Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study.

OBJECTIVE: To investigate the effectiveness of tonsillectomy in reducing acute throat infection (ATI) consultation rates over 6 years' follow-up among children with low baseline ATI consultation rates. DESIGN: Retrospective cohort study. SETTING: UK general practices from the Clinical Practice Research Datalink. PARTICIPANTS: Children aged 4-15 years with ≤3 ATI consultations during the 3 years prior to 2001 (baseline). 450 children who underwent tonsillectomy (tonsillectomy group) and 13 442 other children with an ATI consultation (comparison group) in 2001. MAIN OUTCOME MEASURES: Mean differences in ATI consultation rates over the first 3 years' and subsequent 3 years' follow-up compared with 3 years prior to 2001 (baseline); odds of ≥3 ATI consultations at the same time points. RESULTS: Among children in the tonsillectomy group, the 3-year mean ATI consultation rate decreased from 1.31 to 0.66 over the first 3 years' follow-up and further declined to 0.60 over the subsequent 3 years' follow-up period. Compared with children who had no operation, those who underwent tonsillectomy experienced a reduction in 3-year mean ATI consultations per child of 2.5 (95% CI 2.3 to 2.6, p<0.001) over the first 3 years' follow-up, but only 1.2 (95% CI 1.0 to 1.4, p<0.001) over the subsequent 3 years' follow-up compared with baseline, respectively. This equates to a mean reduction of 3.7 ATI consultations over a 6-year period and approximates to a mean annual reduction of 0.6 ATI consultations per child, per year, over 6 years' follow-up. Children who underwent tonsillectomy were also much less likely to experience ≥3 ATI consultations during the first 3 years' follow-up (adjusted OR=0.12, 95% CI 0.08 to 0.17) and the subsequent 3 years' follow-up (adjusted OR=0.24, 95% CI 0.14 to 0.41). CONCLUSIONS: Among children with low baseline ATI rates, there was a statistically significant reduction in ATI consultation rates over 6 years' follow-up. However, the relatively modest clinical benefit needs to be weighed against the potential risks and complications associated with surgery

Nurturing the young shoots of talent: Using action research for exploration and theory building

This is an Author's Accepted Manuscript of an article published in European Early Childhood Education Research Journal, 19(4), 433-450, 2011, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/1350293X.2011.623515.This paper reports the outcomes of a set of action research projects carried out by teacher researchers in 14 local education authorities in England, working collaboratively with university tutors, over a period of three years. The common aim of all the projects was to explore practical ways of nurturing the gifts and talents of children aged four–seven years. The project was funded by the Department of Education and Skills in England as part of the government's gifted and talented programme. The project teachers felt that their understanding of issues relating to nurturing the gifts and talents of younger children was enhanced through their engagement in the project. It was possible to map the findings of the projects to the English government's National Quality Standards for gifted and talented education which include: (1) identification; (2) effective provision in the classroom; (3) enabling curriculum entitlement and choice; (4) assessment for learning; (5) engaging with community, families and beyond. The findings are also analysed within the framework of good practice in educating children in the first years of schooling. Participating practitioners felt that action research offered them a suitable methodology to explore the complexity of the topic of giftedness through cycles of planning, action and reflection and personal theory building

Production of Metallic Iron from the Pudo Magnetite Ore using End-of-Life Rubber Tyre as Reductant: The Role of an Underlying Ankerite Ore as a Fluxing Agent on Productivity

This research work investigated the nature of a nonmagnetic ore from Pudo in the Upper West Region of Ghana and its fluxing effect on the extent of reduction of the Pudo titaniferous magnetite ore using pulverised samples of charred carbonaceous materials generated from end-of-life vehicle tyres (ELT) as reductants. Reduction studies were conducted on composite pellets of the Pudo titaniferous magnetite iron ore containing fixed amounts of charred ELT and varying amounts (0%, 10%, 15%, 20%, 30%, 40% and 50%) of the nonmagnetic fluxing material in a domestic microwave oven and the extent of reduction was calculated after microwave irradiation for 40 minutes. Analyses by XRF, SEM/EDS and XRD of the nonmagnetic ore revealed an Ankerite type of ore of the form Ca0.95Fe0.95Mn0.1 (CO3)2. From the microwave reduction studies it was observed that premium grade metallic iron could be produced from appropriate blends of the Pudo iron ores using ELT as reductant, with a measured extent of reduction up to 103.8%. Further, the extent of reduction was observed to increase with an increase in the amount of the nonmagnetic fluxing material (Ankerite) that was added as fluxing agent. &nbsp; Keywords: Ankerite, End-of-life Rubber Tyres, Fluxing Agent, Extent of Reductio

Environmental Predictors of Zooplankton Biodiversity Across a Series of Polymictic Reservoirs

Zooplankton are an important part of lentic food webs because they connect photoautotrophic plankton to higher trophic levels. Past studies in 2016 and 2017 determined that zooplankton biodiversity is different across a polymictic reservoir series in Salem County NJ. In the study presented here, we confirmed a similar zooplankton biodiversity pattern in 2018 and we determine which physicochemical variables were good predictors of zooplankton biodiversity. Our results indicate that there are many physicochemical variables that are reliable predictors of zooplankton biodiversity across this polymictic reservoir series. Additional predictor variables are being developed to help us understand which environmental variables are most influential on zooplankton biodiversity and the influence of human land-use

Evaluating the named nurse understanding of recovery in forensic mental health

This article describes a service evaluation carried out on a personality disorder admission ward in a high-secure hospital to evaluate nurses understanding of recovery approaches in mental health. The study used semi-structured questionnaires to determine the participant’s understanding of recovery. The findings highlight that further development is required in staff training and education on recovery. Theories underpinning recovery principles also need to be disseminated to help nurses understand the relevance of current policy developments, and thus improve care

Changing indications and socio-demographic determinants of (adeno)tonsillectomy among children in England--are they linked? A retrospective analysis of hospital data.

OBJECTIVE: To assess whether increased awareness and diagnosis of obstructive sleep apnoea syndrome (OSAS) and national guidance on tonsillectomy for recurrent tonsillitis have influenced the socio-demographic profile of children who underwent tonsillectomy over the last decade. METHOD: Retrospective time-trends study of Hospital Episodes Statistics data. We examined the age, sex and deprivation level, alongside OSAS diagnoses, among children aged <16 years who underwent (adeno)tonsillectomy in England between 2001/2 and 2011/12. RESULTS: Among children aged <16 years, there were 29,697 and 27,732 (adeno)tonsillectomies performed in 2001/2 and 2011/12, respectively. The median age at (adeno)tonsillectomy decreased from 7 (IQR: 5-11) to 5 (IQR: 4-9) years over the decade. (Adeno)tonsillectomy rates among children aged 4-15 years decreased by 14% from 350 (95%CI: 346-354) in 2001/2 to 300 (95%CI: 296-303) per 100,000 children in 2011/12. However, (adeno)tonsillectomy rates among children aged <4 years increased by 58% from 135 (95%CI: 131-140) to 213 (95%CI 208-219) per 100,000 children in 2001/2 and 2011/2, respectively. OSAS diagnoses among children aged <4 years who underwent surgery increased from 18% to 39% between these study years and the proportion of children aged <4 years with OSAS from the most deprived areas increased from 5% to 12%, respectively. CONCLUSIONS: (Adeno)tonsillectomy rates declined among children aged 4-15 years, which reflects national guidelines recommending the restriction of the operation to children with more severe recurrent throat infections. However, (adeno)tonsillectomy rates among pre-school children substantially increased over the past decade and one in five children undergoing the operation was aged <4 years in 2011/12.The increase in surgery rates in younger children is likely to have been driven by increased awareness and detection of OSAS, particularly among children from the most deprived areas