CommEmorating the Last Event: calling time on the end of treatment Bell following RAdioThErapy? The CELEBRATE study

INTRODUCTION

In the UK it is commonplace for patients completing radiotherapy to be invited to ring a bell as a form of celebration. The project aimed to explore the experiences of the end of treatment bell from the perspective of patients who had received treatment for cancer, and therapeutic radiographers who treat patients. The study also aimed to consider possible alternative methods of commemorating the EoT, considering the needs of patients, family members and healthcare professionals.

METHODS

Online focus groups were held with patients (n = 5) and therapeutic radiographers (n = 4) in December 2020; a joint online event (n = 6) was held in March 2022. They were all facilitated by two members of the research team. Thematic analysis was used for data analysis.

RESULTS

Participants' views and experiences were mixed; however, there was a consensus that alternative forms of commemoration should be available to meet patients' diverse needs. Features of a specification were considered and suggestions made for alternative practices, with a focus upon patients' transition needs after radiotherapy has ended.

CONCLUSION

The results indicate that departments should consider the harms as well as the benefits conferred by the EoT bell and explore alternative ways to mark an episode of treatment.

IMPLICATIONS FOR PRACTICE

A one-size-fits-all approach is not appropriate in relation to marking the end of an episode of treatment.

Underpotential Deposition of 3D Transition Metals: Versatile Electrosynthesis of Single-Atom Catalysts on Oxidized Carbon Supports

Use of single-atom catalysts (SACs) has become a popular strategy for tuning activity and selectivity toward specific pathways. However, conventional SAC synthesis methods require high temperatures and pressures, complicated procedures, and expensive equipment. Recently, underpotential deposition (UPD) has been investigated as a promising alternative, yielding high-loading SAC electrodes under ambient conditions and within minutes. Yet only few studies have employed UPD to synthesize SACs, and all have been limited to UPD of Cu. In this work, a flexible UPD approach for synthesis of mono- and bi-metallic Cu, Fe, Co, and Ni SACs directly on oxidized, commercially available carbon electrodes is reported. The UPD mechanism is investigated using in situ X-ray absorption spectroscopy and, finally, the catalytic performance of a UPD-synthesized Co SAC is assessed for electrochemical nitrate reduction to ammonia. The findings expand upon the usefulness and versatility of UPD for SAC synthesis, with hopes of enabling future research toward realization of fast, reliable, and fully electrified SAC synthesis processes.

Tuning Local Atomic Structures in MoS2 Based Catalysts for Electrochemical Nitrate Reduction

In recent years, there has been a substantial surge in the investigation of transition-metal dichalcogenides such as MoS2 as a promising electrochemical catalyst. Inspired by denitrification enzymes such as nitrate reductase and nitrite reductase, the electrochemical nitrate reduction catalyzed by MoS2 with varying local atomic structures is reported. It is demonstrated that the hydrothermally synthesized MoS2 containing sulfur vacancies behaves as promising catalysts for electrochemical denitrification. With copper doping at less than 9% atomic ratio, the selectivity of denitrification to dinitrogen in the products can be effectively improved. X-ray absorption characterizations suggest that two sulfur vacancies are associated with one copper dopant in the MoS2 skeleton. DFT calculation confirms that copper dopants replace three adjacent Mo atoms to form a trigonal defect-enriched region, introducing an exposed Mo reaction center that coordinates with Cu atom to increase N2 selectivity. Apart from the higher activity and selectivity, the Cu-doped MoS2 also demonstrates remarkably improved tolerance toward oxygen poisoning at high oxygen concentration. Finally, Cu-doped MoS2 based catalysts exhibit very low specific energy consumption during the electrochemical denitrification process, paving the way for potential scale-up operations.

Peroxymonosulfate-Based Electrochemical Advanced Oxidation: Complication by Oxygen Reduction Reaction

Peroxymonosulfate (PMS)-based electrochemical advanced oxidation processes (EAOPs) have received widespread attention in recent years, but the precise nature of PMS activation and its impact on the overall process performance remain poorly understood. This study presents the first demonstration of the critical role played by the oxygen reduction reaction in the effective utilization of PMS and the subsequent enhancement of overall pollutant remediation. We observed the concurrent generation of H2O2 via oxygen reduction during the cathodic PMS activation by a model nitrogen-doped carbon nanotube catalyst. A complex interplay between H2O2 generation and PMS activation, as well as a locally increased pH near the electrode due to the oxygen reduction reaction, resulted in a SO4•-/•OH-mixed oxidation environment that facilitated pollutant degradation. The findings of this study highlight a unique dependency between PMS-driven and H2O2-driven EAOPs and a new perspective on a previously unexplored route for further enhancing PMS-based treatment processes.

Palladium Single-Atom (In)Stability Under Aqueous Reductive Conditions

Here, we investigate the stability and performance of single-atom Pd on TiO2 for the selective dechlorination of 4-chlorophenol. A challenge inherent to single atoms is their high surface free energy, which results in a tendency for the surface migration and aggregation of metal atoms. This work evaluates various factors affecting the stability of Pd single-atoms, including atomic dispersion, coordination environment, and substrate properties, under reductive aqueous conditions. The transition from single atoms to clusters vastly enhanced dechlorination kinetics without diminishing carbon-chlorine bond selectivity. X-ray absorption spectroscopy analysis using both in situ and ex situ conditions followed the dynamic transformation of single atoms into amorphous clusters, which consist of a unique unsaturated coordination environment and few nanometer diameter. The intricate relationship between stability and performance underscores the vital role of detailed characterization to properly determine the true active species for dehalogenation reactions.

Contrasting Capability of Single Atom Palladium for Thermocatalytic versus Electrocatalytic Nitrate Reduction Reaction

The occurrence of high concentrations of nitrate in various water resources is a significant environmental and human health threat, demanding effective removal technologies. Single atom alloys (SAAs) have emerged as a promising bimetallic material architecture in various thermocatalytic and electrocatalytic schemes including nitrate reduction reaction (NRR). This study suggests that there exists a stark contrast between thermocatalytic (T-NRR) and electrocatalytic (E-NRR) pathways that resulted in dramatic differences in SAA performances. Among Pd/Cu nanoalloys with varying Pd-Cu ratios from 1:100 to 100:1, Pd/Cu(1:100) SAA exhibited the greatest activity (TOFPd = 2 min-1) and highest N2 selectivity (94%) for E-NRR, while the same SAA performed poorly for T-NRR as compared to other nanoalloy counterparts. DFT calculations demonstrate that the improved performance and N2 selectivity of Pd/Cu(1:100) in E-NRR compared to T-NRR originate from the higher stability of NO3* in electrocatalysis and a lower N2 formation barrier than NH due to localized pH effects and the ability to extract protons from water. This study establishes the performance and mechanistic differences of SAA and nanoalloys for T-NRR versus E-NRR.

Pulsed Electrolysis of Boron-Doped Carbon Dramatically Improves Impurity Tolerance and Longevity of H2O2 Production

Electrocatalytic water treatment has emerged in the limelight of scientific interest, yet its long-term viability remains largely in the dark. Herein, we present for the first time a comprehensive framework on how to optimize pulsed electrolysis to bolster catalyst impurity tolerance and overall longevity. By examining real wastewater constituents and assessing different catalyst designs, we deconvolute the complexities associated with key pulsing parameters to formulate optimal sequences that maximize operational lifetime. We showcase our approach for cathodic H2O2 electrosynthesis, selected for its widespread importance to wastewater treatment. Our results unveil superior performance for a boron-doped carbon catalyst over state-of-the-art oxidized carbon, with high selectivity (>75%) and near complete recoveries in overpotentials even in the presence of highly detrimental Ni2+ and Zn2+ impurities. We then adapt these fine-tuned settings, obtained under a three-electrode arrangement, for practical two-electrode operation using a novel strategy that conserves the desired electrochemical potentials at the catalytic interface. Even under various impurity concentrations, our pulses substantially improve long-term H2O2 production to 287 h and 35 times that attainable via conventional electrolysis. Our findings underscore the versatility of pulsed electrolysis necessary for developing more practical water treatment technologies.

Enhancing the activity of Pd ensembles on graphene by manipulating coordination environment

Atomic dispersion of metal catalysts on a substrate accounts for the increased atomic efficiency of single-atom catalysts (SACs) in various catalytic schemes compared to the nanoparticle counterparts. However, lacking neighboring metal sites has been shown to deteriorate the catalytic performance of SACs in a few industrially important reactions, such as dehalogenation, CO oxidation, and hydrogenation. Metal ensemble catalysts (Mn), an extended concept to SACs, have emerged as a promising alternative to overcome such limitation. Inspired by the fact that the performance of fully isolated SACs can be enhanced by tailoring their coordination environment (CE), we here evaluate whether the CE of Mn can also be manipulated in order to enhance their catalytic activity. We synthesized a set of Pd ensembles (Pdn) on doped graphene supports (Pdn/X-graphene where X = O, S, B, and N). We found that introducing S and N onto oxidized graphene modifies the first shell of Pdn converting Pd-O to Pd-S and Pd-N, respectively. We further found that the B dopant significantly affected the electronic structure of Pdn by serving as an electron donor in the second shell. We examined the performance of Pdn/X-graphene toward selective reductive catalysis, such as bromate reduction, brominated organic hydrogenation, and aqueous-phase CO2 reduction. We observed that Pdn/N-graphene exhibited superior performance by lowering the activation energy of the rate-limiting step, i.e., H2 dissociation into atomic hydrogen. The results collectively suggest controlling the CE of SACs in an ensemble configuration is a viable strategy to optimize and enhance their catalytic performance.

A Protocol for Electrocatalyst Stability Evaluation: H2O2 Electrosynthesis for Industrial Wastewater Treatment

Electrocatalysis has been proposed as a versatile technology for wastewater treatment and reuse. While enormous attention has been centered on material synthesis and design, the practicality of such catalyst materials remains clouded by a lack of both stability assessment protocols and understanding of deactivation mechanisms. In this study, we develop a protocol to identify the wastewater constituents most detrimental to electrocatalyst performance in a timely manner and elucidate the underlying phenomena behind these losses. Synthesized catalysts are electrochemically investigated in various electrolytes based on real industrial effluent characteristics and methodically subjected to a sequence of chronopotentiometric stability tests, in which each stage presents harsher operating conditions. To showcase, oxidized carbon black is chosen as a model catalyst for the electrosynthesis of H₂O₂, a precursor for advanced oxidation processes. Results illustrate severe losses in catalyst activity and/or selectivity upon the introduction of metal pollutants, namely magnesium and zinc. The insights garnered from this protocol serve to translate lab-scale electrocatalyst developments into practical technologies for industrial water treatment purposes.

Single-Atom Cobalt Incorporated in a 2D Graphene Oxide Membrane for Catalytic Pollutant Degradation

We introduce a new graphene oxide (GO)-based membrane architecture that hosts cobalt catalysts within its nanoscale pore walls. Such an architecture would not be possible with catalysts in nanoscale, the current benchmark, since they would block the pores or alter the pore structure. Therefore, we developed a new synthesis procedure to load cobalt in an atomically dispersed fashion, the theoretical limit in material downsizing. The use of vitamin C as a mild reducing agent was critical to load Co as dispersed atoms (Co₁), preserving the well-stacked 2D structure of GO layers. With the addition of peroxymonosulfate (PMS), the Co₁-GO membrane efficiently degraded 1,4-dioxane, a small, neutral pollutant that passes through nanopores in single-pass treatment. The observed 1,4-dioxane degradation kinetics were much faster (>640 times) than the kinetics in suspension and the highest among reported persulfate-based 1,4-dioxane destruction. The capability of the membrane to reject large organic molecules alleviated their effects on radical scavenging. Furthermore, the advanced oxidation also mitigated membrane fouling. The findings of this study present a critical advance toward developing catalytic membranes with which two distinctive and complementary processes, membrane filtration and advanced oxidation, can be combined into a single-step treatment.

Elucidating the Role of Single-Atom Pd for Electrocatalytic Hydrodechlorination

In this study, we loaded Pd catalysts onto a reduced graphene oxide (rGO) support in an atomically dispersed fashion [i.e., Pd single-atom catalysts (SACs) on rGO or Pd₁/rGO] via a facile and scalable synthesis based on anchor-site and photoreduction techniques. The as-synthesized Pd₁/rGO significantly outperformed the Pd nanoparticle (Pd_nano) counterparts in the electrocatalytic hydrodechlorination of chlorinated phenols. Downsizing Pd_nano to Pd₁ leads to a substantially higher Pd atomic efficiency (14 times that of Pd_nano), remarkably reducing the cost for practical applications. The unique single-atom architecture of Pd₁ additionally affects the desorption energy of the intermediate, suppressing the catalyst poisoning by Cl^-, which is a prevalent challenge with Pd_nano. Characterization and experimental results demonstrate that the superior performance of Pd₁/rGO originates from (1) enhanced interfacial electron transfer through Pd-O bonds due to the electronic metal-support interaction and (2) increased atomic H (H*) utilization efficiency by inhibiting H₂ evolution on Pd₁. This work presents an important example of how the unique geometric and electronic structure of SACs can tune their catalytic performance toward beneficial use in environmental remediation applications.

Long-term outcomes of latissimus dorsi flap breast reconstructions: A single-centre observational cohort study with up to 12 years of follow up

INTRODUCTION

The Latissimus Dorsi Myocutaneous Flap (LDMF) is used in post-mastectomy reconstruction. This study has evaluated long-term (up to 12 years) surgical- and patient-reported outcomes from LDMF procedures.

METHOD

A retrospective analysis of consecutive LDMF procedures in two UK hospitals, performed between 2006 and 2016. Case notes were reviewed for indications and outcomes. Patients were sent the BREAST-Q^Ⓡ survey by post. Outcomes, including surgical adverse events, revision, and implant loss rates, were correlated with patient risk factors.

RESULTS

A BREAST-Q was posted to 199/248 LDMF patients in 2018, (excluding 49 patients due to death, reduced cognitive function and incorrect coding) of whom 77 patients responded (38.7%). In 188 cases (representing 208 LDMFs), surgical outcomes were assessable. Median time since LDMF surgery was 7 years (range 2-12). Rates of acute implant loss were 9/139 (6.4%), flap necrosis 7/208 (3.4%), shoulder stiffness 4/208 (1.9%), chronic pain 24/208 (11.5%) and unplanned revision surgery 13/208 (7%). Median satisfaction levels were high with 78% of patients satisfied with treatment outcomes, 65% of patients satisfied with their breasts, 71% of patients satisfied psychosocially and 75% of patients satisfied with their chest. Receipt of radiotherapy was not associated with a higher risk of flap necrosis or capsule formation.

CONCLUSION

Long-term follow-up of a large cohort of LDMF reconstruction patients show relatively low levels of adverse events and unplanned revision surgery and high patient satisfaction, which demonstrates how temporally robust the technique is. With the rise in popularity of acellular dermal matrix reconstructions, the LDMF has relatively fallen out of favour but its potential in primary and delayed reconstruction is demonstrated.

The effect of helium nano-bubbles on the structures stability and electronic properties of palladium tritides: a density functional theory study

Density functional theory calculations have been used to study the incorporation of helium in perfect and defect-containing palladium tritides, where we have calculated the energetics of incorporation and the migration behaviour. Helium atoms preferably occupy the octahedral interstitial and substitutional sites in the perfect and Pd vacancy-containing tritides, respectively. The energetics reveal that helium clusters can form in the lattice, which displace the Pd metal atoms. The defective lattice shows less expansion compared with the perfect lattice, which can accommodate the helium less easily. The path from octahedral–tetrahedral–octahedral sites is the lowest energy pathway for helium diffusion, and the energetics indicate that the helium generated from tritium decay can accumulate in or near the octahedral sites. Density of states analyses shows the hybridization between palladium d and tritium s orbitals and repulsion between palladium d and helium s orbitals, which can distort the lattice as a result of generating localized stress.

Implications of inadequate parental bonding and peer victimization for adolescent mental health

Previous studies have indicated significant associations between relatively poor mental health of children and both perceived negative parenting and exposure to peer victimization at school. This paper examines their relative contribution to the mental status of adolescent school children. Questionnaires were administered to Australian school children (n=1432) aged 12-16 years. These contained reliable self-report measures of mental health (the GHQ) parental bonding (the PBI) and degree of peer victimization. As predicted, multiple regression analyses indicated that low levels of perceived parental care, high parental control and frequent peer victimization were each significantly and independently associated with relatively poor mental health. Together, they accounted for some 17% and 27% of variance in the mental health status of adolescent boys and girls, respectively. Theoretical and practical implications of these findings are considered. Limitations of the study are also discussed (deleted).

Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial)

OBJECTIVES

To establish the cost-effectiveness of surgery and sclerotherapy for the treatment of varicose veins.

DESIGN

Randomised controlled trials (RCTs) were carried out for conservative treatment, sclerotherapy and surgery for varicose veins. An economic analysis was carried out alongside the randomised trial. Economic modelling was undertaken based on the primary data collection and a literature review (database searches undertaken in April 2000 and updated in March 2001).

SETTING

Primary data collection was from a large district general hospital and a teaching hospital both in England over a 2-year period from January 1999. Cost-effectiveness analysis and economic modelling were carried out using an NHS perspective.

PARTICIPANTS

A total of 1009 patients were recruited.

INTERVENTIONS

Thirty-four patents were randomised in Group 1 (minor varicose veins with no reflux, randomised between conservative treatment and sclerotherapy), 77 in Group 2 (moderate varicose veins with reflux, randomised between surgery and sclerotherapy) and 246 in Group 3 (severe varicose veins with reflux, randomised between conservative treatment and surgery). The remaining 652 patients formed the observational part of the study.

MAIN OUTCOME MEASURES

The cost-effectiveness analysis was based on NHS treatment costs for the 2002--3 financial year, and utilities based on the Short Form 6D (SF-6D) preference-based health measure. For the clinical trial, the outcome measures were health-related quality of life (HRQoL) [Short Form with 36 Items (SF-36), EuroQol quality of life questionnaire (EQ-5D), visual analogue scale (VAS) and standard gamble], symptomatic relief, anatomical extent (for which a new classification was developed and validated), patient satisfaction and the incidence of complications.

RESULTS

Of the RCTs, only the Group 3 trial was large enough to provide clear results. This showed that surgical treatment produced better results than conservative treatment in terms of HRQoL, symptomatic relief, anatomical extent and patient satisfaction. Clinical outcomes of surgery and sclerotherapy showed significant improvement in the extent of varicose veins, symptomatic and HRQoL parameters. Cost-effectiveness analysis based on the Group 3 trial showed that the surgery produced an estimated discounted benefit of 0.054 quality-adjusted life-year (QALY) over a 2-year period, with an additional discounted cost of pound 387.45, giving an incremental cost-effectiveness ratio (ICER) of pound 7175 per QALY. Economic modelling suggested that surgery produced a still greater benefit when considered with a 10-year time horizon, with an ICER of pound 1936 per QALY. Injection sclerotherapy produced an incremental benefit of approximately 0.044 QALY at a cost of pound 155 when compared with conservative treatment, giving an ICER of pound 3500 per QALY. When surgery was compared with sclerotherapy, surgery produced greater benefit with a lower ICER (showing extended dominance).

CONCLUSIONS

Standard surgical treatment of varicose veins by saphenofemoral ligation, stripping and multiple phlebectomies is a clinically effective and cost-effective treatment for varicose veins, with an ICER well below the threshold normally considered appropriate for the funding of treatments within the NHS. Injection sclerotherapy also appears to be cost-effective, but produces less overall benefit, with a higher ICER than surgery for patients with superficial venous reflux. In minor varicose veins without reflux, sclerotherapy is likely to provide a small average benefit with acceptable cost-effectiveness. Research is needed into methods for accurate and acceptable utility evaluations for conditions with relatively minor effect on HRQoL and also for a validated and standardised method of classification for varicose veins.

Mortality following aortic surgery as a possible indicator of clinical performance

Background

The mortality rate following aortic surgery has been suggested as a possible indicator of clinical performance.

Methods

Routine hospital data on mortality following aortic surgery were collected for a 2-year interval in the Trent region. Procedural and diagnostic codes, mode of admission, district of residence, treatment and specialty data were analysed and compared with audit data and the Operating Theatre Information System.

Results

Inaccuracies in coding using the HRG (Health Resource Group) codes meant that 21·4 per cent of elective aortic cases (HRG Q01) were probably emergencies and 26 per cent of probable emergency ruptures were not coded as vascular emergencies. The HRG system does not identify complex procedures carried out in specialist centres, thereby distorting the overall mortality figures. Case mix and patient selection introduced a bias, apparent between tertiary and district general hospitals, with higher-risk elective and lower-risk emergency cases at tertiary referral centres. For patients aged over 80 years, two districts undertook no elective aortic surgery, and the rates for emergency surgery varied between 16 and 25 per cent in the districts and 77 per cent in the tertiary centre. After correction for these factors, there remains significant variation in mortality rates between tertiary referral centres and the district hospitals (Table).

Conclusion

Some of the difficulties in using crude mortality rates as an indicator of performance have been highlighted. They are subject to bias and distortions owing to the collection of incorrect information, patient selection differences between hospitals, case-mix differences and tertiary transfer of complicated cases. Other case-mix factors can be accounted for only with more detailed collection of clinical data such as POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scores. However, there remains considerable and worrying variation in selection and outcomes of patients undergoing aortic surgery.

Ways of coping and the health of relatives facing drug and alcohol problems in Mexico and England

AIMS

To compare two contrasting socio-cultural groups in terms of parameters relating to the stress - coping - health model of alcohol, drugs and the family, and to test hypotheses derived from the model in each of the two groups separately.

DESIGN

Cross-sectional, comparative and correlational, using standard questionnaire data, supplemented by qualitative interview data to illuminate the findings.

PARTICIPANTS

One hundred close relatives, mainly partners or parents, from separate families in Mexico City, and 100 from South West England. Data sources. Coping Questionnaire (CQ), Family Environment Scale (FES), Symptom Rating Test (SRT), Semi-structured interview.

FINDINGS

Mean symptom scores were high in both groups, and not significantly different. The hypothesis that relatives in Mexico City, a more collectivist culture, would show more tolerant - inactive coping was not supported, but there was support for the prediction that relatives in South West England would show more withdrawal coping. This result may be as much due to differences in poverty and social conditions as to differences in individualism - collectivism. As predicted by the stress - coping - health model, tolerant - inactive coping was correlated with symptoms, in both groups, after controlling for family conflict, but there was only limited support for a moderating role of coping. Wives of men with alcohol problems in Mexico City, and wives of men with other drug problems in South West England, reported particularly high levels of both engaged and tolerant - inactive coping.

CONCLUSIONS

Tolerant - inactive coping may be bad for relatives' health: causality may be inferred but is not yet proved. Certain groups are more at risk of coping in this way. Qualitative data help understand the nature of tolerant - inactive coping and why it occurs despite the view of relatives themselves that it is counter-productive.

Effects of peer victimization in schools and perceived social support on adolescent well-being

It has been suggested that the mental health of schoolchildren can be undermined by repeated bullying at school and further exacerbated by having inadequate social support. To evaluate this claim, the General Health Questionnaire (GHQ) was administered anonymously to 845 adolescent schoolchildren attending coeducational secondary schools in South Australia, together with measures of the extent to which each reported being bullied at school and the social support available to them. Multiple regression analyses indicated that for both sexes frequent peer victimization and low social support contributed significantly and independently to relatively poor mental health.

The use of a proforma improves colorectal cancer pathology reporting

The detail and accuracy of pathological reporting for colorectal cancer is becoming increasingly recognised as important in the overall management of the patient. However, there is criticism of the variable standards of reporting. We assessed how the use of a proforma affected the completeness of reporting within one hospital. Data on all colorectal cancer patients attending one teaching hospital has been collected prospectively over a 15 month period from 1997 to 1998. The Royal College of Surgeons/Association of Coloproctology proforma lists all items considered to be essential for a complete pathological report of colorectal cancer. Its introduction in September 1997 allowed us to compare reporting before the proforma to that after. Of 54 patients, 46 (85%) had one or more items missing from their report before introduction of the proforma compared with only 8/44 (18%) patients after the proforma (P < 0.001). Circumferential resection margins and apical node status were the items most often absent, being significantly more frequently reported after the proforma (P < 0.05 and P < 0.001, respectively). There was no difference in the median number of lymph nodes harvested after proforma introduction. The introduction of the proforma has not only resulted in improvements in reporting, but has increased the dialogue between surgical oncologists and pathologists. These features should result in improved overall management of the colorectal cancer patient.

Countering bullying at an australian secondary school with students as helpers

To counter bullying at an Australian coeducational secondary school, staff and students co-operated in developing and implementing appropriate policies and procedures. Questionnaires assessing the incidence of bullying and related attitudes were completed by students in Years 7, 9, 10 and 11 in 1995 and again in 1997. Significant reductions in levels of victimization were recorded for Year 7 students only. Significantly increased support for anti-bullying initiatives was found among senior students (Years 10 and 11). Anti-bullying activities directed and undertaken by students themselves received most approval from peers.

Suicidal ideation among adolescent school children, involvement in bully-victim problems, and perceived social support

Relationships among suicidal ideation, involvement in bully-victim problems at school, and perceived social support were investigated with samples of adolescent students (N = 1103 and N = 845) attending secondary school in South Australia. Results obtained from self-reports and peer nomination procedures to identify bullies and victims indicated that involvement in bully-victim problems at school, especially for students with relatively little social support, was significantly related to degree of suicidal ideation.

Towards the safer use of warfarin II: results of a workshop

The use of oral anticoagulation therapy (ACT) is expanding. Due to the combination of the narrow therapeutic range and relatively unpredictable pharmacokinetics and pharmacodynamics, there are relatively high risks involved in using this treatment. The purpose of this paper is to present the results of a focus group's canvassing of ways to improve the management of the use of oral anticoagulants. Recommendations proposed include: (i) better patient selection; (ii) more patient involvement and research into the appropriateness of the current use of ACT in Australia; (iii) increased production, dissemination and implementation of ACT guidelines; (iv) assessment of home and practice ACT monitoring; and (v) research into the effectiveness of academic detailing and the use of management plans by dedicated ACT educators.

Adverse events in health care: setting priorities based on economic evaluation

Adverse events arising from health-care management, rather than a disease process, may place as great a burden on society as all other forms of injury put together. By analysing data from the Quality in Australian Health Care Study (a retrospective review of 14 179 medical records representative of admissions to Australian acute care hospitals in 1992), and applying costing techniques based on Diagnosis Related Group (DRG) cost weights, it is possible to compare the economic impacts of different kinds of adverse events. This can assist in determining priorities for interventions. However, due to limitations inherent in DRG cost weights, there is a need to employ further techniques to refine the costing base of adverse events so that it more closely reflects their resource use. Decisions to invest resources in strategies that reduce the risk of adverse events can then be properly informed by economic data.

Peer victimisation at school and the health of secondary school students

BACKGROUND

Although previous studies have indicated that children who are frequently bullied by peers at school have below average health, both the generalisability of such findings across age groups and how they can be best explained have remained unclear.

AIMS

(i) To examine whether reported peer victimisation is related to current levels of physical and mental health among early and late secondary school students and (ii) to determine whether degree of reported victimisation in early years of secondary schooling can predict the health status of students when they are in senior class.

SAMPLE

Students were selected from those attending the first two years of schooling at a South Australian high school in 1994 (N = 276) and the last two years in 1997 (N = 126). These included a subsample (N = 78) who were assessed at school at both times.

METHOD

Students completed questions which included measures of degree of peer victimisation and mental and physical health.

RESULTS

For the total sample assessed in 1994, but not that of 1997, reported victimisation was significantly correlated with relatively poor physical and mental health. For the re-tested subsample, high levels of peer victimisation in the pre-testing predicted poor physical health for both sexes and poor mental health in girls.

CONCLUSION

Relatively poor health was characteristic of students reporting frequent victimisation by peers in early secondary schooling and also of senior students who reported being bullied frequently three years earlier, suggesting a causal connection.

Tolerate, engage or withdraw: a study of the structure of families coping with alcohol and drug problems in south west England and Mexico City

AIMS

To explore the structure underlying individual differences in the ways family members cope with drinking or drug problems.

DESIGN

Cross-sectional interview and questionnaire study of a series of family members in two contrasting socio-cultural groups.

SETTING

Mexico City and South West England.

PARTICIPANTS

Two hundred and seven family members from separate families, three-quarters women, one-quarter men, mostly partners or parents.

DATA

Long semi-structured interviews; the Coping Questionnaire (CQ).

FINDINGS

Factor and subscale analyses of the CQ data and textual analysis of the interview reports were used to test the hypothesis that the underlying structure to coping could be described in terms of eight or nine coherent and distinct ways of coping. Neither form of analysis gave strong support to this hypothesis.

CONCLUSIONS

It is concluded that the structure of coping can best be described in terms of three broad coping positions: tolerating, engaging and withdrawing. These conclusions challenge some previous assumptions about functional and dysfunctional ways of coping with excessive appetitive behaviour in the family.

Cooperativeness and bully/victim problems among Australian schoolchildren

The relationship was examined between the self-reported cooperativeness of Australian secondary-school students and their involvement in peer abuse at school, both as bullies and as victims. An 18-item Likert-type measure, the Cooperativeness Scale, was developed, and its reliability and concurrent validity were supported by the results of its application to two samples of Australian students (N = 176 and N = 763, respectively) attending different coeducational secondary schools, the first in a predominantly middle-class area and the second in a lower class socioeconomic area. At both schools, girls scored higher in cooperativeness than boys. Students at the second school also anonymously completed multiple measures of the extent of their involvement during the current year in bullying, victimization, or both. As predicted, correlations and multiple regression analyses supported the hypothesis that relatively low levels of cooperativeness were characteristic, not only of both boys and girls who engaged in bullying, but also, to a lesser extent, of those who were frequently victimized by their peers at school.

Can resource use be extracted from randomized controlled trials to calculate costs? A review of smoking cessation interventions in general practice

The ability to extract information on resource use from randomized controlled trials can provide the groundwork for systematically compiling health economic reviews of health interventions. A review of the brief smoking interventions in general practice demonstrates that not all the necessary information can be extrapolated from these trials, and cost data will have to be supplemented from other sources.

School children's perceptions of their families and parents as a function of peer relations

Links were examined between three dimensions of peer relating at school among Australian children and selected family and parental background factors. Questionnaires containing measures of children's tendencies to bully others, to be victimized, and to act in a prosocial manner were administered to boys and girls (N = 1,012) aged 11 to 16 years. In addition, subjects completed a standardized 42-item measure of family functioning and reliable scales assessing attitudes toward, and relationships with, their mother and father. When differences in age were controlled for, multiple regression results for both boys and girls indicated that the tendency to bully peers and the tendency to act prosocially were independently predictive of family functioning and attitudes toward, and relationships with, each parent, negatively for bullying and positively for prosocial behavior. The tendency to be victimized by peers at school among girls was found to be associated with poorer family functioning and more negative attitudes toward mothers; negative relations with absent fathers in single-parent families characterized boys who reported being victimized at school.

The families of problem drug users: a study of 50 close relatives

The research described in this paper resulted from a collaborative multi-centre study of the relatives of problem drug users involving six practitioners and researchers, in four centres within the south-west of England. The objective of this research was simply to interview 50 close relatives of identified problem drug users, with the identification occurring through clinics and self-help groups. Quantitative and qualitative results show that large numbers of these relatives reported many negative experiences. The partners of illicit drug users reported both more and differently patterned problematic behaviours than those of prescribed tranquillizer users. The partners of illicit users also reported different problems to those of the parents. Relatives reported many negative effects in terms of how they viewed the drug user, and how the experiences had affected their health. They also described various coping mechanisms, and the extent of the support which they had received. The results are discussed in terms of coping, and similarity with research into the families of problem drinkers.

Dimensions of interpersonal relation among Australian children and implications for psychological well-being

Three dimensions of interpersonal relations among Australian school children were hypothesized as reflecting tendencies (a) to bully others, (b) to be victimized by others, and (c) to relate to others in a prosocial and cooperative manner. School children from two secondary schools (School A, n = 285; School B, n = 877) answered 20 questions assessing styles of interpersonal relations. Factor analyses of the item scores obtained from each of the two schools provided highly similar results, supporting the factorial independence of the three hypothesized dimensions. Students attending School B answered additional questions to assess self-esteem, level of happiness, and liking for school. Generally low levels of self-esteem were found among children who reported being more victimized than others, and high self-esteem among children practicing more prosocial behavior. The tendency to bully others was correlated negatively with happiness and liking school, but no relationship was found between this variable and self-esteem.

Australian school children's self appraisal of interpersonal relations: the bullying experience

The extent and nature of bullying among South Australian primary school children and their self appraisals of peer relations were investigated in a survey of 412 primary school children between the ages of 7 to 13 years. It was found that 10% of boys and 6% of girls were subject to peer group bullying and for 8% of such children the bullying episodes lasted 6 months or more. Factor analysis of styles of interpersonal relating amongst children identified three independent factors including a tendency to bully, to be victimized and to act in a pro-social manner. The tendency to be victimized correlated negatively with self appraisals of the number of friends, popularity, happiness at school and feelings of safety at school. The findings are discussed in relation to research linking negative self appraisals of interpersonal competence with isolation and proneness to depression in later years.

Assessing community attitudes toward medical practitioner authority

Despite the widespread belief that medical authority is under increasing challenge, no adequate research instrument has been available to measure relevant community attitudes. This paper reports the development of the Attitude Toward Medical Practitioners Scale (the AMPS). Samples of Australians (in total N > 1000) completed the AMPS, using three different procedures. The reliability of the scale, assessed by coefficient alpha, ranged from 0.80 to 0.86. A principal component analysis of the AMPS yielded loadings on each item exceeding 0.3 on the first unrotated factor; subsequent varimax rotation revealed dimensions associated with critical attitudes to doctors and evaluations of doctors' interpersonal competence and technical expertise. Positive and significant correlations between the AMPS and one measure of the General Attitude toward Institutional Authority (GAIAS) strongly suggested that the scale is consistent with generalised evaluations of community authorities. The specific validity of the AMPS was supported for each of three samples, using as validating criteria respondent ratins of the last doctor visited, satisfaction with the consultation and reported compliance with the doctor's advice. Significant improvements were found in the prediction of each of these criteria by the addition of the AMPS to contributions made by the GAIAS and the demographic variables, age and sex. The AMPS is an appropriate measure for assessing community attitudes towards medical practitioners conceived as institutional authorities, at least in the Australian context.

Impulsiveness, attitude to authority, and gender

This article examined the relationship between impulsiveness and attitudes toward institutional authority among Australian secondary school students. Reliable questionnaire measures of these constructs were completed by 48 boys and 57 girls, about 14 years of age. Correlations between impulsiveness and attitude to authority differed between the sexes, with a significant negative correlation of -.43 being obtained for boys only.

Occupational role and perceptions of substance misuse in Australia

This study examined ways in which people from different occupational backgrounds in South Australia perceived issues relevant to the misuse of substances. Questionnaires were completed by representatives from eight occupational groups, namely, Doctors, Nurses, Ambulance Officers, Social Workers, Youth Workers, Teachers, the Police, and Probation and Parole Officers (in total, N = 276). Significant differences were found between occupational groups in their judgments of the relative incidence of substance misuse in the community, the comparative harmfulness of alcohol and marijuana, the attribution of alcohol misuse to personal inadequacy, and the efficacy of treatment of alcohol misuse.

Bullying among Australian school children: reported behavior and attitudes toward victims

The extent of bullying among Australian school children and attitudes toward victims of bullying were investigated in a survey of Australian school children between the ages of 6 and 16 years (n = 685) and their teachers (n = 32). Approximately 1 child in 10 was subjected to peer group bullying. Boys reported being bullied more often than girls, who tended to be more supportive of victims. With increasing age, there was a slight but significant decline in reported bullying; notably, however, attitudes toward victims became less supportive. Attitudes toward victims were examined in detail by using a reliable and validated 20-item Likert scale. Factor analyses of the children's responses yielded three interpretable factors: a tendency to despise the victims of bullies; general admiration for school bullies; and avowed support for intervention to assist the victim. An understanding of such attitudes is desirable for designing effective intervention programs.

Psychological change during residence in a rehabilitation centre for female drug misusers. Part I. Drug misusers

Fifty consecutive entrants to a year-long Christian residential rehabilitation programme for female drug misusers received a comprehensive psychological assessment on intake, 3 and 6 months later, and at completion of the programme. Significant changes were seen in emotional state, self-esteem, personality and attitudes to Christianity. Most of the changes occurred during the first 3 months, but changes in personality continued throughout the period of residence. The 11 women who completed the programme differed significantly from the others on their characteristics at intake; the 26 who dropped out during the first 3 months differed significantly from those who dropped out after that time. In both cases, the differences were at a clinically significant level. The importance of matching drug users to rehabilitation centres is discussed.

Psychological change during residence in a rehabilitation centre for female drug misusers. Part II. Children of drug misusers

This study examined psychological changes in children of female drug misusers who were living with their mothers in a residential rehabilitation centre. The results suggest that the childrens' behaviour and cognitive skills were not adversely affected, and that there were many benefits for drug addicted mothers retaining custody of their children whilst undergoing a rehabilitation programme. The implications of the possible detrimental effects of a mother failing to complete her rehabilitation programme on her children are discussed.

The effect of a national campaign on attitudes toward AIDS

Following a national campaign in Australia which had shown no change in level of knowledge about AIDS (using random samples of the population over 16 years, before and 5 months after the campaign), we assessed the change of attitudes towards, and beliefs about AIDS in the same samples. Results indicated that there were changes in beliefs about how much is known about the transmission of HIV, and that people were less concerned about casual transmission. Those respondents reportedly influenced most by the campaign were those with greater fear of diseases and death. We conclude that media campaigns may have a significant effect on attitudes and beliefs toward AIDS even where there is no effect on level of knowledge, and that the attitudinal changes which may be promoted by such campaigns should also be considered as objectives in campaign design.