Gilles de la Tourette syndrome (TS) and idiopathic focal torsion dystonia are both movement disorders in which the pathologic process is thought to arise within the basal ganglia. However, despite their possible functional links, they are clinically distinct and are generally considered to have different underlying etiologies. There are several reports in the literature that suggest a relationship between eye winking tics, excessive blinking, and blepharospasm and a report of the coexistence of tics and dystonia. We describe a three‐generation family in which TS and dystonias cosegregate. In total, eight patients were affected, five with dystonia and three with TS/facial tics. One of the patients with historic evidence of dystonia subsequently died of motor neuron disease. The identification of this family further strengthens the evidence in favor of an etiologic relationship between some cases of Gilles de la Tourette syndrome and focal dystonia.

Distinguish between the clinical features of communicating and non-communicating hydrocephalus. Define the indications for external ventricular drains (EVD), ventriculo-peritoneal shunts and lumbar drains. Explain the practical aspects of EVD management in intensive care. Hydrocephalus, derived from the Greek words hydro (water) and kephalos (head), describes a congenital or acquired condition in which there is an excessive accumulation of cerebrospinal fluid (CSF) within the head. There is a wide range of causes, most of which involve obstructed CSF circulation or impaired absorption. 1

Tamar Lakes is comprised of two reservoirs, which are located in South West England and in the headwaters of River Tamar at approximately 135 m above ordnance datum. Upper Tamar Lake (UTL) is a direct feed source reservoir of potable water in North Cornwall. Immediately following completion in 1975, UTL was subject to intense blue‐green algal blooms that continue to the present. These blooms create operational problems for water treatment, especially in hot‐dry years. Lower Tamar Lake (LTL) was constructed as a water supply reservoir in 1819 and became obsolete following UTL coming on‐line. Detailed water quality investigations over a period of some 28 years have confirmed the source of nutrient enrichment that fuels the algal blooms to be agriculturally derived, corresponding with a substantial increase in livestock farming. Associated poor land management practices, such as extensive field drainage and inappropriate slurry disposal to land, are linked with substantial elevations in organic contaminants such as ammonia, biochemical oxygen demand (BOD) and suspended solids (SS) during rainfall events. Evidence demonstrates that both reservoirs act as primary treatment lagoons, substantially reducing the worst of these pollutants and providing significant environmental gain. The implications of the Common Agricultural Policy (CAP), the Water Framework Directive (WFD) and regulatory monitoring are discussed in relation to resource management.

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As an advocate for nursing assistants/healthcare assistants to join the RCN, and in light of the acceptance of this at last year'sRCN AGM, I was astounded that Nursing Standard produced the current nurses' pay poster starting at grade C. This ignores our colleagues and friends who work alongside us at grades A and B and could under minethe hard work many of us have made in showing the'assistants' that some members of the RCN value their input to nursing?