Attitudes towards ideal family size of different ethnic/nationality groups in Great Britain, France and Germany.

This article reports upon results from a European Union funded project on the integration of children of international migrants in Britain, France and Germany. It provides both a descriptive and a multivariate analysis of the factors that determine attitudes towards ideal family size. The results reveal that there are large differences between ethnic groups in Britain: Indian and Pakistani respondents in Britain expressed a preference for significantly larger families. However, many children of international migrants expressed a desire for smaller families than the autochthonous population in both countries. This was particularly the case for Portuguese respondents in France and Turks in Germany. Religious affiliation also had a significant effect, above and beyond ethnicity per se. Both Moslems and Christians preferred larger families than those with no religious affiliation. The article concludes that ethnic differences in attitudes towards fertility behaviour will remain important in the foreseeable future in western Europe, particularly in Britain.

Histopathologists’ approach to keratoacanthoma: a multisite survey of regional variation in Great Britain and Ireland

Introduction: This survey examines regional variation in the diagnosis of keratoacanthoma (KA).

Methods: Twenty-three departments from Great Britain and Ireland were invited. The number of cases coded as KA or cutaneous SCC in the previous 12 months was retrieved. An SCC: KA ratio was calculated. Participants also provided free text responses.

Results: Seventeen departments replied. A total of 11 718 cases were included with a breakdown of 998 KA and 10 720 SCC. The mean SCC:KA ratio was 10.7:1, range (2.5:1 to 139:1). Free text responses are presented.

Discussions: An extreme variation in approach is highlighted by this survey. We believe a multidisciplinary team approach to the diagnosis of KA is essential. There seems to be a need for a carefully considered clinicopathological study, backed up by molecular studies, to better understand the natural biology of this diagnosis.

Drivers of inequality in disability-free expectancy at birth and age 85 across space and time in Great Britain

Background: Although mortality and health inequalities at birth have increased both geographically and in socioeconomic terms, little is known about inequalities at age 85, the fastest growing sector of the population in Great Britain (GB).

Aim: To determine whether trends and drivers of inequalities in life expectancy (LE) and disability-free life expectancy (DFLE) at age 85 between 1991 and 2001 are the same as those at birth.

Methods: DFLE at birth and age 85 for 1991 and 2001 by gender were calculated for each local authority in GB using the Sullivan method. Regression modelling was used to identify area characteristics (rurality, deprivation, social class composition, ethnicity, unemployment, retirement migration) that could explain inequalities in LE and DFLE.

Results: Similar to values at birth, LE and DFLE at age 85 both increased between 1991 and 2001 (though DFLE increased less than LE) and gaps across local areas widened (and more for DFLE than LE). The significantly greater increases in LE and DFLE at birth for less-deprived compared with more-deprived areas were still partly present at age 85. Considering all factors, inequalities in DFLE at birth were largely driven by social class composition and unemployment rate, but these associations appear to be less influential at age 85.

Conclusions: Inequalities between areas in LE and DFLE at birth and age 85 have increased over time though factors explaining inequalities at birth (mainly social class and unemployment rates) appear less important for inequalities at age 85.

PREDICTING THE SPATIAL-DISTRIBUTION OF CLIMATE - TEMPERATURE IN GREAT-BRITAIN

1. The prediction and mapping of climate in areas between climate stations is of increasing importance in ecology.

2. Four categories of model, simple interpolation, thin plate splines, multiple linear regression and mixed spline-regression, were tested for their ability to predict the spatial distribution of temperature on the British mainland. The models were tested by external cross-verification.

3. The British distribution of mean daily temperature was predicted with the greatest accuracy by using a mixed model: a thin plate spline fitted to the surface of the country, after correction of the data by a selection from 16 independent topographical variables (such as altitude, distance from the sea, slope and topographic roughness), chosen by multiple regression from a digital terrain model (DTM) of the country.

4. The next most accurate method was a pure multiple regression model using the DTM. Both regression and thin plate spline models based on a few variables (latitude, longitude and altitude) only were comparatively unsatisfactory, but some rather simple methods of surface interpolation (such as bilinear interpolation after correction to sea level) gave moderately satisfactory results. Differences between the methods seemed to be dependent largely on their ability to model the effect of the sea on land temperatures.

5. Prediction of temperature by the best methods was greater than 95% accurate in all months of the year, as shown by the correlation between the predicted and actual values. The predicted temperatures were calculated at real altitudes, not subject to sea-level correction.

6. A minimum of just over 30 temperature recording stations would generate a satisfactory surface, provided the stations were well spaced.

7. Maps of mean daily temperature, using the best overall methods are provided; further important variables, such as continentality and length of growing season, were also mapped. Many of these are believed to be the first detailed representations at real altitude.

8. The interpolated monthly temperature surfaces are available on disk.

Fasciola hepatica from naturally infected sheep and cattle in Great Britain are diploid

Diploid (2n = 2x = 20) and triploid (2n = 3x = 30) Fasciola hepatica have been reported in the UK, and in Asia diploid, triploid and mixoploid (2x/3x) Fasciola spp. exist but there is little information to indicate how common triploidy is, particularly in UK fluke. Here the ploidy of 565 adult F. hepatica from 66 naturally infected British sheep and 150 adult F. hepatica from 35 naturally infected British cattle was determined. All 715 of these parasites were diploid, based on observation of 10 bivalent chromosomes and sperm (n = 335) or, since triploids are aspermic, sperm alone (n = 380). This constitutes the first extensive analysis of the ploidy of F. hepatica field isolates from Great Britain and shows that most F. hepatica isolated from cattle and sheep are diploid and have the capacity to sexually reproduce. These data suggest that triploidy, and by extension parthenogenesis, is rare or non-existent in wild British F. hepatica populations. Given that F. hepatica is the only species of Fasciola present in Britain our results indicate that the parasite is predominantly diploid in areas where F. hepatica exists in isolation and suggests that triploidy may only originate in natural populations where co-infection of F. hepatica and its sister species Fasciola gigantica commonly occurs.

Beyond the boundaries in the island of Ireland

The review essay opens with positive attributes of Ireland but then considers that the island has been subject to centuries of bitter dispute and unrest. The historical background to this is outlined, particularly the interactions between Ireland and its neighbouring island, Great Britain, which dominated Irish affairs. One policy adopted by the British was to encourage migration of Protestants into the largely Catholic island in the vain hope that this would reduce unrest. The
two islands were then united from 1801 as the United Kingdom of Great Britain and Ireland but demands from indigenous Irish Catholics for independence continued, resisted by the Protestant minority who wished to remain inside the UK. After the Great War a solution was imposed that granted most of Ireland independence but left the largely Protestant northeast corner within the UK as Northern Ireland. Reaction to and life with the Irish border are considered and the paper concludes with musings about its future.

Motion Management for Radical Radiotherapy in Non-small Cell Lung Cancer

Intrafraction tumour motion is an issue that is of increased interest in the era of image-guided radiotherapy. It is particularly relevant for non-small cell lung cancer, for which a number of recent developments are in use to aid with motion management in the delivery of radical radiotherapy. The ability to deliver hypofractionated ablative doses, such as in stereotactic radiotherapy, has been aided by improvements in the ability to analyse tumour motion and amend treatment delivery. In addition, accounting for tumour motion can enable dose escalation to occur by reducing the normal tissue being irradiated by virtue of a reduction in target volumes. Motion management for lung tumours incorporates five key components: imaging, breath-hold techniques, abdominal compression, respiratory tracking and respiratory gating. These will be described, together with the relevant benefits and associated complexities. Many studies have described improved dosimetric coverage and reduced normal tissue complication probability rates when using motion management techniques. Despite the widespread uptake of many of these techniques, there is a paucity of literature reporting improved outcome in overall survival and local control for patients whenever motion management techniques are used. This overview will review the extent of lung tumour motion, ways in which motion is detected and summarise the key methods used in motion management.

Defining target volumes for stereotactic ablative radiotherapy of early-stage lung tumours: a comparison of three-dimensional 18F-fluorodeoxyglucose positron emission tomography and four-dimensional computed tomography.:PETCT versus 4DCT for SABR in Early Stage NSCLC

AIMS: High local control rates are achieved in stage I lung cancer using
stereotactic ablative radiotherapy. Target delineation is commonly based on
four-dimensional computed tomography (CT) scans. Target volumes defined by
positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional')
(18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT.

MATERIALS AND METHODS: For 16 stage I non-small cell lung cancer tumours, six
approaches for deriving PET target volumes were evaluated: manual contouring,
standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV
(35%SUV(MAX)), 41% of SUV(MAX) (41%SUV(MAX)) and two different source to
background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum
intensity projection (MIP(MOD) ITV). Volumetric and positional correlation was
assessed using the Dice similarity coefficient (DSC).

RESULTS: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP(MOD) ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV(MAX) = 0.63, 41%SUV(MAX) = 0.57. SBR-1 = 0.52, SBR-2 =0.49. PET-based target volumes were smaller than corresponding MIP ITVs.

CONCLUSIONS: Conventional three-dimensional (18)F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use
(MIP(MOD) ITV). Caution is required in using three-dimensional PET for motion
encompassing target volume delineation.

The Challenges Faced in Developing Novel Drug Radiation Combinations in Non-small Cell Lung Cancer

Lung cancer is the most common cancer diagnosed in the UK. Outcomes for patients with this disease remain poor and new strategies to treat this disease require investigation. One potential option is to combine novel agents with radiotherapy in clinical studies. Here we discuss some of the important issues to consider when combining novel agents with radiotherapy, together with potential solutions as discussed at a recent Clinical Translational Radiotherapy Group (CTRad) workshop.

Radiotherapy and Immunotherapy Combinations in Non-small Cell Lung Cancer: A Promising Future?

The goal of re-programming the host immune system to target malignancy with durable anti-tumour clinical responses has been speculated for decades. In the last decade such speculation has been transformed into reality with unprecedented and durable responses to immune checkpoint inhibitors seen in solid tumours. This mini-review considers the mechanism of action of immune modulating agents and the potential for combination with radiotherapy in the treatment of non-small cell lung cancer.