Aims To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal. Methods Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively. Results Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence. Conclusion This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

A New Life, Bernard Malamud’s 1961 epic of a down-and-out New Yorker in the Pacific Northwest, is unique among his novels. The story takes place far from the urban Jewish milieu that was the author’s usual setting, and not coincidentally, it is the only work in which he fully develops a critique of American culture. Malamud studiously avoids mentioning religion until very late in the book, and then only obliquely. However a close reading, beginning with the significance of the main characters’ names, suggests an inter-religious dynamic. Relations between Judaism and Christianity, Jews and Christians, and Jewish and gentile cultures are front and center in much of Malamud’s fiction – notably in The Assistant, the 1957 novel that immediately precedes A New Life. In A New Life these themes are concealed, or implied – probably because it was written while the author was sojourning in gentile territory, where his values came into sharp conflict with those of the dominant culture. A New Life can be read as a satire on American Philistia from a Jewish point of view, but in the end it goes beyond satire. The coupling of Seymour Levin with Pauline Josephson, the wife of his boss and enemy, and their absconding with her children, suggests a prophecy of a new age in which Jew and gentile combine in a generational assault on American values. In short, the Sixties. The life in question belongs to Seymour Levin, a newly-appointed Instructor in English Composition at Cascadia College, a state institution in a state much like Oregon. Here, the powers-that-be have sacrificed literature and the liberal arts to focus on efficiency, economy, and above all, athletics. Seymour Levin: See More, Leaven. He alights in Cascadia from a transcontinental train ride, to be met by Director of English Composition Gerald Gilley and his flat-chested wife, Pauline. They’re late to the station, having been delayed at the golf course. Seymour introduces himself, awkwardly, as “S. Levin ... From the East” (Malamud 4). Seymour is immediately rechristened “Sy” by the gregarious Gilley, who is campaigning to be the next chairman of the English Department. Declining Gilley’s suggestion that he shave off his beard, he settles into a room in town, learns to drive, marvels at the natural beauty around him, and sets to work at his first-ever college appointment – teaching forestry and engineering students how to write. Levin hopes to resurrect the liberal arts in a school that has written them off. But he’s also resurrecting himself. After years of alcoholic despair, his life turned on a vision he saw in a filthy basement – a shaft of sunlight on his rotting shoes convinced him that life is holy, that the source of freedom is the human spirit. His quest is “to get back what belongs to me ... order, value, accomplishment, love” (189). Values and love quickly get him into trouble. Levin’s moral code has nothing to do with the sexual prudery that is the college’s definition of “morals.” He is a stickler for fairness and equal treatment – the very opposite of Gilley, a pragmatist whose highest value is to “keep the department running smoothly” (37). Levin objects to favored treatment for athletes, but is brushed off with a lecture on how much they do for the school. He pursues a plagiarist; Gilley complies with the student’s request for a transfer out of Levin’s class. Levin realizes, “this man is my enemy” (178). As for love: his heart a famished cat, Levin prowls the town in search of females. He hooks up with a waitress, only to be interrupted by his angry roommate. He lies down with a secretary, but

Objective: We modeled the impact of changing Specialist Treatment Access Rates to different treatment pathways on the future prevalence of alcohol dependence, treatment outcomes, service capacity, costs, and mortality. Method: Local Authority numbers and the prevalence of people “potentially in need of assessment for and treatment in specialist services for alcohol dependence” (PINASTFAD) are estimated by mild, moderate, severe, and complex needs. Administrative data were used to estimate the Specialist Treatment Access Rate per PINASTFAD person and classify 22 different treatment pathways. Other model inputs include natural remission, relapse after treatment, service costs, and mortality rates. “What-if” analyses assess changes to Specialist Treatment Access Rates and treatment pathways. Model outputs include the numbers and prevalence of people who are PINASTFAD, numbers treated by 22 pathways, outcomes (successful completion with abstinence, successfully moderated nonproblematic drinking, re-treatment within 6 months, dropout, transfer, custody), mortality rates, capacity requirements (numbers in contact with community services or staying in residential or inpatient places), total treatment costs, and general health care savings. Five scenarios illustrate functionality: (a) no change, (b) achieve access rates at the 70th percentile nationally, (c) increase access by 25%, (d) increase access to Scotland rate, and (e) reduce access by 25%. Results: At baseline, 14,581 people are PINASTFAD (2.43% of adults) and the Specialist Treatment Access Rate is 10.84%. The 5-year impact of scenarios on PINASTFAD numbers (vs. no change) are (B) reduced by 191 (-1.3%), (C) reduced by 477 (-3.3%), (D) reduced by almost 2,800 (-19.2%), and (E) increased by 533 (+3.6%). The relative impact is similar for other outputs. Conclusions: Decision makers can estimate the potential impact of changing Specialist Treatment Access Rates for alcohol dependence. Objectif : Modéliser l’impact de la variation des taux d’accès aux différentes trajectoires de traitements spécialisés, sur la prévalence future de la dépendance à l’alcool, l’impact du traitement, le volume de services, les coûts et la mortalité. Méthode : Au sein des administrations régionales, les nombres et la prévalence de personnes ayant ‘potentiellement besoin d’être évaluées pour un traitement dans les services spécialisés en dépendance à l’alcool’ (PBÉTSSDA) sont estimés en fonction de niveaux de besoins dits légers, modérés, sévères et complexes. Les taux d’accès aux traitements spécialisés par personne ayant PBÉTSSDA sont estimés en fonction de 22 trajectoires différentes de traitements et sont classifiés à partir de données administratives. Les autres données intégrées dans le modèle incluent la rémission naturelle, la rechute après le traitement, les coûts de services et les taux de mortalité. Les analyses de différents scénarios permettent d’estimer les changements dans les taux d’accès aux traitements spécialisés et aux trajectoires de traitement. Les résultats du modèle incluent : le nombre et la prévalence des personnes ayant un PBÉTSSDA, le nombre de personnes traitées dans les 22 trajectoires, les résultats (avoir complété avec succès et abstinence, la réussite avec atteinte d’une consommation modérée non problématique, retourner en traitement dans les 6 mois, abandon, transfert, détention), les taux de mortalité, besoins en termes de capacité (nombre de personnes en contact avec les services dans la communauté, ou qui bénéficient des services dans un centre résidentiel ou en centre hospitalier), le coût total des traitements et les économies générales en soins de santé. Cinq scénarios sont illustrés : (a) pas de changement; (b) atteinte des taux d’accès au 70e percentile à l’échelle nationale ; (c) augmenter l’accès de 25%; (d) augmenter l’accès aux taux de l’Écosse; (e) réduire l’accès de 25%. Résultats : Initialement, 14 581 personnes présentaient un PBÉTSSDA (2,43% des adultes) et le taux d’accès aux traitements spécialisés est de 10,84%. L’impact sur 5 ans des scénarios sur le nombre de personnes présentant un PBÉTSSDA (par rapport à aucun changement) est : B) réduit de 191 (-1,3%); C) réduit de 477 (-3,3%); D) réduit de presque 2800 (-19,2%); E) augmenté de 533 (+3,6%). Un impact similaire est observé sur les autres résultats. Conclusion : Les décideurs peuvent estimer l’incidence potentielle de la variation des taux d’accès aux traitements spécialisés pour la dépendance à l’alcool. Objetivo: Modelado impacto del cambio de velocidades de acceso de tratamiento especializado para diferentes vías de tratamiento sobre la prevalencia del futuro de la dependencia del alcohol, los resultados del tratamiento, capacidad de servicio, costos, y la mortalidad. Métodos: Los números de la Autoridad Local y la prevalencia de personas que potencialmente necesitan evaluación y tratamiento en servicios especializados para la dependencia del alcohol (PINASTFAD) se estiman según las necesidades leves, moderadas, graves y complejas. La tasa de acceso de tratamiento especializado por persona PINASTFAD se estima y de 22 vías de tratamiento diferentes se clasifican a partir de datos administrativos. Otras variables del modelo incluyen la remisión natural, la recaída después del tratamiento, los costos de servicio y las tasas de mortalidad. Los análisis “¿y si?” Evalúan los cambios en las tasas de acceso al tratamiento y las vías de tratamiento del especialista. Los resultados del modelo incluyen: números y prevalencia de personas que son PINASTFAD, números tratados por 22 vías, resultados (finalización exitosa con abstinencia, consumo no problemático moderado con éxito, nuevo tratamiento dentro de los 6 meses, abandono, transferencia, custodia), tasas de mortalidad, requisitos de capacidad (números en contacto con los servicios de la comunidad, o estancias en lugares residenciales o de hospitalización), los costos totales de tratamiento y ahorros de salud generales.Cinco escenarios ilustran la funcionalidad: (a) sin cambios; (b) lograr tasas de acceso en el percentil 70 a nivel nacional; (c) aumentar el acceso por + 25%; (d) aumentar el acceso a la tasa de Escocia; (e) reducir el acceso por -25%. Resultados: Al inicio del estudio, 14,581 personas son PINASTFAD (2,43% de los adultos) y la tasa de acceso al tratamiento especialista es del 10,84%. El impacto de 5 años de los escenarios en los números de PINASTFAD (versus ningún cambio) es: B) reducir por 191 (-1.3%); C) reducir por 477 (-3.3%); D) reducir por casi 2800 (-19.2%); y E) aumento por 533 (+ 3.6%). El impacto relativo es similar para otros productos. Conclusión: Los responsables de la toma de decisiones pueden estimar el impacto potencial de cambiar las tasas de acceso de tratamiento especializado para la dependencia del alcohol.

JONAS GRETHLEIN and ANIONICS RENGAKOS (eds.), Narratology and Interpretation: The Content of Narrative Form in Ancient Literature. 2009. Pp. VII, 630. Walter De Gruyter. 99.95 [euro] (Hardcover) ISBN 9783110214529 The pioneering work done in 1980s and 1990s by scholars such as Irene de Jong and Massimo Fusillo established models of structuralist narratology as an important tool for of ancient However, last twenty years or so have seen approaches such as feminism and cultural history contributing to a critique of premises and practices of structuralist narratology, and development of a variety of separate narratologies with their own subject-specific aims. This volume situates itself as a response to these developments, aiming, according to back cover blurb, to draw out the subtler possibilities of narratological analysis for of ancient texts. The results are mixed; while some of articles combine narratological concepts with other frames of interpretative reference to powerful effect, or subject narratological practice to critical examination through its application to texts, others recycle traditional lines of approach with little regard for recent theoretical developments in narratology and elsewhere, resulting in pieces which are neither interpretatively incisive nor narratologically illuminating. Nevertheless, complexity and interest of questions volume tackles make engagement with it a rewarding process. The introduction gives a brief account of recent narratological developments (pp. 1-3) and a synopsis of book's contents (pp. 4-11). The former is only very sparingly sketched and will not be of much use to uninitiated. (1) More importantly, by spending only three and a half pages introducing topic, editors miss opportunity for a more thoroughgoing conceptual engagement with premises of narratological method. Seeking a middle ground between structural clarity of classical narratology and interpretative breadth of newer models, editors recommend adhering to narratology in singular so as to preserve its conceptual independence, while also using it as a heuristic tool for interpretation (p. 3). Thus they articulate a version of narratology which 'will not deliver fully developed interpretations', but which present[s] observations which ... are sufficiently formal to enrich various readings (p. 3). Frustratingly, they do not articulate in enough detail their reasons for taking this position, and do not engage to any extent with narratological developments they have flagged up. Not only do they not deal with numerous challenges mounted from various angles to objectivity of narratological models, (2) their conception of narratology as a basically neutral formalist base for other modes of is problematized by some of essays in volume, which show precisely how difficult it is to free one's taxonomizing from interpretative considerations, and how certain interpretative situations require a more or less radical reconsideration of narrative theory's foundational motifs. (3) We might wonder whether clear profile (p. 3) of narratological project is not always an illusion, and whether narratology as a set of concepts and methodologies might rather be seen to emerge from, and bear traces of, implications in other conceptual and heuristic networks. It is worth considering forces that regulate this emergence, and what is at stake in violent rupture necessary to create for narratology a 'pure' formalized space. Genette's move of treating narratives as the development given to a verbal form ... expansion of a verb is a useful pointer in this respect. (4) For Genette, 'I walk' is a minimal form of narrative. This linking of narrativity to a basic linguistic gesture masks how such an account constructs narrativity, rather than simply finding it inherent in things; conceptualizing essence of narrativity as recounting of action requires an erasure of complexities of category 'action' in order to construct an objectivity for datum 'I walk'. …

AIM To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. METHODS A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates. RESULTS Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. CONCLUSION Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.

BACKGROUND:Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial.METHODS AND FINDINGS:Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings.CONCLUSIONS:SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions.TRIAL REGISTRATION:Current Controlled Trials ISRCTN 93681536.

Oxford Archaeology East conducted an archaeological excavation and watching brief at Addenbrooke's Hospital, Cambridge, prior to the construction of a new road along the southern perimeter. The work commenced with monitoring of geo-technical trial pits along the route of the road. Ten trial pits were monitored; archaeological features were encountered in two of the pits at the east end of the proposed road. The monitoring was followed by three small excavation areas – a compound area and two sections of the road. The compound was 0.2ha and contained an area of a predominantly Early Roman field system; the most noteworthy feature was a small kiln consisting of a small sub-circular chamber and a possible flue. The kiln had in-situ burning around its edges and contained a large assemblage of Early Roman pottery, including sherds from a limited range of cordoned jars and larger storage jars; some of which were obvious wasters and sherds which had failed during firing. Certain sherds had been used to re-enforce the clay lining of the kiln. The second area, a spur road to the east of the compound, measured 65m x 12m and contained a much lower density of features; five Early Roman ditches associated with the field system in the compound area were discovered. The Robinson Way access road area, at the east end of the road corridor, covered 0.3ha and revealed a portion of an Early Roman field system in the north, consisting of parallel boundary ditches and at least seven cultivation beds. In the south of the area were two isolated Roman ditches. Other features included a small pit, possibly a well, and a number of tree throws and hollows.

Objective To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking. Design Pragmatic cluster randomised controlled trial. Setting Primary care practices in the north east and south east of England and in London. Participants 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers. Interventions Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation. Main outcome measures The primary outcome was patients’ self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients’ motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler. Results Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings. Conclusions All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. Trial registration Current Controlled Trials ISRCTN06145674.

AIMS To examine the feasibility and acceptability of alcohol screening and delivery of brief interventions within criminal justice settings. METHODS A quantitative survey of those aged 18 or over in English criminal justice settings (three custody suites within police stations, three prisons and three probation offices). MEASUREMENTS The Fast Alcohol Screening Test (FAST) and a modified version of the Single Alcohol Screening Question (M-SASQ) were compared with the Alcohol Use Disorders Identification Test (AUDIT) as the 'gold standard'. Participants completed a health status questionnaire (EQ5D), questions on service utilization and the Readiness to Change Questionnaire. Questions relating to the acceptability and feasibility of delivering brief interventions and about perception of coercion were included. FINDINGS Five hundred and ninety-two individuals were approached and 251 were eligible. Of these, 205 (82%) consented to take part in the study. The mean AUDIT score was 19.9 (SD 13.5) and 73% scored 8 or more on AUDIT. A higher percentage of those approached in the probation setting consented to take part (81%: prison 36%, police setting 10%). Those scoring AUDIT positive were more likely to be involved in violent offences (36.5 vs 9.4%; P < 0.001) and less likely to be involved in offences involving property (27.7 vs 45.3%; P = 0.03). Three quarters of the sample (74%) reported that they would not feel coerced to engage in an intervention about their alcohol use. FAST and M-SASQ had acceptable screening properties when compared with AUDIT with area under the curves of 0.97 and 0.92, respectively. CONCLUSIONS The results confirm that there is a major problem with alcohol use in the criminal justice system and this impacts on health and criminal behaviour. Of the three criminal justice settings, probation was found to be the most suitable for screening. Participants were positive about receiving interventions for their alcohol use in probation settings.

There is a wealth of evidence on the detrimental impact of excessive alcohol consumption on physical, psychological, and social health. There also exists a substantial evidence base for the efficacy of alcohol brief intervention (BI) aimed at reducing consumption across a range of settings. Research conducted in emergency departments (EDs) has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness of BI. However, the majority of this research has been conducted in a single center, and there is little evidence of the generalizability of SBI implementation across EDs. This pragmatic cluster randomized controlled trial randomized nine EDs to a combination of screening tools (the Modified Single Alcohol Screening Question [M-SASQ], the Fast Alcohol Screening Test [FAST], or the Screening and Intervention Program for Sensible Drinking modified Paddington Alcohol Test [SIPS-PAT]) and interventions (patient intervention leaflet [PIL], brief advice [BA], or brief lifestyle counseling [BLC]). The primary hypothesis was that BLC delivered by an alcohol health worker would be more effective than BA or PIL delivered by ED staff. Outcomes were assessed at six and 12 months. Overall, 5992 patients were screened for eligibility in 9 EDs; of these, 3737 (62%) were found eligible, and 1491 screened positive for an alcohol use disorder (40%). Of those who screened positive, 1204 (81%) consented to participate in the trial. The mean age of participants was 35 years, and the mean AUDIT score at baseline was 12.4. The majority of the sample was male (65%) and white (88%). At 12 months, 803 (67%) of participants were followed up. No significant differences in follow-up rates were observed between intervention groups. Overall, the proportion of participants positive for an alcohol use disorder reduced significantly by 16.3%. This reflected a significant decrease of 18.8% in the PIL group and 15.1% in both the BLC and BA groups. An adjusted logistic regression model found no significant effects of intervention group, screening approach, or baseline AUDIT score.

Numerous screening methods have been developed to detect hazardous and harmful drinking in a range of health settings. Recent research has focused on developing briefer screening tools to maximize implementation in busy practice settings, particularly emergency departments (EDs) and primary care. However the relative utility of these tools is not fully understood. Further, there is a need to identify the utility of universal screening, in which all patients approaching primary care are screened, compared with targeted screening, which includes only patients with certain “red flag” conditions or presentations. The Screening and Intervention Program for Sensible Drinking (SIPS) program compared the relative utility of different screening tools (e.g., the Single Alcohol Screening Question [SASQ] and the Fast Alcohol Screening Test [FAST]) and approaches (universal versus targeted screening) in primary care. In addition, the utility of the Paddington Alcohol Test (PAT), a targeted screening tool, was compared with SASQ and FAST in EDs. Compared with the Alcohol Use Disorders Identification Test (AUDIT), the FAST had a higher sensitivity than the SASQ in primary care. Although targeted screening in primary care is a more efficient screening method, it misses a large proportion of patients who could benefit from brief interventions. The SASQ performed better in EDs than either the FAST or PAT. These results have important implications for the choice of screening tools in different settings.

Background: To map and contact all specialist alcohol treatment services in England and to investigate the characteristics of responding agencies.Methods: A national cross-sectional survey of alcohol treatment agencies in England. A questionnaire was designed to gather information about agency characteristics, including the service structure, staffing, modalities of treatment, and associated funding.Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7%) responded to the survey. Variations in agency characteristics were noticed across geographical regions, as well as across sectors. The estimated annual spending on alcohol treatment was 217 pound million.Conclusions: Whereas the regional variation in agency characteristics has implications for access to particular types of treatment, the inter-sector variation has implications for the allocation of funding. The estimated annual spending of 217 pound million is greater than previous national estimates. A national framework for alcohol service mapping could benefit identification of areas for improvement and lead to more successful treatment outcomes.

Background: Although there is currently a high level of need for alcohol treatment in the United Kingdom, there has been a lack of research into alcohol treatment to date. This study reports on what the current challenges to alcohol treatment services in England are, what resources might help to improve services, and which groups are poorly served by alcohol treatment services, as perceived by service providers.Methods: Qualitative data was obtained in three open-ended questions from a sample of 207 alcohol treatment agencies that responded to the national alcohol needs assessment postal survey.Results: Lack of funding, a general lack of resources to provide services, inadequate access to detoxification and rehabilitation services, and a lack of trained staff to deliver services were key challenges presented. More staff, improved access to detoxification and rehabilitation services, better premises, more funding allocation, improved links with other services, and better resources in general to provide services were the key factors reported to improve services. Clients with complex needs (e.g., dual diagnosis, brain damage), women with children, homeless people, and ethnic minorities were perceived to be poorly served by alcohol treatment services.Conclusions: Alcohol treatment services in England face many challenges which should be incorporated into future alcohol treatment service development.

This excavation identified the southern edge of a substantial, later Iron Age rural settlement, the agricultural land surrounding this settlement and the transitional zone between these different areas of use. The settlement itself originated in the Middle Iron Age with evidence of ditched fields, a roundhouse, a water hole, pits, post built structures and a trackway. The water hole contained a well preserved log ladder and a large number of associated working wood chips. The log ladder was subsequently carbon dated to between 400 - 200BC. In the subsequent phase the trackway and some earlier boundaries went out of use although the pattern of a relatively open farmstead continued. The site continued to be occupied into the Roman period. This use of the site, while still settlement related, appeared to be much less intense and took place at a time when the previous Iron Age settlement had faded from the landscape and when the nucleus of the settlement had either moved north or shrunk in size. The Roman remains consisted of a single moderately sized enclosure.

Background: To map and contact all alcohol treatment services in England offering Tier 2, 3 and 4 interventions and describe the characteristics of their service-users.Methods: A national cross-sectional survey of alcohol treatment providers in England, designed to gather information about the characteristics of clients referred, assessed, and treated in the financial 2003/4.Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7 %) responded to the survey. The majority of clients were men, particularly within residential and non-statutory agencies. A higher proportion of residential clients were highly alcohol dependent, homeless and neurologically impaired, whereas, community clients were more likely to be offenders or to have mental health problems. Non-statutory services were more likely to see homeless clients, offenders, and clients with mental health problems and neurological deficits than statutory services who, typically, see a more dependent population.Conclusions: Findings support the need for more specialist service provision for severely dependent offenders and dependent drinkers with serious mental illness. To aid future mapping of alcohol services, which allows areas of need to be identified, it is recommended that services have a monitoring system similar to that for drug misuse with the National Drug Treatment Monitoring System.

Background A large number of randomised controlled trials in health settings have consistently reported positive effects of brief intervention in terms of reductions in alcohol use. However, although alcohol misuse is common amongst offenders, there is limited evidence of alcohol brief interventions in the criminal justice field. This factorial pragmatic cluster randomised controlled trial with Offender Managers (OMs) as the unit of randomisation will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in probation and different intensities of brief intervention to reduce excessive drinking in probation clients. Methods and design Ninety-six OMs from 9 probation areas across 3 English regions (the North East Region (n = 4) and London and the South East Regions (n = 5)) will be recruited. OMs will be randomly allocated to one of three intervention conditions: a client information leaflet control condition (n = 32 OMs); 5-minute simple structured advice (n = 32 OMs) and 20-minute brief lifestyle counselling delivered by an Alcohol Health Worker (n = 32 OMs). Randomisation will be stratified by probation area. To test the relative effectiveness of different screening methods all OMs will be randomised to either the Modified Single Item Screening Questionnaire (M-SASQ) or the Fast Alcohol Screening Test (FAST). There will be a minimum of 480 clients recruited into the trial. There will be an intention to treat analysis of study outcomes at 6 and 12 months post intervention. Analysis will include client measures (screening result, weekly alcohol consumption, alcohol-related problems, re-offending, public service use and quality of life) and implementation measures from OMs (the extent of screening and brief intervention beyond the minimum recruitment threshold will provide data on acceptability and feasibility of different models of brief intervention). We will also examine the practitioner and organisational factors associated with successful implementation. Discussion The trial will evaluate the impact of screening and brief alcohol intervention in routine probation work and therefore its findings will be highly relevant to probation teams and thus the criminal justice system in the UK. Ethical approval was given by Northern & Yorkshire REC Trial Registration number ISRCTN 19160244

Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption on the physical, psychological and social health of the population. There also exists a substantial evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption across a range of healthcare settings. Primary research conducted in emergency departments has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness. Within this body of evidence there is marked variation in the intensity of brief intervention delivered, from very minimal interventions to more intensive behavioural or lifestyle counselling approaches. Further the majority of primary research has been conducted in single centre and there is little evidence of the wider issues of generalisability and implementation of brief interventions across emergency departments. Methods/design The study design is a prospective pragmatic factorial cluster randomised controlled trial. Individual Emergency Departments (ED) (n = 9) are randomised with equal probability to a combination of screening tool (M-SASQ vs FAST vs SIPS-PAT) and an intervention (Minimal intervention vs Brief advice vs Brief lifestyle counselling). The primary hypothesis is that brief lifestyle counselling delivered by an Alcohol Health Worker (AHW) is more effective than Brief Advice or a minimal intervention delivered by ED staff. Secondary hypotheses address whether short screening instruments are more acceptable and as efficient as longer screening instruments and the cost-effectiveness of screening and brief interventions in ED. Individual participants will be followed up at 6 and 12 months after consent. The primary outcome measure is performance using a gold-standard screening test (AUDIT). Secondary outcomes include; quantity and frequency of alcohol consumed, alcohol-related problems, motivation to change, health related quality of life and service utilisation. Discussion This paper presents a protocol for a large multi-centre pragmatic factorial cluster randomised trial to evaluate the effectiveness and cost-effectiveness of screening and brief interventions for hazardous alcohol users attending emergency departments. Trial Registration ISRCTN 93681536

This paper describes the Heterodyne Instrument for the Far-Infrared (HIFI), to be launched onboard of ESA's Herschel Space Observatory, by 2008. It includes the first results from the instrument level tests. The instrument is designed to be electronically tuneable over a wide and continuous frequency range in the Far Infrared, with velocity resolutions better than 0.1 km/s with a high sensitivity. This will enable detailed investigations of a wide variety of astronomical sources, ranging from solar system objects, star formation regions to nuclei of galaxies. The instrument comprises 5 frequency bands covering 480-1150 GHz with SIS mixers and a sixth dual frequency band, for the 1410-1910 GHz range, with Hot Electron Bolometer Mixers (HEB). The Local Oscillator (LO) subsystem consists of a dedicated Ka-band synthesizer followed by 7 times 2 chains of frequency multipliers, 2 chains for each frequency band. A pair of Auto-Correlators and a pair of Acousto-Optic spectrometers process the two IF signals from the dual-polarization front-ends to provide instantaneous frequency coverage of 4 GHz, with a set of resolutions (140 kHz to 1 MHz), better than < 0.1 km/s. After a successful qualification program, the flight instrument was delivered and entered the testing phase at satellite level. We will also report on the pre-flight test and calibration results together with the expected in-flight performance.

Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population. Methods/design The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions. Discussion The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care. Trial registration ISRCTN52557360