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Liver disease, of which liver cirrhosis is the most advanced stage, constitutes the fourth most common cause of life-years lost in men and women younger than 75 years in England, where mortality rates from liver disease have increased by 25% in the past decade. Alcohol consumption is the most common modifiable risk factor for disease progression in these individuals, but within the UK, there is substantial variation in the distribution, prevalence, and outcome of alcohol-related liver disease, and no equity of access to tertiary transplantation services. These revised recommendations were agreed by an expert panel convened by the UK Liver Advisory Group, with the purpose of providing consensus on referral for transplant assessment in patients with alcohol-related disease, and clarifying the terminology and definitions of alcohol use in liver injury. By standardising clinical management in these patients, it is hoped that there will be an improvement in the quality of care and better access to liver transplant assessment for patients with alcohol-related liver disease in the UK.

St Helena is a British Overseas Territory. This paper investigates how an imagined and ideological link between Britain and the island was created, maintained and eventually weakened. British citizenship was removed in 1981. Since its return in 2002, many St Helenians have migrated to the UK. Whilst a sense of Britishness has weakened, a sense of lived Britishness has simultaneously occurred. Investigating the feelings, emotions and cultural values within this migrant community, the islanders are far from deluded about their downgraded national identity and, as a community, are willing to articulate their mixed emotions.

Introduction Alcohol-related Liver Disease (ArLD) is the most common indication for liver transplantation (LT) in the UK (30%) but many patients are deemed physically or psychologically unsuitable at the time of LT assessment and post-LT alcohol relapse rates remain high (1–2% Kawaguchi et al. 2014). A specialist high intensity ArLD clinic was established to optimise patient’s pre-LT assessment from a medical, addiction, psychological and nutritional perspective and evaluate high risk patients assessed for LT within a specialist MDT clinic environment. The clinic comprises of 2 Transplant Hepatologists, addiction psychiatry specialists, liver dietician & researchers. The aim was to review the impact of the high intensity clinic programme in patients transplanted for complications of ArLD cirrhosis. Methods Data was reviewed retrospectively from all patients attending clinic from inception, 25/5/2016- 31/9/2018. Electronic notes and alcohol addictions/transplant databases were interrogated. Patients were contacted anonymously (independent from health practitioners) by Psychology researchers for follow-up psychological data. Results 261 patients were seen, 247 (seen pre-LT) were included for analysis (173M: 74F), mean age 54y (SD±19.65), UKELD=53 (SD±5.63). 124 (50%) were presented in the transplant listing meeting, 71 (57.25%) accepted. 46 underwent LT at time of analysis, median waiting list time=39d [range 3–373]. 11/247 attendees (4%) had documented relapse within the programme pre-LT. 54/247 (21.9%) were referred to the high intensity clinic after being turned down by the transplant listing meeting, considered physically or psychologically unsuitable. Of these, 59.3% were re-presented after further intervention and subsequently listed. Of all attendees, 54 deaths (21.9%) were recorded on follow-up (2 on the LT waiting list & 4 post LT). Follow-up questionnaire completion rate was 78% (32/41) demonstrating high levels of patient engagement. Patient satisfaction with the clinic was high. Median follow-up post-LT was 13mo [range –8.4]). Post-transplant relapse in this high risk group managed in the high intensity clinic was 0/46 (0%)–vs 6/49 (12.2%, p Conclusion The High Intensity MDT clinic is an effective clinical environment for treating high risk patients and managing their physical and psychological risk factors. Specialist addiction-focussed MDT management enables patients who were initially deemed unsuitable for transplantation to be listed for surgery and is shown to significantly reduce short term relapse in this cohort of patients.

School nursing lecturers and specialist community public health nursing (school nursing) students have written to the Secretary of State for Health, to explain why investing in school nursing services to deliver tier one mental health care would be an efficient and cost-effective way to address the mental health crisis.

Vibrio cholerae cells, infected with the sex factor P, produce discrete, plaque-like clearings when plated on lawns of P − cells. We investigated the nature of these clearings and conclude that they are probably sites of active mating. We developed a quantitative assay for P + cells and used it to study the kinetics of sex factor spread in broth cultures. Both established and newly infected donor populations were efficient sex factor donors, indicating that P is not self-repressed. We also investigated the kinetics of recombinant formation in broth matings. In 1-hr matings, we routinely found recombination frequencies of 10 −6 per donor cell. Kinetic studies of recombinant formation showed that the markers tested all appeared at early times. Thus P, the V. cholerae sex factor, seems to resemble F in its transfer properties.

Classical and El Tor strains of Vibrio cholerae were examined for production of bacteriophage or bacteriophage-related material by electron microscopy of mitomycin C-induced cultures. The strains were also tested for pathogenicity by using the ligated ileal loops of adult rabbits. Of the 27 strains tested, 25 showed a correlation between the production of bacteriophage-related material and pathogenicity. Both P + and P − strains produced bacteriophage tails. The bacteriophage tails of strains 569B and ATCC 9168 and other strains were shown to occur in an extended form with tail appendages.