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AUSTRALIAN INJURY PREVENTION PLAN: PRIORITIES FOR 2001–03

The national injury prevention plan for Australia and an implementation plan have been developed as a collaborative endeavour by all Australian governments with advice from non-government agencies, professional bodies and industry organizations; the plans were approved by the Council of Health Ministers in August 2001. The four priority areas are falls in older people; falls in children; drowning and near drowning; and poisoning in children. These were selected on the basis of the evidence of injury burden and potential health gain; effectiveness, cost-benefit and acceptability of a range of interventions; and of there being a clear and actionable role for the health sector. Other significant injury areas are being addressed through specific national strategies on road injury, workplace injury, and suicide prevention. The plan is intended to focus national effort towards the priority issues; to improve knowledge, strengthen infrastructure, and implement injury prevention activities; and to promote evidence based, sustainable injury prevention interventions. A specific and separate plan is to be developed for injury prevention for indigenous people. Responsibility for implementing the plan rests with what is called the Strategic Injury Prevention Partnership, a group that includes representatives of state and federal health departments. The implementation plan identifies specific actions, key players, and possible allies for specific, identified actions in each of the priority areas. Details can be found at www.nphp.gov.au/sipp or from the Injury Prevention Section, Department of Health and Aged Care GPO Box 9848, Canberra ACT 2601, Australia.

LIFEGUARD EFFECTIVENESS REPORT

This report, published in October 2001 by the Centers for Disease Control and Prevention (CDC) Injury Center, assesses lifeguards as a strategy for preventing drowning and water related injuries. The product of an expert meeting and a review of data from the United States Lifesaving Association and other sources, the report will help communities, local government officials, and owners of private water recreational areas make informed decisions about whether to begin, retain, or discontinue lifeguarding services. Available from www.cdc.gov/ncipc/lifeguard/lifeguard.htm.

SPONSORSHIP OF SPORTS SAFETY EQUIPMENT

VicHealth, the Victorian Health Promotion Foundation funded by a specific tax on tobacco, actively promotes participation in sport as a means to maintain regular exercise. On the understanding that an estimated one million Australians suffer sporting injuries each year, resulting in significant health, economic, and social costs to individuals and the community VicHealth has established a program to increase the use of safety equipment in sport. Under the program up to $2500 (US$ 1280) is available for the purchase of safety equipment for use in sporting programs. Locally based non-profit organizations which have as their primary responsibility the organisation and implementation of physical activities within a local community are eligible to apply. Those with tobacco sponsorship are not eligible. Equipment must meet Australian Standards or be recommended by the sport's governing body and be transferable between players; for example, head gear, mobile safety netting, safety mats, mobile hand rails, buoyancy vests, eye and ear protectors, and goal post padding. Preference is given to junior clubs, and for equipment that encourages participation among specified groups such as indigenous Australians. VicHealth classifies the program as an investment in good health.

VIETNAM APPROVES NATIONAL INJURY PREVENTION STRATEGY

Vietnam's Prime Minister Phan Van Khai has approved the national policy on preventing accidents and injury from 2002–10. Under the policy, accidents are expected to be reduced in all aspects of life including on the road, in the workplace, at home, in schools, and in other public places. Awareness of accident prevention will be raised in offices and organizations throughout the country. According to the plan, by 2010 the number of accidents in schools will fall by 40% and in other public places, the workplace and in homes by 30%. The death toll from traffic accidents will be reduced from 14 per 10 000 vehicles to 11 by 2005 and to nine by 2010.

LINKS BETWEEN HEAD INJURIES AND DEPRESSION

Concussions and other head injuries in early adulthood may significantly raise the risk of depression decades later, a study of World War II veterans has found. The study has implications for football and hockey players, motorcyclists, and others who have taken blows to the head. The new findings suggest that the risk persists even 50 years later. The study involved 1718 veterans hospitalized for various ailments during the war and questioned 50 years later. About 11% who had suffered head injuries said they currently had major depression, compared with 8.5% of those hospitalized during the war for other reasons. Overall, the lifetime prevalence of major depression was 18.5% in the head injury group and 13.4% among the other veterans, Holsinger and Plassman of Duke University and colleagues reported in January's Archives of General Psychiatry. The researchers found similar depression rates in veterans who had received their injuries in combat and in those whose injuries occurred elsewhere. Thus it is unlikely that post-traumatic stress syndrome, which can include symptoms of depression, would explain the findings, the researchers said. Dr Plassman said the findings could mean that people who suffer head injuries today—for example, football players—will have a greater risk of depression. Many of the veterans who suffered head injuries did so in non-combat situations like motor vehicle accidents and sports, she said.

LIFEJACKETS FOR ALL RECREATIONAL CRAFT IN NEW ZEALAND

Lifejackets are likely to be required to be carried on all recreational craft from mid 2002. “Seventy five percent of all those who drown while boating could have avoided death by wearing a lifejacket. This rule proposes that every skipper will be responsible for providing a lifejacket of the appropriate size for every person on board”, said Transport Minister Mark Gosche. “In conditions where safety is likely to be comprised, such as in bad weather, rough seas or poor visibility, the rule makes it compulsory for lifejackets to be worn by all on board”. Together with the Maritime Safety Authority's ongoing education programmes, this rule is expected to provide a significant improvement to the levels of safety on recreational craft. Infringements are likely to result in NZ$100–$200 fines. For copies of the draft rules visit Maritime Safety Authority web site www.msa.govt.nz.

CUTTING INJURIES FROM BIKE HANDLEBARS

Bicycle accidents that seem minor can cause serious abdominal injuries in children, say researchers in Philadelphia who have designed a handlebar that they hope will make biking safer. In a typical low speed bike crash, the bicycle hits an obstruction like a rock or a curb and comes to a stop. The cyclist instinctively turns the handlebar to regain balance, causing one end to swing toward the midriff. As the cyclist tips forward and falls, the closer end of the handlebar digs into the rider's abdomen while the opposite end hits the ground. The impact can injure the kidneys, liver, and spleen. Researchers at the Children's Hospital of Philadelphia reconstructed a number of such accidents based on interviews with children with abdominal injuries. “In many of these cases, there wasn't a lot of bruising. The symptoms of the injuries were delayed for hours”, said Dr Kristy Arbogast, a bioengineer at the hospital who led the effort to design a safer handlebar. In a crash, the new design could cut the force of the handlebar's impact on the cyclist's abdomen by half, said the research group. Dr Arbogast said that cushioning the impact was likely to lower the risk of injury, but that more tests were needed to confirm its safety. A petition under review by the US Consumer Product Safety Commission (CPSC) may compel bike manufacturers to consider new handlebar designs like the one developed by Dr Arbogast's group. According to a study presented at the American Academy of Pediatrics last fall, more than 800 children in the United States are hospitalized every year for abdominal injuries caused by handlebars.

AUSTRALIAN BIG BROTHER BULLYING BULLIES

In one Victorian public junior school, 32 surveillance cameras have for the past year been watching out for vandalism and harassment in the corridors, computer rooms, and schoolyard. Australian Secondary Principals Association president Ted Brierley says surveillance cameras are a necessary tool for schools seeking to live up to community expectations of a safe environment for students at all times. Large number of Victorian high schools use video surveillance to monitor bullying on school grounds: earlier this year, six private schools in Sydney claimed to have eliminated serious bullying problems overnight by installing surveillance cameras. The Australian Council of State School Organisations says that surveillance cameras are no substitute for education based programs to stop bullying, claiming that surveillance makes it worse because it is a parallel response to bullying: it says I'm going to bully you to stop bullying.

WHO GUIDANCE ON MONITORING INJURIES

Experts from more than 50 countries have combined forces to produce guidelines that will help healthcare staff in developing countries to set up systems to monitor the toll of death and disability from injuries. The manual, which is published by the World Health Organization and the CDC in the United States, is designed to help planners and front line clinical staff produce systematic data on injuries, whether they are working in a computerised city hospital or a remote first aid clinic. The information that the systems generate will help target action to cut injury rates. Now that the role of prevention from seat belts to fire safety is better understood, public health efforts are still hampered by lack of information on numbers, types, and circumstances of injuries. Monitoring systems are least developed in poorer countries, where the toll of deaths and disability is often highest. Although the guidelines are designed as a practical aid to setting up data collection systems in all settings, they are meant to be particularly useful in countries with severe restraints on resources. They explain how to set up simple, cheap but effective systems for collecting, coding, and processing data in places where there may be little or no electronic equipment, inadequate electricity supplies, few staff, and no research expertise. The manual reproduces model forms used in hospitals in South Africa, Jamaica, and Nicaragua. The WHO's injury surveillance guidelines are available at www.who.int/violence_injury_prevention/index.html.

VALUE OF SWIM LESSONS QUESTIONED

Parents who introduce toddlers to swimming programs before the age of 4 may be given a false sense of security about their child's safety. The American Academy of Pediatrics has published a policy paper on “Swimming Programs for Infants and Toddlers” (RE9940, volume 105, number 4) (www.aap.org/policy/re9940.htm) that says “Aquatic programs for infants and toddlers have not been shown to decrease the risk of drowning, and parents should not feel secure that their child is safe in water or safe from drowning after participating in such programs. Regardless of the program design or focus, infant and toddler aquatic programs are unable to ensure that children will understand water hazards, use appropriate avoidance strategies, or attain program safety goals. Currently, no data are available to determine if infant and toddler aquatic programs increase or decrease the likelihood of drowning. Programs that claim to make children safe in water or safe from drowning are misrepresenting what is possible and are giving parents a false sense of security about their child's safety in the water”.

The policy recommends:

  • Children are generally not developmentally ready for formal swimming lessons until after their fourth birthday.

  • Aquatic programs for infants and toddlers should not be promoted as a way to decrease the risk of drowning.

  • Parents should not feel secure that their child is safe in water or safe from drowning after participation in such programs.

  • Whenever infants and toddlers are in or around water, an adult should be within an arm's length, providing “touch supervision”.

  • All aquatic programs should include information on the cognitive and motor limitations of infants and toddlers, the inherent risks of water, the strategies for prevention of drowning, and the role of adults in supervising and monitoring the safety of children in and around water.

DROP IN NEW ZEALAND DROWNING DEATHS

New Zealand figures show a record low number of drownings last year, with the provisional death toll standing at 110, the lowest number of drownings in a year since records began in 1980. The previous low was 121 in 1999, while there were 134 drownings in 2000. Water Safety New Zealand executive director Alan Muir says there has been a dramatic fall in drownings since the peak of 214 in 1985. He credited the big drop to the safety programmes run by all the organisations involved in water activities, from the Coastguard to Swimming New Zealand.

DON'T FORGET YOUR CHILD

Each year, infants and small children die from being left in vehicles. NASA has developed a safety device to alert parents who inadvertently leave their children strapped in car seats. Inspired by flight test technology, the device uses precision materials and electronics to sense when a child is seated in a car seat or booster seat after the driver has left the vehicle. The child presence sensor, developed at NASA's Langley Research Center, serves as a second set of eyes and ears for distracted parents. It can be retrofitted to existing car seats. The sensor's driver alarm hangs on the driver's key ring, and sounds 10 warning beeps if the driver moves too far from the vehicle. If the driver doesn't return within one minute, the alarm will beep continuously and can't be turned off until it is reset by returning to the child safety seat. The sensor switch triggers immediately when a child is placed in the car seat and deactivates when the child is removed. The sensor detects weight once the child is placed in the seat, transmitting a unique code to the driver alarm via a radio frequency link.

WHO DISCUSSION ON VIOLENCE

The WHO Executive Board, made up of a sample of 32 member states, decides on strategic technical and administrative issues of importance for the organization and to set the agenda for the World Health Assembly. In January, it discussed a paper describing the World Report on Violence and Health and WHO's role in the prevention of violence. The full paper is available at www.who.int/gb/EB_WHA/PDF/EB109/eeb10915.pdf. The paper was well received with high level representatives of 18 countries and one non-governmental organization making comments, the largest number of interventions for any paper by the Executive Board.

MONSTERS AND BEARS RECALLED

About 39 000 copies of Monsters In The Closet children's board books are being recalled as the snap that secures the book could detach, posing a choking hazard to young children, the US CPSC announced in February. The CPSC and publishers Random House have not received any reports of injuries involving this book.

At the same time, Unilever Home and Personal Care USA announced the voluntary recall of about four million plush Snuggle(r) bears. The eyes and noses of these bears can come off, posing a choking hazard to young children. The company has received 32 reports of the eyes and noses coming off of these bears, with three of these reporting that children had placed detached eyes from these bears in their mouths.

RESEARCH ON IMPROVING PROTECTIVE CAPACITY OF HELMETS

The Australian Transport Safety Bureau has commissioned and published research on improving the shock absorbing liner in helmets. The report notes that approximately a quarter of motorcyclists and cyclists, wearing helmets, die from severe head injuries and that in another third of all fatalities severe head injuries were implicated. It argues that no significant safety improvement for bicycle and motorcycle helmets has been introduced in the last three decades and that problem with current helmets is that they do not effectively absorb impact forces nor do they properly decelerate and spread blows from the point of impact. The aim of the research was to develop a better impact absorbing liner than is currently being used in the manufacture of bicycle and motorcycle helmets. It was reported that researchers have indicated that helmet foam liners are too stiff and hard, that research on foam liners from fatal accidents showed little or no evidence of impact damage and that some research reported that the human skull distorted rather than the hard stiff foam liner, resulting in brain damage or death and that this “[indicates] a need for a softer absorbing liner”. It was argued that a dual density liner, combining low and high density foams in a particular configuration would reduce the proven safety deficiencies of the currently used single density hard-stiff foam liners. The research tested whether foam made of the new design performed better than existing material using tests specified in the Australian Standards for motorcycle and bicycle helmets. The report says that the new design of shock absorbing foam liner displayed “significantly more crushing, greater time-duration (interaction), less slab-cracking and recorded peak decelerations less than the required 300 g” (Morgan DE, Szabo LS. Improved shock absorbing liner for helmets. Australian Transport Safety Bureau, July 2001. Australian Transport Safety Bureau, PO Box 967, Civic Square ACT 2608, Australia).

Figure 1

“Parked cars kill kids” (NSW Police and NSW Department of Community Services).

$3 MILLION CRIB DEATH SETTLEMENT

In one of the largest settlements ever in a case involving an unsafe children's product, the makers of the Playskool Travel-Lite portable crib have agreed to pay $3 million to the family of a 16 month old child, whose strangulation death was tied to the faulty crib. Kolcraft Enterprises Inc, which manufactured the crib, and Hasbro Inc, which licensed the names Playskool to Kolcraft, will pay the family of Daniel Keysar who died in May 1998, after the Travel-Lite crib in which he was sleeping collapsed and strangled him. The settlement was announced in December as the case was about to go to trial.

Daniel Keysar's parents demanded that the settlement should be announced to be used as a tool to teach parents about the dangers of recalled children's products. Portions of the settlement will be used to fund Kids In Danger, an organization that educates parents about product safety issues and advocates for more comprehensive safety standards in children's products. The crib unexpectedly collapsed and the child became trapped in its folding side rails. He suffocated before daycare workers became aware of the problem.

The Kids In Danger executive director said that the death was all the more tragic because the Travel-Lite crib had been recalled five years before. In March 1993, Kolcraft recalled the 11 638 Playskool Travel-Lite portable cribs in circulation. The recall came after three infants were killed in accidents linked to the design of the product. Over the last decade, the organisation said, six children have died in Travel-Lite cribs and 16 have died in cribs using a similar design. As is often the case with recalls of children's products, only a fraction of the faulty Travel-Lite cribs were collected by the manufacturer.

SCHOOL HEALTH GUIDELINES

The CDC has released School Health Guidelines to Prevent Unintentional Injuries and Violence in the Recommendations and Reports series of the CDC's Morbidity and Mortality Weekly Report. The guidelines can be downloaded from www.cdc.gov.mmwr. For more information, contact CDC's Division of Adolescent and School Health at +1 888 231 6405, by email at heatlhyyouth{at}cdc.gov, or visit their web site at www.cdc.gov.nccdphp/dash.

VICTORIA INCREASES CONTROLS OF DRINK-DRIVING

The Australian State of Victoria has for many years deserved its position as a model for road safety action. After 2001 returned the worst motor vehicle accident deaths in a decade it appears that new work is required. On 21 December 2001, new requirements came into effect controlling drink driving. From that date drivers with blood alcohol reading of 0.07 or more automatically lose their licence for at least six months. First time offenders with a reading between 0.05 and 0.07 will receive 10 demerit points (12 demerit points result in loss of licence). The change removes magistrates' discretion to allow first time offenders to keep their licence in certain circumstances, usually for work or family reasons. Provisional drivers subject to zero alcohol restrictions will lose 10 points for a blood alcohol concentration below 0.05 and loss of licence for readings above 0.05. All motorcycle riders are required to have a zero reading for the first year. The examination of the law followed public discussion when a television personality was permitted to keep his licence and did not have a conviction recorded after returning a reading of 0.098. It was argued that many first time drink-drivers who bothered to take their case to court were allowed to keep their licence so the government acted to remove this discretion.

SAFEST YEAR ON NEW ZEALAND ROADS FOR 40 YEARS

On 1 January 2002 the New Zealand Transport Minister announced that 2001 was the safest year on New Zealand roads in nearly 40 years, with the death toll of 452, the lowest since 1964. The 2001 low beat the 2000 record low by 10. Higher visibility resulted from 183 highway patrol cars, part of a $152 million road safety package introduced last year, the first increase in road safety spending in nearly six years. The package also included almost doubling spending on community driver education programmes, more comprehensive breath testing (particularly in high risk rural areas) and tougher enforcement of speed restrictions and seat belt rules. The ministry noted that average speeds on the open roads were down in 2001, overall seatbelt wearing figures was at a record high and the police reported fewer drunk drivers on the roads.

WHO INITIATIVE ON ENVIRONMENTAL HAZARDS

The WHO has created a task force for the protection of children's environmental health to address the environmental hazards which specifically affect children. The fibst initiative to fight child mortality and morbidity linked to unhealthy environments was a conference in March 2002 held in Bangkok. WHO notes that inadequate drinking water and sanitation, indoor air pollution, and accidents, injuries and poisonings are three of the causes of the approximately three million deaths suffered annually by children under age 5 due to environmental hazards. Accidental injuries—including road traffic accidents, drowning, burns, and poisonings—are the cause of over 400 000 deaths per year in children under 5. Research suggests that over 40% of the global burden of disease due to environmental risk factors may fall on children under 5, even though they constitute about 10% of the world's population. The Bangkok Conference also examined ways in which the environment in places besides the home, notably schools, but also workplaces, can be made safer for children. Schools are of particular significance, as a healthy and secure school environment can help protect children from health hazards, abuse, and exclusion and can foster learning. “A commitment to child health means that hazards should be reduced in all places where children spend significant parts of their day, including the roads and forms of transport they use to get to and from these places” said Dr Richard Helmer, Director of WHO's department responsible for environmental health.

NEW NATIONAL EMERGENCY HOTLINE

Everyone in the US can now enjoy free 24 hour access to their regional poison control center through a single national, toll-free number—(800) 222 1222—that was launched on 30 January 2002. In the first full month of operation, the number received 44 000 calls about potential poisonings. The goal of National Poison Prevention Week, held in March, was to help reduce the annual toll of about 30 deaths to children under 5 years old. The poison control centers receive more than one million calls each year about unintentional poisonings of children under 5 years of age from medicines and household chemicals.

NEW ZEALAND TAKES ACTION ON BABYWALKERS

New Zealand has taken action to curb the injury risks associated with babywalkers. From 1 March 2002, compliance with the American (ASTM) Standard on babywalkers became mandatory. The regulation covers all new and second hand walkers; fines up to NZ$100 000 can be made.

FACT SHEETS REVISED

The 2002 fact sheets are now available in English and Spanish from Safe Ride News Publications. There have been major changes in many of the sheets and all have been reviewed by specialists in their fields. A number of illustrations have been upgraded and new ones added. To improve readability, font size has been raised in almost all fact sheets to at least 12 points. This has meant considerable rewriting, with simplified language throughout. Reading levels are sixth to seventh grade (using the Flesch reading ease scale). In several cases, information incorporates new American Academy of Pediatrics policy recommendations. Two fact sheets have been expanded: Air Bags and Kids Don't Mix and Learning about LATCH. Air Bags and Kids Don't Mix now incorporate how to identify a vehicle with airbags, need-to-know information on side impact air bags, and what to do if you have no space in the back seat for a child restraint. Learning about LATCH is now much less crowded and includes additional illustrations and answers to common questions. A more complete list of updates is on the web site www.saferidenews.com (extracted from Safe Ride News, January/February 2002).

SOCIOECONOMIC STATUS AND INJURY

Victorian injury data have been improved by the addition of information on socioeconomic status to the existing collection of injury data for deaths, hospitalisations, and emergency department presentation. To take advantage of this improvement an analysis of injury data by socioeconomic status has been undertaken and published in Hazard, the journal of the Victorian Injury Surveillance and Applied Research System (VISAR) at Monash University in edition 49, summer 2001/2. The report has a detailed analysis for death, admission, and hospital presentation and by major E code categories. The analysis confirms work elsewhere that people with low socioeconomic status are more likely to commit suicide, self harm, or suffer homicide and other assaults. When presenting to emergency departments high socioeconomic status people are more likely to be transferred to another hospital or to be admitted to hospital; when admitted high socioeconomic status people have significantly longer length of stays. Contact details: Accident Research Centre, PO Box 70A Monash University, Victoria 3800, Australia. Hazard can be downloaded from www.general.monash.edu.au/muarc/visar.

SUIT AGAINST GUN MAKERS GAINS GROUND IN ILLINOIS COURT

In a major victory for advocates of gun control, a court in Illinois ruled in January that gun makers and dealers can be sued for distributing firearms in a way that makes it easy for criminals and juveniles to obtain them, a practice that creates what the court said could amount to a public nuisance. The decision is the first by an appellate court to uphold a new legal approach being taken by many cities, lawyers, and victims of gun violence. The approach holds that gun makers knowingly create a public nuisance by the way they distribute their products. Gun control groups hope the Illinois decision could lead to successful lawsuits against an industry that has been largely immune to them.

GRIM STATISTICS ON OLDER MOTORCYCLISTS

Motorcycle deaths in the US jumped by more than a third from 1998 to 2000, with most of the increase involving middle aged riders on big bikes, according to a new study of data from the National Highway Traffic Safety Administration. The study, published in February's Annals of Emergency Medicine, showed that while riders over 40 still accounted for a minority of motorcycle deaths, they were the only group whose death rate increased over the last decade.

CALL FOR DRUGS AND DRIVING ACTION

The British Medical Association has called on the UK government to develop a campaign to highlight that taking drugs—whether prescribed, over the counter, or illegal—can impair driving capacity in a similar way to alcohol. Visit www.bma.org.uk to access the BMA's drugs and driving web site.

KIDSAFE WEEK IN OCTOBER

New Zealand's Kidsafe Week runs from 18–25 October this year, focusing on water safety especially among preschoolers, reports Plunket Safety Update. When this topic was last the theme of the week, research showed that it had a significant impact on people's actions, with half of those who received materials making changes to their homes.

The same issue of Safety Update reports significant increases in child restraint use in three regions, according to annual national surveys carried out by the Land Transport Safety Authority. The survey carried out at 66 sites revealed that average child seat use by the under 5 was 82%, 3% higher than in 2000.

UK INJURY PREVENTION COURSE

The second delivery of the UK's postgraduate level injury prevention short course will take place in October 2002 and February 2003. The move follows the results of the Department of Health funded evaluation, which showed that the students had problems with their workplace projects during the long summer holidays. Details of the course can be found on the Child Accident Prevention Trust web site, www.capt.org.uk.

TOLL-FREE NEW ZEALAND POISONS NUMBER

Thanks to funding from ACC, national toll-free access is now possible to the National Poisons Centre throughout New Zealand, after it had been shown that cost limited some people's access to the service. Calls to 0800 POISON have increased by 25% since it became free, according to Safekids News.

NHMRC FUNDING FOR INJURY PREVENTION RESEARCH

In November 2001, Australia's National Health and Medical Research Council announced funding for four injury prevention projects: policy response to indigenous petrol sniffing; risk factors for serious farm work related injury among adult males; improving vision to prevent falls: a randomised trial; and cohort study of risk factors for young male driver injuries. The grants totalled about A$1.85 million.

Contributors to these news and notes include Les Fisher, Anara Guard, Peter Jacobsen, Etienne Krug, John Langley, Barry Pless, Ian Scott, Jan Shield, and Amy Zierler. Michael Hayes has edited the contributions. Items for the December 2002 issue, including calendar entries, should be sent to Michael Hayes at the Child Accident Prevention Trust, 18–20 Farringdon Lane, London EC1R 3HA, UK (fax +44 (0)20 7608 3674, email mh{at}capt.org.uk) by 1 September 2002.

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