbolism had developed which incorporated the emblem of a rapant lion and historical figures from Macedonia's past, and the churches continued preserve the local customs and serve as cultural centres for the population. The significance of all these elements together cannot be overstated, the language of medieval Macedonia is the same as the language of the Macedonians today. Unfortunately, only a small portion of the larger amount of Macedonian literature from the Middle Ages has survived, much of it being looted and destroyed by Greek-speaking officials, clerics and teachers. Nevertheless, Macedonian as a language reached its current form centuries before the creation of the Balkan states in the 19th and 20th centuries. "

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

Purpose To test if two of the adverse event triggers proposed by the Institute of Healthcare Improvement can detect adverse drug events (ADEs) in a UK secondary care setting, using an electronic prescribing and health record system. Methods In order to identify triggers for over-anticoagulation and potential opioid overdose and we undertook a retrospective review of electronic medical and prescription records from 54,244 hospital admissions over a 1-year period, alongside a review of medical incident reports. Once prescription data were linked to triggers and duplicates were removed, case note review eliminated the false positive ADEs. Additionally, we tested the use of an electronic algorithm for the International Normalized Ratio (INR) ≥6 trigger. Results The INR ≥6 electronic trigger identified 46 potential ADEs and the naloxone electronic trigger identified 82 ADEs. Based on the available case note review, the INR ≥6 trigger had a positive predictive value (PPV) of 38 % (14/37) and the naloxone trigger had a PPV of 91 % (61/67). The electronic algorithm for the INR ≥6 trigger identified 12 ADEs, thus reducing the need of case note review. This was in comparison with one and two critical incidents reported in the trust medical incident reports system, which respectively related to over-coagulation with warfarin and over-sedation with opioid medication. Conclusions We have integrated automated and manual methods of detecting ADEs using previously defined triggers. Incorporating electronic triggers in already established electronic health records with prescription and laboratory test data can improve the detection of ADEs, and potentially lead to methods to avert them.

Aims Tobacco tax increases are the most effective means of reducing tobacco use and inequalities in smoking, but effectiveness depends on transnational tobacco company (TTC) pricing strategies, specifically whether TTCs overshift tax increases (increase prices on top of the tax increase) or undershift the taxes (absorb the tax increases so they are not passed onto consumers), about which little is known. Design Review of literature on brand segmentation. Analysis of 1999-2009 data to explore the extent to which tax increases are shifted to consumers, if this differs by brand segment and whether cigarette price indices accurately reflect cigarette prices. Setting UK. Participants UK smokers. Measurements Real cigarette prices, volumes and net-of-tax-revenue by price segment. Findings TTCs categorise brands into four price segments: premium, economy, mid and 'ultra-low price' (ULP). TTCs have sold ULP brands since 2006; since then, their real price has remained virtually static and market share doubled. The price gap between premium and ULP brands is increasing because the industry differentially shifts tax increases between brand segments; while, on average, taxes are overshifted, taxes on ULP brands are not always fully passed onto consumers (being absorbed at the point each year when tobacco taxes increase). Price indices reflect the price of premium brands only and fail to detect these problems. Conclusions Industry-initiated cigarette price changes in the UK appear timed to accentuate the price gap between premium and ULP brands. Increasing the prices of more expensive cigarettes on top of tobacco tax increases should benefit public health, but the growing price gap enables smokers to downtrade to cheaper tobacco products and may explain smoking-related inequalities. Governments must monitor cigarette prices by price segment and consider industry pricing strategies in setting tobacco tax policies. Keywords Cigarette prices, cigarette taxation, tobacco industry, tobacco industry pricing strategy, tobacco tax policy.

Methylomonas methanica MC09 is a mesophilic, halotolerant, aerobic, methanotrophic member of the Gammaproteobacteria , isolated from coastal seawater. Here we present the complete genome sequence of this strain, the first available from an aerobic marine methanotroph.

Computerised clinical decision support systems (CDSS) are increasingly being used by nurses to support their clinical practice. One of the factors which may affect how nurses use technology such as CDSS may be their clinical experience. This paper uses data from a wider study examining how nurses use CDSS to examine the role of experience in nurses' use of CDSS. Data was drawn from two sources; a secondary analysis of interviews from a study examining nurses' use of CDSS in telephone triage and the analysis of observations and interviews of nurses using CDSS in two case sites. Two themes arose from the analysis of the data; the integration of knowledge from CDSS and how experience affects CDSS use. The implications of these results are discussed in relation to our knowledge of the characteristics of the development of expertise in nursing.

At the end of the 1970s a racist rock music movement known as White Power music emerged in Great Britain in connection with political parties of the extreme right and remains a vibrant force in racist social movements today. Throughout the 1990s, White Power music expanded significantly from its origins in a clandestine network of punk-inspired live shows and record promotions into a multi-million dollar, international enterprise of web-pages, radio stations and independent record labels promoting White Power musicians performing a wider range of musical genres. In this article, we view White Power music as a cultural resource created and produced by racist movements and used as a tool to further key movement goals.  Specifically, we examine White Power music’s role when used to 1) recruit new adherents, especially youth, 2) frame issues and ideology to cultivate a White Power collective identity, and 3) obtain financial resources. In doing so we rely upon in-depth interviews with W...

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

To assess the effectiveness of the current UK clinical practice in reducing hepatic fat (IHCL). Whole body MRI and (1)H MRS were obtained, before and after 6 mo nutritional counselling, from liver, soleus and tibialis muscles in 10 subjects with non-alcoholic fatty liver disease (NAFLD). A 500 Kcal-restricted diet resulted in an average weight loss of 4% (-3.4 kg,) accompanied by significant reductions in most adipose tissue (AT) depots, including subcutaneous (-9.9%), abdominal subcutaneous (-10.2%) and intra-abdominal-AT (-11.4%). Intramyocellular lipids (IMCL) were significantly reduced in the tibialis muscle (-28.2%). Decreases in both IHCL (-39.9%) and soleus IMCL (-12.2%) content were also observed, although these were not significant. Several individuals showed dramatic decreases in IHCL, while others paradoxically showed increases in IHCL content. Changes in body composition were accompanied by improvements in certain liver function tests: serum aspartate aminotransferase (A...

Background Medication-related problems (MRPs) are the undesirable effects of pharmacotherapy that can potentially lead to harm. The epidemiology of MRPs in paediatric renal patients is unknown. We aimed to characterise MRPs in this population at two tertiary care hospitals in the UK. Methods Prescription charts for children (≤18 years) were reviewed to identify MRPs, and characterised using a specific proforma with a standard operational definition. MRP predictors were evaluated by logistic regression and severity was assessed using a validated scale. Results Two hundred and sixty-seven MRPs were identified from 266 prescription chart reviews. The incidence was 51.2 % (203 MRPs, 166 charts; 95 % CI 43.2-60.6 %) of hospitalised patients and 32 % (64 MRPs, 100 charts; 95 % CI 22.9-41.1 %) in outpatients. The number of prescribed medications was the only independent predictor during inpatient treatment (OR 1.06, 95 % CI 1.02-1.10, p=0.002) with no significant predictors identified at outpatient clinics. The severity level of the MRPs was minor: 53.9 %, (144 out of 267); or moderate: 46.1 %, (123 out of 267). Sub-optimal drug effect was the predominant MRP (inpatient: 68 %; outpatient: 39 %). Prescribing error and patients' medicine-taking behaviour were the main contributory factors. The majority of the MRPs in the inpatient setting were resolved. Conclusion Many factors are associated with MRPs in children; the associations are cumulative and interdependent. Investment in preventive strategies and extending the support from the acute health care setting into the community are invaluable for optimising pharmacotherapy.

Background. The World Health Organisation's Ottawa Charter for Health Promotion in 1986 sought to create a framework for health promotion action that conveyed the notion of capacity building as it related to specific settings. It provided the catalyst from which the health-promoting ...

Spinal cord stimulation (SCS) is an effective method of relieving chronic intractable pain, and one of its key indications is failed back surgery syndrome (FBSS). The objective of the current study was to evaluate the cost effectiveness of 10 kHz high-frequency SCS (HF10 SCS) compared to conventional medical management (CMM), reoperation, and traditional nonrechargeable (TNR-SCS) and rechargeable SCS (TR-SCS). A health economic model of SCS in the United Kingdom was reproduced in the perspective of the health care system to simulate costs and quality adjusted life years (QALYs) over 15 years. In the model, both a decision tree and the Markov model were used to describe the health outcomes of the evaluated therapies. HF10 SCS therapy showed a favorable incremental cost-effectiveness ratio (ICER) of £3,153 per QALY gained as compared to CMM and established dominance (less costly, more QALYs) compared to TNR-SCS (£8,802 per QALY vs. CMM) and TR-SCS (£5,101 per QALY vs. CMM). This first...

A recent finding of the Confidential Enquiry on Maternal and Child Health (CEMACH) 1 was that maternal mortality is associated with risk factors such as increased maternal age (>35 years), obesity [body mass index (BMI) > 30], late booking and social disadvantage. In the 3-year period from April 2002, there were 10 maternal deaths at Northwick Park Hospital (NPH); due to this excessive number, the unit was investigated by the Health Care Commision 2 and placed under 'special measures' by the Department of Health until October 2006.

The implementation of a pharmacovigilance service compliant with the legal and regulatory responsibilities of clinical trial sponsors presents particular challenges for sponsors in a non-commercial setting.In this paper we examine these challenges in detail. We identify and discuss the key steps in the development of a pharmacovigilance service within a public health service and university setting in the United Kingdom. We describe how we have established a central Pharmacovigilance Office with dedicated staff and resources within our organisation. This office is supported by an electronic pharmacovigilance reporting infrastructure developed to facilitate the receipt and processing of safety information, the onward reporting in compliance with legislation and the provision of sponsor institution oversight of clinical trial participant safety. An education and training programme has also been set up to ensure that all relevant staff in the organisation are fully aware of the pharmaco...

ObjectiveDespite widespread concern over exploitation of the European Union's fish stocks, dietary guidelines in the UK continue to recommend two portions of fish per week. The present study sought to investigate whether health and/or sustainability are motivating factors when purchasing and consuming fish and whether there are sociodemographic trends.DesignA structured, self-completion postal questionnaire exploring consumers’ attitudes towards purchasing fish, their dietary intake, stated purchasing behaviour and sociodemographic information.SettingNottinghamshire, UK.SubjectsAdults from 842 households randomly selected from the electoral register.ResultsOver half of the participants (57·0 %) were aware of the health benefits of fish consumption and reported health as a primary motivator for purchasing fish; however, only 26·8 % actively sought to purchase fish from a sustainable source (e.g. Marine Stewardship Council (MSC) certified fish). Only 30·6 % of participants met cur...

The purpose of this paper is to explore the contribution of paediatric accident and emergency nurses to the care of children. Method: Using a case study approach, the paper focuses on the experiences of three nurses working in this setting, obtained through working alongside the nurses and discussing and observing their experiences. Findings: It became apparent that the nurses were regarded as ''experts'' in the care of children in this setting. The nurses themselves however, did not share this perception. Their experiences are analysed with reference to literature on expertise, focussing specifically on published accounts of children's nurses' experiences, and research which has explored the concept of expertise within the context of accident and emergency work. The implications for continuing professional development needs are discussed within the context of recent government reports, which make recommendations in respect of access and delivery of on-going professional education. To this end it is advocated that a multi-professional approach is adopted, with children's nurses sharing learning and thus access to, courses customarily provided to adults nurses working in this setting.

Objective: No outcome measures specific to pulmonary hypertension (PH) currently exist. The aim of the study was to develop health-related quality of life (symptoms and functioning) scales and a quality of life scale that would allow comprehensive, accurate and valid patient-reported outcome assessment in clinical studies. Methods: The content of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was derived from qualitative interviews conducted with 35 patients. Item reduction was based on the analysis of responses to a postal survey (n=75) and patient interviews (n=15) designed to determine face and content validity. A final postal validation study (n=91) was performed to determine reproducibility and construct validity. Results: The questionnaire was well received by participants who found it to be relevant, comprehensible and quick and easy to complete. Rasch and factor analyses were conducted to ensure unidimensionality of the final CAMPHOR scales; Overall symptoms (made up of Energy, Breathlessness and Mood subscales), Functioning and Quality of life. The CAMPHOR scales had good internal consistency (a=0.90-0.92) and reproducibility (test-retest correlations=0.86-0.92). They also exhibited convergent, divergent and known groups validity. Conclusions: The CAMPHOR is a valuable new instrument for assessing patient-reported outcome in PH clinical trials and routine practice.

Active support, a package of procedures which includes activity planning, support planning and training on providing effective assistance, was introduced in five community residences serving 19 adults with severe intellectual disability following a multiple baseline design. The ...

Background: Exposure to environmental tobacco smoke is a major threat to public health. Greece, having the highest smoking prevalence in the European Union is seriously affected by passive smoking. The purpose of this study was to measure environmental tobacco smoke (ETS) exposure in the non smoking areas of hospitality venues and offices in Greece and to compare the levels of exposure to levels in the US, UK and Ireland before and after the implementation of a smoking ban. Methods: Experimental measurements of particulate matter 2.5 µm (PM 2.5), performed during a cross sectional study of 49 hospitality venues and offices in Athens and Crete, Greece during February-March 2006. Results: Levels of ETS ranged from 19 µg/m 3 to 612 µg/m 3 , differing according to the place of measurement. The average exposure in hospitality venues was 268 µg/m 3 with ETS levels found to be highest in restaurants with a mean value of 298 µg/m 3 followed by bars and cafes with 271 µg/ m 3. ETS levels were 76% lower in venues in which smoking was not observed compared to all other venues (p < 0.001). ETS levels in Greek designated non-smoking areas are similar to those found in the smoking sections of UK hospitality venues while levels in Ireland with a total smoking ban are 89% lower and smoke-free communities in the US are 91-96% lower than levels in Greece. Conclusion: Designated non-smoking areas of hospitality venues in Greece are significantly more polluted with ETS than outdoor air and similar venues in Europe and the United States. The implementation of a total indoor smoking ban in hospitality venues has been shown to have a positive effect on workers and patrons' health. The necessity of such legislation in Greece is thus warranted.

P athology, or laboratory medicine as we prefer to call it, represents approximately 4% of the overall NHS budget, provides information for up to 70% of clinical decisions and is highly regarded by hospital clinicians (Heathcare Commission, 2007). Yet despite this, laboratory medicine is not regarded as a clinical service but a cost pressure and has been subjected to a number of reviews over recent years by the Audit Commission and now the Department of Health through Lord Carter of Coles with an aim of improving efficiency.

Qualitative research on self-management for people with Type 2 Diabetes Mellitus (T2DM) has typically reported one-off retrospective accounts of individuals&#39; strategies. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or unsupportive over time, by using qualitative findings from both longitudinal intervention studies and usual care.

Background The number of asylum seekers, refugees and internally displaced people worldwide is rising. Western countries are using increasingly restrictive policies, including the detention of asylum seekers, and there is concern that this is harmful. Aims To investigate mental health outcomes among adult, child and adolescent immigration detainees. Method A systematic review was conducted of studies investigating the impact of immigration detention on the mental health of children, adolescents and adults, identified by a systematic search of databases and a supplementary manual search of references. Results Ten studies were identified. All reported high levels of mental health problems in detainees. Anxiety, depression and posttraumatic stress disorder were commonly reported, as were self-harm and suicidal ideation. Time in detention was positively associated with severity of distress. There is evidence for an initial improvement in mental health occurring subsequent to release, al...

There is increasing awareness of the damage caused to valuable and often unique sensitive habitats by people pressure as degradation causes a loss of plant species, disturbance to wildlife, on-site and off-site impacts of soil movement and loss, and visual destruction of pristine environments. This research developed a new perspective on the problem of recreational induced environmental degradation by assessing the physical aspects of soil erosion using the fallout radionuclide caesium-137 ( 137 Cs). Temporal sampling problems have not successfully been overcome by traditional research methods monitoring footpath erosion and, to date, the 137 Cs technique has not been used to estimate longer-term soil erosion in regard to sensitive recreational habitats. The research was based on-sites within Dartmoor National Park (DNP) and the South West Coast Path (SWCP) in south-west England. 137 Cs inventories were reduced on the paths relative to the reference inventory (control), indicating loss of soil from the path areas. The Profile Distribution Model estimated longer-term erosion rates (ca. 40 years) based on the 137 Cs data and showed that the combined mean soil loss for all the sites on 'paths' was 1.41 kg m À2 yr À1 whereas the combined 'off path' soil loss was 0.79 kg m À2 yr À1 , where natural (non-recreational) soil redistribution processes occur. Recreational pressure was shown to increase erosion in the long-term, as greater soil erosion occurred on the paths, especially where there was higher visitor pressure.

There is growing interest in the provision of trial results to trial participants. However, there are a number of gaps in the research base relating to the closure of clinical trials and feedback of results to participants.The aim of this research was to explore the practice of feeding back trial results to trial participants and to identify best practice in this area. Postal questionnaires were sent to members of the UK National Cancer Research Institute Clinical Studies Groups (NCRI CSG) and to patients over the age of 18 years who completed trial treatment (located in one Cancer Network) during a 16-month period (April 07–July 08).145 NCRI CSG member surveys and 81 patient questionnaires were returned. The vast majority of all respondents supported the idea of offering results to trial participants. However, NCRI members and trial participants differed in their opinions about the timing and method for the provision of results.The results provide an insight into the views of these groups in relation to desire for results and practical aspects of results feedback which should inform further investigations into trial management and the practice of feedback of trial results.