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Poet Kate Williams offers advice on setting up poetry-writing sessions with years 3-4, explaining how it can be a fun, creative and rewarding experience for all.

Objective To develop a valid and reliable interviewer-administered questionnaire to measure the presence and severity of storage abnormality symptoms of incontinence, urgency, frequency and nocturia. Subjects and methods Subjects were 930 men and women aged 40 years, taking part in a randomized controlled trial of a continence nurse practitioner (CNP) service. Criterion validity was tested by comparing questionnaire responses to 24-h pad test and 3-day urinary diary. Responsiveness was assessed by comparing questionnaire responses before and after treatment. Questions about urgency were investigated for construct validity in patients taking part in the trial who underwent urodynamic investigation (243). Test-retest and inter-rater reliability was measured at ≈ 6 days in subjects recruited to an associated epidemiological study (104 and 102, respectively). Results The questionnaire responses showed significant associations with pad-test and diary measures. Questions about the severity of daytime incontinence performed better than those measuring night-time incontinence. The response categories of soaked, wet, damp and almost dry had better associations with the pad test than other measures of the severity of incontinence. Test-retest and inter-rater reliability was good for all questions, and all were responsive to change in symptoms, showing significant differences before and after treatment. Conclusion There is a clear need for standardization of measurement using well-validated instruments. This interviewer-administered questionnaire is valid, reliable and sensitive to change in a wide range of severity of symptoms, and in both men and women aged 40 years. The questionnaire provides a useful assessment tool for primary and secondary care in research and clinical settings.

Adult diabetics ( N = 94) completed a questionnaire containing measures of diabetesrelated self-efficacy, outcome expectancies, social support and diabetes self-care. Self-efficacy was consistently associated with self-care in the areas of diet, exercise and blood glucose testing. Outcome expectancies were correlated with exercise and blood glucose testing. The relationship between self-efficacy and blood glucose testing was moderated by outcome expectancies, such that self-efficacy had a greater effect when combined with strong beliefs in outcomes. At low levels of self-efficacy, strong outcome beliefs were associated with poorer self-care. Social support was associated with exercise self-care, and diet-specific positive family interactions were associated with better diet adherence. The relationship between social support and exercise self-care was mediated by self-efficacy. When the effects of self-efficacy were controlled, social support was no longer a significant independent predictor of self-care. ...

The implementation of evidence-based interventions in clinical practice is often alluded to in the literature; however, the development of these interventions is rarely documented. Within continence care, there is a large body of relevant literature on which primary clinical interventions can be based. The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of inter-related studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. This article describes one aspect of the Leicestershire study, namely the development of evidence-based intervention protocols for use in a new nurse-led continence service. This service is currently being evaluated in a randomized controlled trial.

Background: Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed. Aims: To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage, degree of soiling, and level of impact on quality of life. Methods: In a cross sectional postal survey, 15 904 adults aged 40 years or more (excluding residents of nursing and residential homes) were selected randomly by household from the Leicestershire Health Authority patient register. Participants were asked to complete a confidential health questionnaire. Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more. Respondents were also asked if bowel symptoms had an impact on their quality of life. Results: From a total sample of 10 116 respondents, 1.4% reported major faecal incontinence and 0.7% major faecal incontinence with bowel symptoms that had an impact on quality of life. Major faecal incontinence was significantly associated with a lot of impact on quality of life (odds ratio 12.4, 95% confidence interval 7.5–20.6). Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women. Conclusions: This study has confirmed that faecal incontinence is a fairly common symptom, particularly in older people. Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high. Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life.

Many pathogens, including those infecting insects, are transmitted via dormant stages shed into the environment, where they must persist until encountering a susceptible host. Understanding how abiotic conditions influence environmental persistence and how these factors influence pathogen spread are crucial for predicting patterns of infection risk. Here, we explored the consequences of environmental transmission for infection dynamics of a debilitating protozoan parasite (Ophryocystis elektroscirrha) that infects monarch butterflies (Danaus plexippus). We first conducted an experiment to observe the persistence of protozoan spores exposed to natural conditions. Experimental results showed that, contrary to our expectations, pathogen doses maintained high infectivity even after 16 days in the environment, although pathogens did yield infections with lower parasite loads after environmental exposure. Because pathogen longevity exceeded the time span of our experiment, we developed a mechanistic model to better explore environmental persistence for this host-pathogen system. Model analysis showed that, in general, longer spore persistence led to higher infection prevalence and slightly smaller monarch population sizes. The model indicated that typical parasite doses shed onto milkweed plants must remain viable for a minimum of 3 weeks for prevalence to increase during the summer-breeding season, and for 11 weeks or longer to match levels of infection commonly reported from the wild, assuming moderate values for parasite shedding rate. Our findings showed that transmission stages of this butterfly pathogen are long-lived and indicated that this is a necessary condition for the protozoan to persist in local monarch populations. This study provides a modeling framework for future work examining the dynamics of an ecologically important pathogen in an iconic insect.

Abnormal visual experience during childhood often leads to amblyopia, with strong links to binocular dysfunction that can include poor acuity in both eyes, especially in central vision. In animal models of amblyopia, the non-deprived eye is often considered normal and what limits binocular acuity. This leaves open the question whether monocular deprivation (MD) induces binocular dysfunction similar to what is found in amblyopia. In previous studies of MD cats, we found a loss of excitatory receptors restricted to the central visual field representation in visual cortex (V1), including both eyes’ columns. This led us to ask two questions about the effects of MD: how quickly are receptors lost in V1? and is there an impact on binocular acuity? We found that just a few hours of MD caused a rapid loss of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor proteins across all of V1. But after a few days of MD, there was recovery in the visual periphery, leaving a loss of AMPA receptors only in the central region of V1. We reared animals with early MD followed by a long period of binocular vision and found binocular acuity deficits that were greatest in the central visual field. Our results suggest that the greater binocular acuity deficits in the central visual field are driven in part by the long-term loss of AMPA receptors in the central region of V1.

BACKGROUND Molecular phenotypes of invasive breast cancer predict early recurrence. Ductal carcinoma in situ (DCIS) exhibits similar phenotypes, but their frequency and significance remain unclear. To determine whether DCIS molecular phenotypes predict recurrence, 314 women (median age 57.7 years) with primary DCIS who were screened or entered DCIS trials in a specialist breast unit from 1990 to 2010 were studied. PATIENTS AND METHODS Expression of Ki67, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) within primary DCIS was established using immunohistochemistry (IHC). Patients were subdivided into molecular phenotypes using IHC surrogates [Luminal A (ER/PR+HER2-), Luminal B (ER/PR+/HER2+), HER2 type (ER and PR-/HER2+) or triple negative (ER/PR/HER2)] and recurrence rates compared. RESULTS Overall, there were 57 (18.2%) recurrences, 35 (11.2%) DCIS and 22 (7%) invasive cancer. A low rate of recurrence at 5 years was seen in Luminal A DCIS (7.6%), compared with 15.8%-36.1% in other phenotypes. Independent predictors of overall recurrence on multivariate analysis were involved (

Background The aim of the study was to establish the prevalence of urinary symptoms and felt need in adults. This paper discusses problems with setting thresholds to distinguish cases from non-cases in this field of research. Few studies have provided detailed age- and sex-specific prevalence estimates for felt need in relation to urinary symptoms. Methods A cross-sectional postal survey was carried out of 15 904 community-dwelling adults aged 40 years or more registered with general practitioners in Leicestershire. Subjects were selected randomly by household from the Leicestershire Health Authority Register. The postal questionnaire consisted of questions on general health, urinary and bowel symptoms, quality of life, service use and demographic characteristics. Results Thirty-four per cent of the sample reported clinically significant symptoms. The prevalence and severity of symptoms increased with age. However, only 2 per cent of the sample reported symptoms that were clinically significant, bothersome and socially disabling. Conclusion Urinary symptoms are very common in adults over 40 years of age living in the community. However, symptom-based estimates probably overestimate the level of need for health care in the community. It may be more effective and efficient to target services, in the first instance, on those people who report clinically significant symptoms that are bothersome or socially disabling. A consensus on thresholds and definitions of urinary symptoms is required to standardize clinical and research work and to target services more appropriately.

This study used qualitative methods to assess patients' views of a new nurse-led continence service that was being evaluated in a randomized trial as part of the Leicestershire Medical Research Council (MRC) Incontinence Study. The service was provided by a team of five nurses who had received a 3-month training programme on the assessment procedures and the evidence-based practice protocols. In-depth qualitative interviews were carried out by four trained interviewers with 23 respondents, seven male & 16 female (mean age 58 years), and were analysed using NUD*IST software. The main themes to emerge were related to the interpersonal skills and technical skills of the nurse and how these impacted on the effectiveness of treatment. An informal, friendly approach by nurses with good communication skills relieved patients' embarrassment and anxiety, giving them confidence and trust in the nurses, thus facilitating information exchange and effectiveness of care. Good communication skills conveyed the nurses' specialist technical skills and knowledge, encouraging patient compliance with treatments.

The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of interrelated studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms. This paper describes one aspect of the Leicestershire MRC Incontinence Study, namely the development, implementation and evaluation of a new nurse-led continence service. When developing a new service it is important to determine its acceptability and suitability to the target population. The new mode of service delivery was dependent on specially trained Continence Nurse Practitioners (CNP) delivering predefined evidence-based treatment interventions. Objective and subjective outcome measures were used to evaluate the service. The service was shown to be effective in reducing urinary symptoms and led to high levels of patient satisfaction. This service is currently being evaluated in a randomized controlled trial.

Background and Purpose —To establish prevalence of urinary symptoms among community-dwelling stroke survivors and how these symptoms affected lives of these survivors compared with a nonstroke population. Methods —The present study was a community-based postal survey in Leicestershire community, UK (that excluded institutional settings), that was designed to track stroke, urinary, and bowel symptoms and the effect of such symptoms on relationships, social life, daily activities, and overall quality of life. Subjects included 14 600 people who were living in the community and ≤40 years of age, randomly selected from the Leicestershire Health Authority Register. Results —A 70% response rate was achieved with the return of 10 226 questionnaires. Prevalence of reported stroke was 4% (n=423). Prevalence of urinary symptoms was 34% (n=3197). Overall, stroke survivors had a higher prevalence of symptoms than the nonstroke population (64% to 32%, respectively). These symptoms were reported to have more of an effect on the lives of the stroke survivors compared with the nonstroke population even when adjusted for age and sex differences. This reported impact was not related to the stroke per se but to the severity of the urinary symptoms. Conclusions —These data show a high prevalence of urinary symptoms among community-dwelling stroke survivors. These symptoms were reported to have considerable impact on the lives of stroke survivors, which needs to be taken into account in future research and clinical practice.

Diabetic foot problems are major complications of diabetes mellitus, and are often understated by nurses when assessing diabetic patients. Diabetes is a chronic disorder which affects people of all ages. Diabetes can affect the nerve and/or blood supply to the lower limbs (Pudner, 1998). This leads to complications such as foot ulcers. Foot ulcers have been found to be one of the most common reasons for a diabetic to be admitted to hospital (Fletcher, 1990). These ulcers are often difficult to heal, and can result in gangrene and loss of a limb.

Kate Williams and Elizabeth Griffiths outline the causes of malodorous wounds and present the various types of debridement and treatment available for this challenging problem.

Want to get your children fired up about reading and writing? An author visit is always an exciting option but it will require careful thought and advance planning.

It is generally recognized that the majority of health care has been largely based upon opinion rather than research evidence of clinical effectiveness. Attempts to rectify this have been initiated by increasing emphasis on the dissemination of findings. For example, in the UK this had been supported via the Cochran Collaboration and the Centre for Dissemination and Reviews. Dissemination does not, however, guarantee implementation. The complex nature of research utilization has been studied and obstacles identified that can influence the uptake of research by practising nurses. Sandra Funk and colleagues developed the BARRIERS Scale using this research and literature on research utilization. The scale may be helpful for identifying and measuring the barriers to research utilization perceived by nurses working within the UK and has formed the basis of the present study. A convenience sample of 316 comprising a broad spectrum of nurses working in the UK provided the data. Comparison is made with North American nurses from the studies used in the scale's development. The results suggest there ware items which are consistently perceived as either strong or negligible barriers by both groups of nurses. Differences, however, did emerge between nurses from the UK and North America on several items. These included the confidence in evaluating research and the perception of the nurse's authority to change patient procedures. Psychometric evaluation was also done. These findings are presented and discussed.

Community nurses need to have an up-to-date knowledge of which bandages are available on NHS prescription (i.e. on Drug Tariff) so that they can select the most appropriate bandage for their patient from those currently available. It seems that, for many years, both doctors and nurses have selected bandages for their patients without any clear knowledge of how the materials in the bandage will perform or what effect they will have (McCollum, 1992). Ideally, the nurse would first carry out an accurate assessment of the wound and then use this information to select an appropriate bandage, based on a full knowledge of its components, indications for use, and correct application technique. A bandage that is applied incorrectly can cause serious tissue damage. This article presents an up-to-date guide to the bandages currently available on Drug Tariff. However, since the Drug Tariff status of wound care products is constantly changing, community nurses need to keep up to date with the changes if they are to provide optimum care for their patients.

Introduction DCIS accounts for 20% of screen-detected breast cancers, but also presents symptomatically. Historically, approximately 5% of DCIS was thought to be symptomatic, but accurate evaluation of the presentation of symptomatic DCIS is needed to determine its incidence and tumour biology. Methods Clinico-pathological details of a consecutive series of patients presenting to a single breast-unit, with a pre-operative diagnosis of DCIS, were selected. Data included age, mode of presentation, pre-operative clinical and radiographical findings. The final tumour histology, operation, size, grade, ER status (and HER2 expression in invasive cases) were recorded. Results 375 patients had a pre-operative histological diagnosis of DCIS. 308 (82%) screen-detected (median age 59), 67 (18%) presented via symptomatic clinics (median age 50). At final histology 286 (74%) were pure DCIS, and 67 (23%) had an invasive focus. 43% (29/67) of symptomatic cases had an invasive focus at final histology versus 19% (60/308) screen-detected ( p ≤ 0.001). 31% (9/29) of symptomatic, versus 10% (6/60) of screen-detected cases with invasion were node positive ( p = 0.05). 45% (28/62) intermediate/high-grade symptomatic cases had an invasive focus at final histology, compared to 19% (57/297) intermediate/high-grade screen-detected cases. 86% (212/248) screen-detected pure DCIS was ER positive compared to 68% (26/38) symptomatically presenting pure DCIS ( p ≤ 0.001). Overall, 13% (38/248) pure DCIS presented symptomatically ( p = 0.001). Conclusions Overall, thirteen percent of pure DCIS present symptomatically. Nearly half of symptomatically presenting DCIS at core biopsy has an occult invasive focus and is more frequently ER negative. Symptomatic DCIS with an invasive focus is more likely to have lymph node involvement.

Appointment reminders help parents deal with complex immunization schedules. Preferred content of text-message reminders has been identified for English-speakers. Spanish-speaking parents of children under three years old were recruited to develop Spanish text-message immunization reminders. Structured interviews included questions about demographic characteristics, use of technology, and willingness to receive text reminders. Each participant was assigned to one user-centered design (UCD) test: card sort, needs analysis or comprehension testing. Respondents (N=54) were female (70%) and averaged 27 years of age (SD=7). A card sort of 20 immunization-related statements resulted in identification of seven pieces of critical information, which were compiled into eight example texts. These texts were ranked in the needs assessment and the top two were assessed for comprehension. All participants were able to understand the content and describe intention to act. Utilizing UCD testing, Spanish-speakers identified short, specific text content that differed from preferred content of English-speaking parents.

Freely accessible online, with a wide set of authors and a wider readership, First Monday can be seen as striving for global knowledge on the social aspects of the Internet. In a meta-analysis now underway, we found First Monday to be the third most prolific journal on a particular subject: local communities’ uses of information technology. Our study also sheds some light on what constitutes global knowledge. The data suggests that a synthesis of English-language published knowledge is a first step. It points to a bigger agenda: reaching into the world’s local settings in a proportionate and representative way. That would mean publishers outside the U.S. and U.K.; scholars in other countries; and studies in other languages. This is what it would take to learn from all our cultures and countries.

Background: Some say 'prison works', others say that it only harms. Overall, longitudinal studies of prisoners suggest some positive impact on mental state, but post-release recidivism is high. How do men at high risk for repeated imprisonment experience it? Aim: To explore prison (gaol) experience among men awaiting trial in custody. Methods: In a prospective longitudinal study, 170 men were interviewed just after reception about their social context and mental state and again three weeks later, when each was asked to describe his current prison experience; 75% had been in prison before. Data were analysed qualitatively and quantitatively. Results: Each man had views on his imprisonment. Data were saturated after 20 interviews. The core concern was its overall emotional impact, in full negative to positive range, with recognition that this could and did change in either direction, both passively and through active processes. Underpinning themes were along the dimensions of missing people to asylum from the outside world; in-prison bullying to positive staff and/or inmate relationships; boredom to relief in routine; and 'doing my head in' to salvation from drug-induced decline. Testing the model in the whole sample confirmed no association between prison impact and pre-prison factors. Negative experience was associated with severe depression within but not before this imprisonment. More positive experience related to good in-prison relationships. Conclusions: During pre-trial custodial detention, there is a greater range of experience than generally previously reported. The simple expedients of prison staff developing good relationships with prisoners, and facilitating these between prisoners, could be life-saving. Highly positive experiences may be more an indictment on community services than an endorsement of imprisonment.

In the previous chapters, international scholars have given evidence that low fertility rates and childlessness are rising around the world. But how does this play out in real life, where young mothers are daily making decisions to have or not to have more children? What reasons do current mothers give for having fewer babies, and what do they see as the barriers to larger families? The two principal authors here agreed to use their Mumsnet website to elicit some views. Within four days, there were more than 100 ‘postings’. Kate Williams was responsible for setting up the questions on the website.

The concept of a ubiquitous city, or uCity, is gaining attention worldwide. In a uCity, anyone is enabled by information and communication technologies (ICT) to do anything, anywhere, at any time. The uCity concept has spread more quickly than its implementation, which relies on a complex set of interrelated technologies, practices, and actors, including but not limited to the provision of ICT infrastructure, the availability and accessibility of information and services, and the adoption of mobile communication devices by a variety of users. To aid in measuring and implementing a uCity, we explore ways to measure the “ubiquity” of a city, with particular attention given to the first “A” above – i.e., “anyone”. Empirical findings from Chicago highlight: 1) ICT access, 2) the connectivity of institutions and individuals, and 3) the ubiquity of virtuality. A socio-technical perspective and social network and social capital theories guide this study. The underlying social and motivational processes are essential to all aspects of becoming a uCity. KEYWORDS: Ubiquitous city, urban planning, community informatics, Chicago

BackgroundAdherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. ObjectiveTo examine current forms of communication about immunization information, parents’ satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. MethodsStructured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen’s kappas > 0.70). ResultsRespondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20–41 years (mean = 29, SD 5), with one or two children (range 1–9). Nearly all (48/50, 96%) had an S-TOFHLA score in the “adequate” range. All parents (50/50, 100%) engaged in face-to-face contact with their child’s physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child’s name (21/172, 12%). ConclusionsMost parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.