East Devon Research Articles

Website watch.

The UK Rehabilitation Forum is an electronic discussion list enabling health professionals involved in rehabilitation to discuss issues and share insights to improve practice, promote evidence-based practice and professional development. This site was started by Kathy Dinsmore, a senior occupational therapist currently working as part of a multi-disciplinary rehabilitation service in East Devon. www.rehabforum.co.uk.

A Re‐evaluation of Small Tetrapods from the Middle Triassic Otter Sandstone Formation of Devon, England

Material of small sauropsids from the Otter Sandstone Formation of east Devon (Sherwood Sandstone Group; Middle Triassic; Anisian) includes remains that were formerly attributed to a primitive procolophonid. In the light of new specimens, this material is instead found to contain remains of a diapsid and a procolophonine procolophonid. Among these fossils, the medium‐sized procolophonine, Kapes bentoni sp. nov., is the first record of this Russian genus in the British Triassic. Coartaredens isaaci gen. et sp. nov. is a small diapsid tentatively assigned to Lepidosauromorpha. The heterodont lower dentition of Coartaredens comprises a row of large, conical posterior teeth and tightly packed, procumbent incisiforms. Two additional specimens are distinguished on the basis of distinctive dentary remains. One of these is of possible procolophonid affinity, while the dentition of the second resembles that of the aberrant Early Triassic parareptilian genus Sclerosaurus.

Synthetic heavy mineral stratigraphy: applications and limitations

A multi-disciplinary study of the dominantly fluvial Lower Triassic Otter Sandstone Formation (east Devon, UK) is presented. The approach integrates a variety of methods including sedimentology, conventional heavy mineral analysis, single grain microprobe analysis and elemental whole rock geochemistry (ICP-AES and ICP-MS). A species-level conventional heavy mineral study is compared to a whole rock geochemical analysis for the corresponding samples to investigate whether or not heavy mineral compositions can be discriminated from elemental whole rock data. The comparison provides sufficient evidence that the absolute and relative abundance of some of the heavy minerals; apatite, iron–titanium oxides, monazite and zircon can be discriminated geochemically. The established element–mineral relationships are used to construct both synthetic heavy mineral assemblages and synthetic heavy mineral index values from the geochemical data, which show considerable similarity to those of the conventional heavy mineral analysis. The presented synthetic heavy mineral logs display intraformational packages that enable subdivision of this barren continental succession. Furthermore, the observed subdivision is correlatable over a considerable distance when extended into the offshore Wessex Basin. The chemical approach unquestionably lacks the sensitivity of conventional heavy mineral analysis, however, by comparison it is rapid. This novel approach demonstrates that synthetic heavy mineral stratigraphy based, as here, on a well constrained stratotype has considerable potential for creating high-resolution correlations in both outcrops and the subsurface and may be of significant value to people working with reservoir characterisation.

Questionnaire survey of women aged 56–59 years: Consultations in general practice, use of hormone replacement therapy (HRT) and participation in screening programmes

ObjectivesTo ascertain attitudes to consultations in general practice and the gender of the doctor. To determine whether women participate in the National Health Service (NHS) screening programmes available to them...

Anonymity and confidentiality: Rural teenagers' concerns when accessing sexual health services

ContextWhile confidentiality is recognised as a key aspect of successful health services aimed at young people, most research has looked at the concerns of those in urban centres. This paper...

The East Devon experience

The East Devon experience

Engineering geological significance of relict periglacial activity in South and East Devon

Quaternary glacial ice barely impinged on SW England with the maximum limits of the various ice advances now being reasonably well established. In SW England a probable Anglian ice front was located in Barnstaple Bay that is likely to have occupied some of the existing land surface in the area. Elsewhere the ice front does not appear to have got beyond the north coast of Devon and Cornwall, although a till has been identified on the Isles of Scilly and a possible glacial corrie has been described on Exmoor. Beyond these limits, however, the SW region will have been subject to repeated extensive and intensive periglacial activity. The effects of periglaciation will not have been removed by any subsequent ice advances, thus the region provides an excellent area to evaluate the importance of periglacial activity to engineering geology. Information on the nature and extent of periglaciation is mainly limited to detailed studies carried out in specific areas. However, the Quaternary history of SW England has recently been summarized and these summaries refer to the extent of periglacial processes. In this paper, the nature and engineering geological implications of periglacial processes and deposits from four contrasting areas of south and east Devon are discussed.

Comparison between outcrop-spectral gamma ray logging and whole rock geochemistry: implications for quantitative reservoir characterisation in continental sequences

A high-resolution spectral gamma-ray (SGR) log is compared to elemental whole rock geochemical data in a reservoir scale outcrop analogue, the Otter Sandstone Formation (Sherwood Sandstone Group), east Devon. SGR data compare closely to those generated for point samples by inductively coupled plasma (ICP) techniques, with disparities attributable to the different sample volumes. ICP data reveal separate mineralogical sources for radio-elements, which enable three lithotypes to be discriminated using Th/U ratio and K 2O data. Once established, the discriminants are applied to the SGR log enabling three lithotypes to be dicriminated. These conclusions suggests that SGR logs have significant potential for real-time lithotype prediction in continental sequences, which in turn enable predictions of reservoir quality, and increase confidence in the interpretation of sedimentary architecture.

Design or accident? The natural history of teenage pregnancy.

The UK has the highest rate of teenage pregnancy in Western Europe. A retrospective record-based study was conducted in an East Devon general practice to gain greater understanding of the outcome of first teenage pregnancy and subsequent reproductive history. The comparison group was women who had first conceived between the ages of 25 and 29 years. 149/673 women born between 1968 and 1977 became pregnant when teenagers. Of these, 70 (47%) had the baby, 67 (45%) had a termination and 10 (7%) had a spontaneous miscarriage; 2 others experienced fetal loss. Of the women aged 25-29 at first conception, 127 (92%) had the baby, 6 (4%) had a termination and 5 (4%) had a miscarriage. 40 (27%) of the teenage group went on to have a second teenage pregnancy, including 12 of the 67 who had their first pregnancy terminated. Although teenage pregnancy is often viewed as unplanned and unwanted, the reality is more complex. Among this group, many first pregnancies were desired. Even among those whose first pregnancy was terminated, 18% went on to have a baby while still a teenager.

The State and Social Change in Early Modern England c.1550-1640 (review)

172 Reviews Hindle, Steve, The State and Social Change in Early Modern England c.l5501640 (Early Modern History: Society and Culture), Basingstoke, Macmillan, 2000; cloth, pp. xi, 338; R R P £45; ISBN 0-333-633384-9. This substantial monograph is a 'must-read' for all scholars of Early Modem England. It describes the effects of the increasing regulation of the realm from 1550 and the way in which the middling sort were implicated in this process of governance. As Hindle writes on thefirstpage 'it is an argument both about the distinctiveness of the particular period in the development of English governance and about the increasingly sophisticated political culture of the "middling sort" of people'. In analysing this sedimentary process (as Hindle sees it) he provides a new understanding ofthe way in which public policy operated in Tudor and Stuart England. Through the lenses ofthe contemporary conception of economic change and by examining the processes of law in the areas of poor regulation, criminal justice, moral campaigns for the reformation of manners, and parochial administration in general, Hindle aims to bring a holistic view to areas of early m o d e m social and economic life that have usually been discussed in isolation. H e largely succeeds in this aim and in so doing, puts the politics back into social history in a very satisfying way. H e also places the emphasis firmly on the micropolitics ofthe civil parish, arguing that every parish was, effectively, a microcosm of state authority and, in consequence, 'the most ubiquitous and therefore perhaps the most significant politics in Early M o d e m England were the politics of the parish, and especially those ofthe poor rate' (p. 237). Hindle's material on poor relief can be extracted as an exemplar of his approach. Social welfare was the concern of the first generation of social historians but in the English context they have, largely, been studied in an apolitical and congratulatory way because relief was statutory and apparently comprehensive. Yet in the parish of Colyton in east Devon in the second half of the seventeenth century (an area I have researched in some depth), the distribution of relief, and access to land and housing, was dependent on religious standing. But the insights about the political nature of local governance are only 6ne of the new directions that w e can attribute to Hindle. Historians of crime will have much to think over with Hindle's revised view of 'binding over'. And Hindle's general argument is of great importance when questioning the meaning of 'the state' in the early m o d e m period. The book is bristling with too many potent issues to discuss in a short review. Reviews 173 This monograph is the product ofa mass of detailed research in both local and national record offices about the micro-politics ofordinary situations. Hindle unearths the stories of some apparently ordinary people, whose actions appear extraordinary when viewed against the rich backdrop that Hindle is able to draw from his broad and astute reading of the vast literature about early modern England. His approach of marrying a study of local elite politics with the dynamics of day-to-day life could be productive in many case-study situations. Of course, not all the ideas and material in the book are by any means entirely new to Early Modernists, such as the exploration of the relationship between 'the Centre' and the localities, but in Hindle's hands they receive a new shine. There is a tendency to want a very good book to cover everything and a few ofthe current concerns of social historians are little debated here. For example, gender relations are not really within the political arena discussed here. Hindle's focus is essentially on rural England and his arguments could be misappropriated ifapplied to urban governance. In this sense, this book complements the work done by scholars who have dissected the workings ofthe early m o d e m city, such as Ian Archer and Jeremy Boulton in their writings about London in the same period. Hindle is a prolific member of the 'Cambridge School' of Early M o...

Prehistoric and Roman Sites in East Devon: The A30 Honiton to Exeter Improvement DBFO Scheme 1996-9

Prehistoric and Roman Sites in East Devon: The A30 Honiton to Exeter Improvement DBFO Scheme 1996-9

Public Law Representations and Substantive Legitimate Expectations

Members of the public seek and rely on advice and acts of public bodies and their officials, yet to what extent can public bodies and their officials be held to their representations?' The type of problem that can arise is where a public body has made a representation, which is within its powers to make, but it later seeks to resile from it. Or, where a public body has set out policy criteria for dealing with a particular area of decision-making, and an individual has relied on these criteria and legitimately expects a favourable decision based on these criteria, and then the public body changes its mind and seeks to apply different policy criteria to the particular area and so dashes the expectations of those affected. Can the individual obtain the substantive benefit which would be forthcoming if the public body was held to the representation or the original policy criteria was still the public body's chosen option? Is a legitimate expectation aroused in the applicant, and if so, does it give rise only to a procedural protection:2 a right to be heard as to whether the original policy criteria or representation should apply? Or does it give rise to substantive protection: the original criteria will be applied or the representation adhered to? This question has generated a considerable amount of debate in the courts3 and amongst commentators.4 The recent Court of Appeal decision in R v North and East Devon Health Authority, ex p. Coughlan5 has brought the doctrine of substantive legitimate expectation back into the spotlight, having had a shadow cast over it by a differently constituted Court of Appeal in R v Secretary of State for the Home Department, ex p Hargreaves.6

LEGITIMATE EXPECTATION: THE SUBSTANTIVE DIMENSION

THE need to redress the inequality of power between the citizen and the State, which lies at the heart of public law, is illustrated nowhere more clearly than in the facts of R. v. North and East Devon Health Authority, ex p. Coughlan [2000] 2 W.L.R. 622. As a result of her severe disability Pamela Coughlan was, for many years, looked after as a hospital in-patient. In 1993, however, she agreed to move to a purpose-built care facility on the strength of the respondent’s promise that it would be her “home for life”; yet, only five years later, the health authority decided to close the new home, citing financial reasons. That the applicant possessed a legitimate expectation which would be breached by closure of the home was not in doubt. The difficult question was how the expectation could be protected. Courts have long been willing to enforce procedural promises and to safeguard expectations of substantive benefits by requiring the adoption of a fair procedure (typically consultation) before the benefit is denied. Coughlan, however, makes it clear that courts may go further than this by substantively protecting substantive expectations.

General practitioners' attitudes to sexual activity in under-sixteens.

In the UK, under-sixteen-year-olds with some exceptions can be provided with contraceptive care even if unwilling to inform their parents. Nonetheless, many teenagers express doubts about confidentiality in these circumstances, as well as fear of being judged. The attitudes of general practitioners in North and East Devon towards the Gillick ruling regarding the treatment of under sixteens for sexual health matters were assessed. They were asked to indicate their level of agreement or disagreement with a series of statements. 235 (73%) responded, and only 15 (6.5%) rejected the notion that the same duty of confidentiality applies to under-sixteens as to older patients. 76% did, however, prefer parents to know they had been consulted about contraception. Only 7 GPs believed that provision of contraception encourages under-age sex. Despite GPs' general acknowledgment of the importance of confidentiality in relation to sexual activity, teenagers may well be discouraged from seeking advice if they expect strong pressure to tell their parents.

Pre-failure strains as precursors of sliding in a coastal mudslide

A large coastal mudslide at West Down Beacon in East Devon surges occasionally with most of its displacement resulting from basal sliding. Frequent monitoring of surface markers on the mudslide between surges has indicated that, in the months before large surge displacements, there are small displacements caused by shear deformation. These pre-failure strains may be useful precursors of the main movements. The inter-surge conditions of the soil matrix of the mudslide have been recreated in a ring-shear apparatus specially adapted to be stress- rather than strain-controlled. The test results demonstrate the manner in which considerable shear distortions can occur within the mudslide during the early phases of a displacement surge, before the reactivation of failure at residual strength in the basal shear zone.

Zinc, copper and chlorophyll-derivatives in the polychaete Owenia fusiformis

An earlier study of metals in the polychaete Owenia fusiformis showed that individuals within intertidal populations were remarkably variable in terms of whole-body concentrations of zinc and copper. Four populations have now been studied, two in south Cornwall (Fal Estuary and Par Sands) and one each in east Devon (Torre Abbey Sands) and north Brittany (Grève de St Michel). Investigations of the distributions of zinc and copper within the body have demonstrated that consistently zinc is concentrated in the middle body whilst copper increases to a maximum posteriorly. Zinc is accumulated in the mid-gut cells in the form of numerous spherules, 1–2 μm in diameter: X-ray microanalysis shows these to be largely composed of zinc phosphate but containing also magnesium, calcium and iron, together with sulphur and chlorine. Viewed under the microscope the spherules are greenish due to a pigment identified by high performance liquid chromatography absorption scanning as a pheophorbide-like chlorophyll-degradation product. In contrast, copper is widely distributed throughout the body and much is deposited as small granules, 0.2–0.3 μm in diameter, in laminar groupings in hypodermal and peri-intestinal tissues. The identity of the green pigment responsible for the characteristic body colour of O. fusiformis has not been specifically determined but it appears to have a copper basis since dark-green tissues have a significantly higher copper content than those with a light-green colour. The possible role of chlorophyll degradation products in zinc and copper uptake is discussed.

An audit of practice nurse specialist clinics for minor illness

Background: the concept of skill mix seeks to match clinical presentation with anintervention based on skill and training, and a number of studies have suggested that a number of tasks performed by doctors can be undertaken satisfactorily by nurses. The objective of our study was to measure patient satisfaction following the introduction of a Minor Illness Clinic that was run by practice nurses. the study was undertaken in a nine-partner practice where a direct-access nurse-led Minor Illness Clinic had been in operation since October 1998. an audit was undertaken by a postal survey to 181 patients who attended theMinor Illness Clinic. The audit was conducted externally by the Primary Care Audit Group of the North and East Devon Health Authority. The audit included reason for the appointment, whether the patients were satisfied with the consultation, whether patients required a prescription following their consultation and whether the nurse requested an opinion from the GP. In addition, we sought to capture qualitative data by asking patients to comment on their experience of the Minor Illness Clinic. From a retrospective analysis, we obtained the number of patients who were seen by a GP within 5 days of their appointment. there was 53% response rate to the postal questionnaire. Of these respondents,97% said they were satisfied to be seen by a nurse, 57% required a prescription and in 23% of cases the nurse requested an opinion from the GP. Seventeen per cent of patients saw a GP within 5 days of their appointment compared with a level of 5% of patients returning after a GP consultation for minor illness. The majority of our qualitative data was positive and found the Minor Illness Clinic a useful contribution to our medical services. following the introduction of a nurse-led Minor Illness Clinic, we found highlevels of patient satisfaction which was supported by the qualitative comments we received. A major problem identified was the time required for prescriptions to be signed by the doctor. The patient re-consultation rate was only slightly higher than would have been anticipated from a GP-led service.

Ethics vs economics

The 1990s will be recorded by future health historians as a decade dominated by one question: how to fund long-term care? The debate took centre stage again last month when the Court of Appeal ruled on the landmark case of R v North and East Devon Health Authority, ex parte Pamela Coughlan. Although the judgement has not resolved the complexities responsible for much of the current confusion, it has, in effect, issued an ultimatum to the politicians in Whitehall to do so.

Cervical smears: a PN audit

The North & East Devon Primary Care Audit Group actively promotes multidisciplinary and interface audit within its area. To facilitate a greater involvement from practice nurses, the practice nurse representatives (Ann Hook and Claire Pratt) organized a small audit group for practice nurses. Audit expertise was provided by the audit team manager (Liz Cosford). The aim was to enable the nurses to gain more confidence with audit.

Involvement in multiprofessional continuing education: a local survey of 24 health care professions

Multipmfessional education is becoming recognised increasingly widely as the way forward for the health professions. A survey was conducted within one English health authority, namely North and East Devon, to determine how much of it was actually taking place at post-qualifying level. Unlike previous survyes, which have mostly been addressed to educational providers, this was sent to individual workers in all the established health professions and sought to measure the extent of actual involvement within each profession, along with attitudes towards learning in a multiprofessional context. Nearly threequarters of those who replied had been involved in some form of multiprofessional education during a specified 12-month period, although levels of involvement varied greatly between professions, with some professions having markedly better access to opportunities than others. A key finding was that a number of professions are effectively excluded from multiprofessional education. Considerable interest in learning in a multiprofessional setting was found at all levels and amongst all groups of health professionals, and there was a clear demand from all professions for more opportunities, especially in the field of counselling and communication skills.