In conclusion, we observed that the replacement of CYA by TAC does not lead to a better management of severe SDNS.

INTRODUCTIONTo UNDERSTAND adult social behaviour we must know something of its development. Por the child, an important phase in the development of his social relations is the shift from the small circle of his family to the wider horizons of school and peer groups. This phase may be conveniently studied in a nursery school, which, for many children, represents their first encounter with a large group of like-aged children.The description and analysis of social behaviour in nursery schools was one of the dominant themes iti American child psychology in the 192O's and 193O's. Though some of the work was marred by a preoccupation with the nature-nurture pseudoquestion and naive motivational assumptions, much valuable descriptive work was achieved before the tradition was lost in the 194O's. Two of the reasons for this demise are pointed out in a perceptive and prophetic essay by Lawrence Frank in a volume that serves as a fitting memorial to the era (Barker, Kounin and Wright, 1943). "The skill and ingenuity that have been displayed in the construction and refinement of these instruments [I.Q,. tests] should be emphasized because at times it appeared that the interest of child psychologists was so absorbed in this occupation that it precluded much concern for or curiosity about the children themselves . . .[this] threatened to arrest the further developtnent of child psychology, in so far as other interests and problems not susceptible to psychometric formulation and approach were neglected." Prank was over-optimistic in writing this in the past tense, as he was when he pointed out that "the increasing prestige of the statistical method not only operated to condition the problems which students selected for study" but also produced anomalies which could not "be resolved because so little was known about the child subjects beyond sex and chronological age and the one or two measurements tbat had been obtained". These trends, coupled with the domination o^S~R psychology, killed the tradition.In the last few years we have seen a revival of interest in descriptive studies which may be largely attributed to a few ethologists who have turned their attention from animals to their own species. They are producing detailed descriptions of the expressions, gestures and movements of pre-school children (Blurton Jones, 1967; McGrew, 19G8) which are a necessary element for a successful analysis of social behaviour.The quality and quantity of social interaction is, in part, determined by the situation in which children meet. Por example, several studies have shown that social interaction varies with the occupation chosen by the child (Parten, 1933;Green, 1933} and is more marked in the absence of toys (Johnson, 1935). Restriction of

BackgroundManagement of proctitis refractory to conventional therapies presents a common clinical problem. The use of acetarsol suppositories, which are derived from organic arsenic, was first described in 1965. Data concerning clinical efficacy and tolerability are very limited.AimTo examine the efficacy of acetarsol suppositories for the treatment of refractory proctitis.MethodsA retrospective analysis was performed on patients with inflammatory bowel disease treated with acetarsol suppositories between 2008 and 2014 at Addenbrooke’s Hospital, Cambridge, United Kingdom. Clinical response was defined as resolution of symptoms back to baseline at the time of next clinic review.ResultsThirty-nine patients were prescribed acetarsol suppositories between March 2008 and July 2014 (29 patients with ulcerative colitis, nine with Crohn’s disease, and one with indeterminate colitis). Thirty-eight were included for analysis. The standard dose of acetarsol was 250 mg twice daily per rectum for 4 weeks. Clinical response was observed in 26 patients (68%). Of the 11 patients who had endoscopic assessment before and after treatment, nine (82%) showed endoscopic improvement and five (45%) were in complete remission (Wilcoxon signed-rank test p = 0.006). One patient developed a macular skin rash 1 week after commencing acetarsol, which resolved within 4 weeks of drug cessation.ConclusionAcetarsol was effective for two out of every three patients with refractory proctitis. This cohort had failed a broad range of topical and systemic treatments, including anti-TNFα therapy. Clinical efficacy was reflected in significant endoscopic improvement. Adverse effects of acetarsol were rare.

IntroductionThe prevalence of faecal incontinence (FI) in people with inflammatory bowel disease (IBD) has not been fully explored. FI is not only associated with social stigma but also with decreased quality of life. In the general population prevalence is estimated at between 1-10%. Awareness of the prevalence of FI in IBD is important to aid management strategies and resource allocation. Methods Aim: To investigate the prevalence of FI in adults with IBD in a tertiary care setting. Methods: We performed a cross sectional questionnaire survey of 380 adults attending IBD outpatients at Guy's & St.Thomas' Hospitals. Patient surveys were: the validated International Consultation on Incontinence -Bowels (ICIQ-B) questionnaire, detailing frequency and severity of bowel pattern, control and quality of life; and the non-validated Bowel Leakage questionnaire, detailing any prior interventions by health care professionals. Demographics of age, gender, diagnosis, Montreal classification, St Mark's Continence Score and disease activity were also recorded. Data was entered into a database and analysed using a SPSS statistical package. Results Median age was 38 years (IQR 31-50) and 180/380 (47%) were female. The mean duration of IBD diagnosis was 8.7 years (3.4-15.1). 151/380 (40%) had UC vs 229/380 (60%) CD. Overall, 255/380 (67%) reported FI as defined by any episode of uncontrolled bowel opening in the preceding three months, while 343/380 (90%) reported anal incontinence of flatus or faeces. Incontinence was strongly associated with disease activity, occurring during disease flares in 57% of people. However, 37% experienced incontinence both during relapse and remission, whilst only 5% experienced incontinence uniquely when in remission. The ICIQ-B control score was associated with current disease activity in CD (r = 0.29, p < 0.0001) but not in UC. There was no significant difference in FI prevalence between patients with Crohn's Disease (CD) or Ulcerative Colitis (UC), (66% vs 68%, p = 0.74). Conclusion Faecal incontinence in IBD increases in proportion to disease activity. Given the availability of specialist FI interventions and support, we recommend that sensitive questioning regarding FI should be part of routine disease surveillance in the outpatient setting to cater for this unmet need. Disclosure of Interest None Declared.