Camborne Redruth Community Hospital

Non-motor symptoms (NMS) in Parkinson's disease (PD) are common, significantly reduce quality of life and at present there is no validated clinical tool to assess the progress or potential response to treatment of NMS. A new 30-item scale for the assessment of NMS in PD (NMSS) was developed. NMSS contains nine dimensions: cardiovascular, sleep/fatigue, mood/cognition, perceptual problems, attention/memory, gastrointestinal, urinary, sexual function, and miscellany. The metric attributes of this instrument were analyzed. Data from 242 patients mean age 67.2 +/- 11 years, duration of disease 6.4 +/- 6 years, and 57.3% male across all stages of PD were collected from the centers in Europe, USA, and Japan. The mean NMSS score was 56.5 +/- 40.7, (range: 0-243) and only one declared no NMS. The scale provided 99.2% complete data for the analysis with the total score being free of floor and ceiling effect. Satisfactory scaling assumptions (multitrait scaling success rate >95% for all domains except miscellany) and internal consistency were reported for most of the domains (mean alpha, 0.61). Factor analysis supported the a prori nine domain structure (63% of the variance) while a small test-retest study showed satisfactory reproducibility (ICC > 0.80) for all domains except cardiovascular (ICC = 0.45). In terms of validity, the scale showed modest association with indicators of motor symptom severity and disease progression but a high correlation with other measures of NMS (NMSQuest) and health-related quality of life measure (PDQ-8) (both, rS = 0.70). In conclusion, NMSS can be used to assess the frequency and severity of NMS in PD patients across all stages in conjunction with the recently validated non-motor questionnaire.

Abstract Throughout the developing world, river sand and gravel is widely exploited as aggregate for construction. Sediment is often mined directly from the river channel and makes an important contribution to the national demand for aggregates. However, instream mining, if not carefully controlled, can cause significant damage to the river and its associated biota, and to the adjacent land, as well as creating conflict with other users of the river. The economic and environmental geology of river sand and gravel mining in developing countries is poorly known and there is little knowledge available to inform existing regulatory strategies. Research work on selected river systems in Jamaica and Costa Rica has generated a considerable amount of new information on resources and sediment budgets, on market and supply options, on the physical, biological and social impacts of extraction, and on best-practice legislative and mineral planning issues. A methodology has been developed for effective control of instream sand and gravel mining operations including a Code of Practice, which regulators can use for examining and reconciling the conflicting claims of sand and gravel extraction and the environment.

Though substantial coal-washing activities are carried out in a tropical climate, in the 70-yr history of coal flotation, the effect of diurnal and seasonal variations in temperature as an operational variable has received only limited attention. This review examines the current knowledge on the effect of temperature on coal flotation performance and finds that coals with strong natural hydrophobicity do not seem to be affected by a variation in pulp temperature. Difficult-to-float coals, however, appear to float well within a temperature range of 20–35°C with considerable improvement in all flotation indices, concentrate yield and ash, recovery of combustibles, flotation rate, and tailing ash as compared to their values at higher or lower temperature.

Three studies were performed using a fast dissolving formulation of selegiline hydrochloride designed for buccal absorption "Zydis Selegiline". The aim of the first study was to compare the therapeutic efficacy of Zydis Selegiline (1.25 mg or 10 mg) with conventional selegiline hydrochloride tablets "conventional selegiline tablets" (10 mg) in patients with Parkinson's disease (PD) who were previously treated with conventional selegiline tablets as an adjunct to levodopa/dopamine agonist therapy. Patients were observed for 4 weeks to ensure that they were stable. Stable patients (n=197) were then randomised to continue with conventional selegiline tablets 10 mg (n=68), or to treatment with Zydis Selegiline 1.25 mg (n=64) or Zydis Selegiline 10 mg (n=62) for 12 weeks in this randomised, parallel group study. A further aim was to establish the acceptability of Zydis Selegiline compared with conventional selegiline tablets. Patient preference for Zydis Selegiline was also evaluated in a second study, a single-dose, randomised, two-way crossover study conducted in patients with PD (n=148). Patients were stratified by the presence or absence of swallowing and salivation problems and were randomised to either Zydis Selegiline 5 mg or a placebo fast-dissolving formulation. In a third study, the degree of potentiation of the tyramine pressor effect following Zydis Selegiline was compared with that following conventional selegiline tablets in healthy volunteers. A total of 24 healthy volunteers were randomised to receive Zydis Selegiline 1.25 mg or conventional selegiline tablets 10 mg for 14-16 days in an open-label, randomised parallel group study. Both Zydis Selegiline (1.25 mg and 10 mg) treatments were shown to be therapeutically equivalent to conventional selegiline tablets 10 mg based on comparison of mean total Unified Parkinson's Disease Rating Scale (UPDRS) scores. Therapeutic equivalence was defined a priori as the 90% confidence interval (CI) for the difference in total UPDRS scores between groups to lie entirely within the range +/-5. The difference (90% CI) in mean adjusted total UPDRS between Zydis Selegiline 1.25 mg and conventional selegiline tablets 10 mg was -2.50 (-4.84, -0.17), and for Zydis Selegiline 10 mg and conventional selegiline tablets 10 mg, 0.04 (-2.30, 2.38). For the motor subscores of the UPDRS, differences between adjusted means (90% CI) compared with the conventional selegiline tablets group were: Zydis Selegiline 1.25 mg, -2.14 (-3.94, -0.33) and Zydis Selegiline 10 mg, -0.90 (-2.70, +0.91). Patients who switched from conventional selegiline tablets to Zydis Selegiline 1.25 mg showed a slight improvement in UPDRS scores following 12 weeks of treatment (standard error of difference 1.039; p=0.01). In the single-dose crossover study, most (61%) patients liked Zydis Selegiline 5 mg; a significantly greater proportion than the null hypothesis of 50% (p<0.002). However, only 62 patients (46%) indicated that they liked the taste of Zydis Selegiline. Nevertheless, the proportion of patients who preferred Zydis Selegiline (65%) to their usual medication was significantly greater than the null hypothesis of 50% (p<0.001). Similar findings were demonstrated in the 12-week study where a higher proportion of patients who received up to 3 months of treatment indicated a preference for either Zydis Selegiline 1.25 mg (90%) or Zydis Selegiline 10 mg (86%) over conventional selegiline tablets 10 mg. More than 90% of patients found Zydis Selegiline easy to take, with 61% rating it as extremely easy. Most (81%) patients taking Zydis Selegiline 1.25 mg liked the taste compared with 45% taking Zydis Selegiline 5 mg (in the previous study). Zydis Selegiline did not potentiate the tyramine effect: a pressor effect was elicited after 400 mg tyramine both before and after 14 days of treatment with Zydis Selegiline 1.25 mg. In contrast, after 14 days treatment with conventional selegiline tablets 10 mg, the threshold dose required to elicit the tyramine pressor response was significantly (p<0.0001) reduced from 400 mg to 200 mg. In summary, Zydis Selegiline at doses of 1.25 mg and 10 mg was therapeutically equivalent to conventional selegiline tablets 10 mg. The Zydis Selegiline formulation was well-liked by all patients, with most preferring Zydis Selegiline 1.25 mg to their usual selegiline tablet. Furthermore, Zydis Selegiline was well tolerated and, unlike conventional selegiline tablets, appeared to retain specificity for inhibition of monoamine oxidase type B (MAO-B), since it did not potentiate the pressor response to tyramine.

Parkinson's disease affects one in every 100 people over the age of 60 and one in ten nursing home residents. This article explores common problems associated with the disease and implications for nurses working with patients who display symptoms.

We report the development of a novel ceramic, made from recycled soda lime glass, which has an unusual microstructure and an interesting combination of properties. It is made by a process which is simple and robust; the glass is powdered, blended with a minor proportion of Ca(OH)2, compacted in a die and cured in saturated steam at ∼100 ◦C. Sophisticated equipment is not needed, and energy requirements are low. We discuss potential applications, and propose the name casamic for this novel calcium, silica ceramic. Green glass bottles were crushed, dry-milled and dry-screened at 150 μm. The particle size distribution (psd) of the product was measured using a Malvern Mastersizer to be 94 mass% <100 μm, 33% <10 μm, 1% <1 μm. The surface area was 0.73 m2 g−1 (BET nitrogen). In a typical synthesis, 100 parts by mass of glass powder was thoroughly mixed with 7–10 parts of commercial grade Ca(OH)2, using a mortar and pastle. Ten parts of water were mixed in at high shear, and the damp powder sifted at 1.4 mm. Portions were placed in cylindrical dies and pressed uniaxially over the range 0.1–200 MPa. The disc of compacted powder was removed from the die and cured in saturated steam within the temperature range 80◦–135 ◦C. After curing, the ceramic (casamic) was allowed to equilibrate in the atmosphere for at least 2 days, before testing. A similar curing procedure has been used [1] to investigate mixtures of Ca(OH)2 and natural pozzolanas. Bending strengths were measured by the “ball-on-ring” method, using a model CK 10 instrument from Engineering Systems, UK. A ceramic disc, 32 mm diameter and 3–10 mm thick, was supported on a ball race, 26 mm diameter, and a 5 mm diameter steel ball was pressed with increasing force into the center of the disc until it fractured. Bending strengths were calculated from the force of fracture using the formula of de With [2], and assuming a value of 0.3 for the Poisson ratio. Figs 1 and 2 show that bending strength increases with compaction pressure, curing temperature and curing time. Other experiments, not reported here, showed that bending strength is relatively insensitive to the type of soda lime glass, the psd of the glass powder, or the relative proportions of glass, Ca(OH)2 and water. It was convenient to adopt a standard procedure of compacting at 50 or 200 MPa and curing at 115 ◦C for 3 h. This resulted in bending strengths of 15–19 MPa and 23–30 MPa for the two compaction pressures respectively. It is instructive to compare these values with the bending strengths of related construction materials (Table I), which were measured using discs of similar TABLE I Bending strengths of casamic and related materials. Earthenware discs were cut from commercial wall tiles. Samples of porcelain were prepared in the laboratory from commercial formulations

The risk from coast erosion to a shaft containing nuclear waste at Dounreay, Caithness is assessed. The physical setting of the shaft, data on the rates of erosion in the Devonian Flagstones and the drift capping of the local cliffs and future influences on erosion rates and flooding are summarized. A two-layer model of superficials and flagstones is used to address the immediate concern of lateral erosion towards the shaft. Superficials’ erosion is assessed from a comparison of successive cliff surveys. Flagstones’ erosion proceeds chiefly by the deepening of slots in the weaker interbeds, with associated cantilever failures and block removal through wave action. The rate of slot development is estimated from the growth rate of tafoni within them. Whether erosion proceeds by superficials’ or flagstones’ erosion alone or in combination depends on the level of rockhead in the cliffs in relation to tide and wave levels. These threshold rockhead levels vary with the morphology and degree of exposure of the cliffs. They will also rise with time relative to Ordnance Datum in response to the general rise in sea level. Estimates of the periods remaining before the shaft is exposed by coast erosion are made through the above model, both planimetrically and sectionally. They range from about 160 to over 240 years. Flooding by the sea is likely to commence about 400 years hence. The UKAEA plans to remove the nuclear waste from the shaft within the next two decades, well before the above factors would have an impact.

Tony Lingard, Head of Learning Support, Camborne School and Community College, Cornwall, questions whether the National Literacy Strategy is raising the achievement of lower attainers and suggests adaptations, based on his own Literacy Acceleration programme, which he argues could make the Strategy far more effective.