Diffuse oesophageal spasm and related disorders.

A significant proportion of patients with non cardiac chest pain and/or dysphagia may have diffuse oesophageal spasm. Conventional techniques of endoscopy and barium studies had a low diagnostic yield for oesophageal motility disorders. Baseline oesophageal manometry using intraoesophageal microtransducers (Gaeltec) diagnosed diffuse oesophageal spasm in 66% of the patients. In view of the intermittent nature of the symptoms, provocative testing during manometry with a Bernstein acid perfusion test and edrophonium injection was used to increase the diagnostic accuracy. The edrophonium provocation test increased diagnostic yield by 34%. Treatment was initially conservative and if this failed then balloon dilatation of the oesophagus was performed. Balloon dilatation relieved symptoms but reduced lower oesophageal sphincter pressure. Success was obtained in the absence of pathological reflux. Dilatation did not result in increased gastro-oesophageal reflux. Many patients with the globus symptom have organic disease accounting for their symptoms. Spasm of the upper oesophageal sphincter secondary to gastro-oesophageal reflux and motility disorders of the oesophageal body have been postulated as causes for the globus sensation. Using the microtransducer system, it was possible to examine the upper oesophageal sphincter with greater accuracy. Patients with the globus symptom as a presenting symptom and normal pan­ endoscopy were investigated with cine-barium, oesophageal manometry and ambulatory pH recording to assess oesophageal motility and reflux. The upper oesophageal sphincter complex was examined but all features, including coordination, were normal. An association between globus and gastro-oesophageal reflux has been demonstrated. No link could be shown between acid perfusion and upper oesophageal sphincter dysfunction. When compared to controls, the globus patients did not have increased psychological abnormality on two psychometry questionnaires. This suggests that the basis for globus may be related to a sensory abnormality in the pharynx in relation to reflux disease

Manipulatives and multiplicative thinking

This small study sought to determine students’ knowledge of multiplication and division and whether they are able to use sets of bundling sticks to demonstrate their knowledge. Manipulatives are widely used in primary and some middle school classrooms, and can assist children to connect multiplicative concepts to physical representations. Qualitative data were generated from semi-structured interviews with 32 primary and middle school children aged nine to eleven years. Participants were asked to work out the answer to multiplication and division examples and explain their thinking using bundling sticks. Results suggest that the majority of participant students may have a limited knowledge of aspects of the multiplication process and even less knowledge of the division process. The study also identified that many of the students appeared uncomfortable and/or unfamiliar with using bundling sticks and a number of them had difficulty in using bundling sticks to explain the multiplication and division processes. We conclude that manipulatives such as bundling sticks do not magically lead children to mathematical learning but are sufficiently powerful to warrant teachers familiarising themselves with how manipulatives can be used to develop conceptual understanding

Breast cancer awareness among older women

The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67–73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women

The Mechanism of Oxide Ion Conductivity in Bismuth Rhenium Oxide, Bi28Re2O49

We have carried out a combined experimental and computational study of oxide ion conductor Bi28Re2O49, with the aim of elucidating the conductivity mechanisms and pathways in this material. Single crystals of Bi28Re2O49 were grown from melt and the structure was investigated for the first time by single crystal X-ray diffraction. The structural model obtained is consistent with the Re atoms in Bi28Re2O49 being both four- and six-coordinate, in a 3:1 ratio, in agreement with previous EXAFS and IR spectroscopy studies. The thermal displacement parameters of the oxygen atoms bonded to Re suggest substantial disorder of the Re coordination polyhedra. Ab-initio molecular dynamics simulations were performed to probe the oxide ion migration pathways in Bi28Re2O49 and the roles of the Bisingle bondO and Resingle bondO sublattices. The key conclusion is that the ability of Re to support variable coordination environments is vitally important in Bi28Re2O49; it provides a mechanism for ‘self-doping’ of the structure, i.e. the creation of O2 − vacancies in the fluorite-like Bisingle bondO sublattice by exchange of O atoms with the Resingle bondO sublattice, and the subsequent increase of the average coordination number of Re. All three crystallographically unique oxygen sites in the Bisingle bondO sublattice play roles in the ionic migration processes, by facilitating the O2 − exchange between the ReOx groups and by contributing to the O2 − diffusion via the vacancy-hopping mechanisms