Assessing the quality of provision in community nurseries

This paper raises a number of issues in the assessment of quality of provision for pre-school children before comparing the quality of provision offered by community nurseries to that offered by traditional nursery schools. Quality at all locations was assessed using the Harms and Clifford Early Childhood Rating Scale and was found in each case to be at the good to excellent end of the range. Quality varied over time and between locations although all showed improvements by the third and final rating. It is possible to conclude that the community nursery model can provide an environment of comparable quality to that experienced in traditional nursery schools. It was also possible to conclude that quality is vulnerable to internal and external pressures and that monitoring quality can also have the effect of promoting quality when staff are able to respond to feedback from ratings.     

Does the BJGP need more fizz and pop?--A Midland Faculty readership survey.

BACKGROUND: The British Journal of General Practice (BJGP) is the leading primary care journal in the world. By impact factor, it ranks 24th of all medical journals. However, despite major changes in the journal since its inception in 1954, there have been no published readership surveys since a limited report in 1969. AIM: To canvass members of the Midland Faculty and to add to the debate about the future of the BJGP. METHOD: A postal questionnaire was sent to a random sample of 299 members, fellows and associates of the Midland Faculty asking for their views about the BJGP. RESULTS: Two hundred replies were received (a response rate of 67%). The median year of qualification of responders was 1981, and 32 (16%) held academic posts. Ninety-nine (49%) disagreed with the present format of the BJGP, which compared poorly with the British Medical Journal (BMJ) in simple rank order of importance. Readership was equal to that of the BMJ (93% reading it within 28 days of arrival), but fewer people read it within a week of receiving it. The most popular sections were the editorials, original articles and letters; least popular were the book reviews and the pull-out magazine, Connection. All sections were rated excellent to average. Readers wished for an expansion of the BJGP to include clinical reviews, medical politics and humorous pieces. Most responders felt that Connection should remain separate. There was dissatisfaction with the delay between submission and publication of original articles, particularly among the academic general practitioners (GPs). Academics and fundholders did not differ from other readers in their views of the content or style of the BJGP. Half of the responders stated that the BJGP should be self-financing and should be open to more advertising. Responders' free comments largely related to improving the style of articles and expanding the BJGP. CONCLUSION: There is a view that the present BJGP is not relevant to the non-academic GP. This is probably due to style rather than content. Simple comparisons with a weekly multi-disciplinary journal may not be valid. The style could be updated to improve retention of information and to highlight areas of particular relevance. Readers are satisfied with the core content of the BJGP but want it to expand to include humour, clinical reviews and medical politics, for example. There is no evidence that the BJGP is more appealing to the academic GP. This study supports an expanded BJGP with an improved style.     

An Eph-related receptor protein tyrosine kinase gene segmentally expressed in the developing mouse hindbrain.

In search of genes possibly involved in the regulation of hindbrain segmentation, we have isolated mouse cDNA clones corresponding to putative protein kinase genes by polymerase chain reaction amplification of cDNA from 9.5-day-old embryo hindbrains. In situ hybridization analysis revealed that one of these genes, Sek, was expressed in an alternating segment-restricted pattern in the developing hindbrain. Isolation and analysis of Sek cDNAs covering the entire coding sequence indicated that Sek encoded a putative receptor protein tyrosine kinase, belonging to the Eph family. These data are consistent with a role of the Sek gene product in a signal transduction process involved in pattern formation in the hindbrain.     

A randomized trial of two types of adjuvant chemotherapy in radiotherapy-treated patients with clinical stages I and II high-grade non-Hodgkin's lymphoma

Summary This paper reports the 8-year results of comparing the use of two types of adjuvant chemotherapy following involved field radiotherapy for clinical stages I and II high-grade non-Hodgkin's lymphoma. Twenty-four patients received 6 weeks of VAP plus 2 years of oral maintenance chemotherapy, and 30 had six cycles of CMOPP. Four patients were not in complete remission at completion of i. v. chemotherapy (CR rate 91%). Ten patients (18.5%) have relapsed (VAP/M=5; CMOPP=5), with only two of these remaining alive, both of them being disease free. There have been three deaths from intercurrent causes, one from malignant melanoma and the other two from myocardial infarction. The relapse-free survivals at 2, 5 and 8 years were 80%, 76% & 76% respectively. The overall survivals at the same time points were 86%, 72% & 68%. There were no significant differences in either relapse-free or overall survival for either of the two treatment groups. The shorter period of weekly intravenous chemotherapy (VAP/M) was better tolerated than 36 weeks of CMOPP, and the former appears to produce equivalent results.     

Age and simple reaction time: decade differences for 5,325 subjects

In a booth at a public exhibition entitled "Medicines for Man," 5,325 men, women, and children carried out a 1-minute test of simple reaction time (RT) with 1 to 10 second randomized variable preparatory interval (PI). They recorded their ages by decade. Average RT over the last eight (of ten) trials increased progressively from the 20s up to age 60 and over, and downward to the teens and under 10s. The single fastest RT in each test varied much less with age, only the 20s being clearly faster than the rest, with the under 10s slower. Within-subject variability of RT was increased only in the under 10s and over 60s. Ability to sustain attention during the longer PIs may underlie the gross average RT differences with age, and possibly some more basic neural property the superiority of the 20s in fastest RT.     

Some factors affecting the strength of the cement-metal interface

A manufacturing technique to increase the bonding between bone cement and metal prostheses has been assessed in the laboratory by "push-out" tests, and the effects of contamination of the cement and of the prosthesis with blood and intramedullary contents have been studied. The technique, known as pre-coating, increases bond strength; this increase is preserved after contamination of the cement which does, however, cause some lowering of interface shear strength. The implications for clinical practice are discussed.