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Non-native trees profoundly alter the structure and resilience of native forest ecosystems through direct or indirect effects on ecosystem processes, e.g. by altering invertebrate communities, but such effects are poorly understood in New Zealand. We sampled adjacent stands of the non-native tree Douglas fir (Pseudotsuga menziesii) and native beech (Nothofagaceae) forests and tested whether the overall invertebrate communities varied across forest types. We then assessed whether natural enemies, both trophic-generalist predators and more trophic-specialist parasitoids, differed across forest types. We found a trend for lower overall invertebrate family diversity in Douglas fir plantations compared to native beech forests. Parasitoid abundance was lower in Douglas fir forests compared to native beech forests, although we could not tease apart whether these effects were due to differences in forest age, forest type, or a combination of these factors. Our findings suggest that there are subtle shifts in invertebrate community composition from native forests to non-native forests, and that trophic specialisation might play a key role in determining which natural enemies can inhabit non-native forests in New Zealand. Nevertheless, our small sample size calls for further exploration of these patterns. [ABSTRACT FROM AUTHOR]

The integration of ethics in engineering education has largely been focused at the curriculum design level. The authors posit that this integration be done at the accreditation level and investigate how ethics may be more extensively incorporated in the documentation of a particular engineering accreditation body's qualification standards. The paper proceeds, by means of a narrative review, to justify an expanded conception of the teaching of ethics within engineering education. It builds a synthesis of contrasting conceptual approaches to the teaching of ethics within engineering and proposes a conceptual framework to guide both regulators and educators to identify and engage with different elements of the ethics across the curriculum within an engineering programme. The South African case study provides a context to engage with existing policy formulation around programme accreditation and to demonstrate the application of the proposed conceptual framework across the graduate attributes so to indicate how ethics might be more comprehensively integrated within a programme. This demonstrates that ethics needs to be repositioned at the centre of the preparation of engineers, rather than at the periphery. The expected consequence of this integration is the more extensive incorporation of ethics within and across accredited engineering programmes. [ABSTRACT FROM AUTHOR]

Introduction: Although the direct oral anticoagulant rivaroxaban is recommended for stroke prevention in patients with non-valvular atrial fibrillation based on Phase III clinical trials, there is still a need for additional safety data from everyday clinical practice. The ROSE study was initiated to collect further information on the safety and utilisation of rivaroxaban in a broader range of patient groups in routine clinical practice. Methods and results: The ROSE study was conducted in hospitals in England and Wales. Consenting adults with non-valvular atrial fibrillation newly started on rivaroxaban were eligible and followed up for 12 weeks. Data was derived through secondary use of medical records. The primary outcome was major bleeding within gastrointestinal, urogenital and intracranial sites. A total of 4846 patients were enrolled in the study September 2013 to January 2016, 965 of which were treated with rivaroxaban for non-valvular atrial fibrillation. The median age in the rivaroxaban non-valvular atrial fibrillation cohort was 76 years, 53.6% were male. The median HAS-BLED score was 2 and the median CHA2DS2-VASc score was 4. The risk of major bleeding within each of the primary sites of gastrointestinal, urogenital and intracranial during the 12 week observation period was low (0.2%; n = 2). The risk of major bleeding in all sites was 1.0% (n = 10) at a rate of 5.5 events per 100 patient years. Conclusion: In terms of the primary outcome risk of major bleeding within gastrointestinal, urogenital and intracranial sites during the 12 week observation period, the risk estimates in the non-valvular atrial fibrillation rivaroxaban user population were low (<1%), and consistent with risk estimated from clinical trial data and in routine clinical practice. [ABSTRACT FROM AUTHOR]

In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8 × 10 6 copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG. [ABSTRACT FROM AUTHOR]

Reduction of hospital-acquired pressure ulcers is a patient and nursing priority. Although evidence-based interventions to prevent such ulcers are well known, reducing this healthcare burden has proven consistently difficult. Via case studies, this article describes how a bundle approach to pressure ulcer prevention may be adapted for use within different clinical areas. It illustrates how collaborative learning may facilitate the spread of improvement work across a health board and build improvement skills within nursing. [ABSTRACT FROM AUTHOR]

Reduction of hospital-acquired pressure ulcers is a patient and nursing priority. Although evidence-based interventions to prevent such ulcers are well known, reducing this healthcare burden has proven consistently difficult. Via case studies, this article describes how a bundle approach to pressure ulcer prevention may be adapted for use within different clinical areas. It illustrates how collaborative learning may facilitate the spread of improvement work across a health board and build improvement skills within nursing. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatitis B e antigen (HBeAg) seroconversion is an important clinical and virological “landmark” during chronic hepatitis B virus (HBV) infection. Mutant viruses carrying the precore G1896A and/or the basal core promoter (BCP) A1762T/G1764A mutations are associated with HBeAg seroconversion. However, the exact role of these mutants in HBeAg seroconversion remains unclear, partly because the evolution of these mutant viruses before and after seroconversion has not been well studied. Methods: Using our novel mutant quantification methods, the percentage of the mutant viruses was analyzed both cross-sectionally and longitudinally, before and after seroconversion. Results: Cross-sectional analysis showed that the percentage of both precore and BCP mutants gradually increased with age in the HBeAg-positive population. Follow-up of 18 HBeAg-positive patients revealed that the mutant percentage may stay low and stable for many years, followed by a steady increase in the percentage of G1896A and/or A1762T/G1764A mutants, from <10% to 50–100%, within about 3 years prior to seroconversion. In all cases, increase of mutant percentage was preceded or accompanied by elevated serum alanine aminotransferase. After the seroconversion, the mutant percentage could remain high or decrease significantly, sometimes to below 20%. Conclusions: Levels of G1896A and A1762T/G1764A mutants (of genotypes B and C) in the HBeAg-positive patients may predict the time of HBeAg seroconversion. The dominance of these mutants in the HBeAg-positive phase is more likely the result of immune selection rather than the enhanced replication capability of the mutants. However, anti-HBe antibody may not be a major selection force for these mutants. [Copyright &y& Elsevier]

The article presents the study which examines how patient's weight is incorporated in the existing health care systems that requires an accurate measurement to ensure positive patient outcome. It explains that the risk of complications and adverse outcomes increases when the patients are not weighed in the prescribing high risk medicines (HRM). It recommends that patient weight must be a mandatory element for the admission process for compliance monitoring.

Abstract: Background: Hepatitis B virus (HBV) precore G1896A mutation is associated with Hepatitis B e antigen (HBeAg) seroconversion. This mutation and the adjacent G1899A mutation also appear to associate with increased risk of hepatocellular carcinoma. Quantitative mutant dynamics may help determine the potential of these mutants as clinical biomarkers. However, a reliable method to quantify either mutant is not available, partly because the viral genome has polymorphisms in general and the precore mutations are complex. Objectives: (1) To develop a reliable and ultrasensitive assay for the quantification of HBV G1896A and/or G1899A mutants. (2) To obtain preliminary data on the quantities of the precore mutants in patients. Study design: A SimpleProbe real time PCR assay was developed to quantify the HBV precore mutants. Dual melting analysis and a primer-probe partial overlap approach were used to increase detection accuracy. A wild-type selective PCR blocker was also developed to increase mutant detection sensitivity. Results: The assay correctly identified the precore sequence from all 62 patient samples analyzed. More than 97% of precore sequences in the GenBank can be recognized. Mutant detection sensitivity reached 0.001% using a wild type-selective PCR blocker. At least one precore mutant can be detected from all 20 HBeAg-positive individuals who were negative for precore mutations by DNA sequencing. Conclusions: The reliability of this ultrasensitive mutation quantification assay was demonstrated. The same approaches may be useful for the detection of other clinically significant mutations. Evolution of the precore mutants warrants further studies. [Copyright &y& Elsevier]

Objectives: There has been a large influx of central and east European (CEE) migrants to the U.K. following the expansion of the European Union. This paper examines factors associated with genitourinary medicine (GUM) clinic attendance and sexually transmitted infection (STI) diagnosis among CEE migrants in London.Methods: A survey of sexual behaviour was conducted among CEE migrants attending two central London GUM clinics (n=299) and community venues in London (n=2276). Routinely collected clinic data were also analysed.Results: CEE migrants made up 2.9% of male and 7.0% of female attendees at the clinics. Half the women attending sessions for female sex workers were from CEE countries, and paying for sex was widely reported by men. Women were more likely than men to have attended a GUM clinic in the U.K. (7.6% vs. 4.5%, p=0.002). GUM survey respondents were more likely than community survey respondents to report one or more new sexual partners in the past year (women 67.9% vs. 28.3%, p < 0.001; men 75.6% vs. 45.1%, p < 0.001) and homosexual partnership(s) in the past 5 years (men 54.3% vs. 1.8%, p < 0.001), but were less likely to report assortative heterosexual mixing (women 25.9% vs. 74.2%, p < 0.001; men 56.5% vs. 76.3%, p < 0.001).Conclusions: CEE patients make up a notable minority of patients attending two central London GUM clinics. Higher numbers of sexual partners, homosexual partnerships and sexual mixing with people from outside the country of origin are associated with GUM clinic attendance. Heterosexual CEE men report behaviours associated with HIV/STI acquisition but appear to be underutilising GUM services. [ABSTRACT FROM AUTHOR]

Background: Since May 2004, 10 central and east European (CEE) countries have joined the European Union. While HIV rates remain low among men who have sex with men (MSM) in CEE countries, there is no research on the sexual behaviour of CEE MSM in the U.K.Methods: CEE MSM living in the U.K. (n=691) were recruited for an online questionnaire by two popular MSM websites.Results: The majority of men had arrived in the U.K. since May 2004. A previous sexually transmitted infection (STI) diagnosis was reported by 30.7%, and 4.8% reported being HIV positive, the majority diagnosed in the U.K. Unprotected anal intercourse with a casual partner of unknown or discordant HIV status was reported by 22.8%. Men who had been in the U.K. for longer (>5 years vs. <1 year) reported more partners in the past 5 years (67.2% vs. 50.4% had >10 partners, p < 0.001) and were less likely to report their most recent partner was from their home country (14.9% vs. 33.6%, p < 0.001). Among migrant CEE MSM living in London, 15.4% had been paid for sex in the U.K. and 41.5% had taken recreational drugs in the past year.Conclusion: CEE MSM in the U.K. are at risk for the acquisition and transmission of STI and HIV through unprotected anal intercourse with non-concordant casual partners. Sexual mixing with men from other countries, commercial sex and increased partner numbers may introduce additional risk. This has important implications for the cross-border transmission of infections between the U.K. and CEE countries. [ABSTRACT FROM AUTHOR]

Background: Accession of 10 Central and Eastern European (CEE) countries to the E.U. resulted in the largest migratory influx in peacetime British history. No information exists on the sexual behaviour of CEE migrants within the U.K. The aim of this study was to assess the sexual lifestyles and health service needs of these communities.Methods: A survey, delivered electronically and available in 12 languages, of migrants from the 10 CEE accession countries recruited from community venues in London following extensive social mapping and via the Internet. Reported behaviours were compared with those from national probability survey data.Results: 2648 CEE migrants completed the survey. Male CEE migrants reported higher rates of partner acquisition (adjusted OR (aOR) 2.1, 95% CI: 1.3 to 2.1) and paying for sex (aOR 3.2, 95% CI: 2.5 to 4.0), and both male and female CEE migrants reported more injecting drug use (men: aOR 2.2, 95% CI: 1.3 to 3.9; women: aOR 3.0, 95% CI 1.1 to 8.1), than the general population; however, CEE migrants were more likely to report more consistent condom use and lower reported diagnoses of sexually transmitted infections (STI). Just over 1% of respondents reported being HIV positive. Most men and a third of women were not registered for primary care in the U.K.Discussion: CEE migrants to London report high rates of behaviours associated with increased risk of HIV/STI acquisition and transmission. These results should inform service planning, identify where STI and HIV interventions should be targeted, and provide baseline data to help evaluate the effectiveness of such interventions. [ABSTRACT FROM AUTHOR]

Background: Following the expansion of the European Union, there has been a large influx of Central and East European (CEE) migrants to the UK. CEE men who have sex with men (MSM) represent a small minority within this population that are none-the-less important to capture in sexual health research among the CEE migrant community. This paper examines the feasibility of recruiting CEE MSM for a survey of sexual behaviour in London using respondent driven sampling (RDS), via gay websites and in GUM clinics. Methods: We sought CEE MSM to start RDS chain referral among GUM clinic attendees, our personal contacts and at gay events and venues in central London. We recruited CEE MSM (n = 485) via two popular websites for gay men in Britain (March-May 2009) and at two central London GUM clinics (n = 51) (July 2008-March 2009). Results: We found seventeen men who knew other CEE MSM in London and agreed to recruit contacts into the study. These men recruited only three men into the study, none of whom recruited any further respondents, and RDS was abandoned after 7 months (July 2008-January 2009). Half of the men that we approached to participate in RDS did not know any other CEE MSM in London. Men who agreed to recruit contacts for RDS were rather more likely to have been in the UK for more than one year (94.1% vs 70.0%, p = 0.052). Men recruited through gay websites and from GUM clinics were similar. Conclusions: The Internet was the most successful method for collecting data on sexual risk behaviour among CEE MSM in London. CEE MSM in London were not well networked. RDS may also have failed because they did not fully understand the procedure and/or the financial incentive was not sufficient motivation to take part. [ABSTRACT FROM AUTHOR]

Bedrails are used extensively in both the hospital and community care settings to protect vulnerable people from falling out of bed. However, there is evidence of indiscriminate bedrail use and some inadvertent use of bedrails as a form of restraint, which in turn may compromise patient safety, dignity and autonomy. This article describes a night-time bedrail audit undertaken in one integrated NHS trust to determine the numbers and types of bedrails in use, the patient demographic, locations where bedrails were used and, importantly, why staff decided to use them. The information collected was used to inform local policy development and improve practice. The implications of the audit findings for practice are discussed, and a new decision aid for the use of bedrails is presented. [ABSTRACT FROM AUTHOR]

Background: Since May 2004, ten Central and Eastern European (CEE) countries have joined the European Union, leading to a large influx of CEE migrants to the United Kingdom (UK). The SALLEE project (sexual attitudes and lifestyles of London's Eastern Europeans) set out to establish an understanding of the sexual lifestyles and reproductive health risks of CEE migrants. CEE nationals make up a small minority of the population resident in the UK with no sampling frame from which to select a probability sample. There is also difficulty estimating the socio-demographic and geographical distribution of the population. In addition, measuring self-reported sexual behaviour which is generally found to be problematic, may be compounded among people from a range of different cultural and linguistic backgrounds. This paper will describe the methods adopted by the SALLEE project to address these challenges. Methods: The research was undertaken using quantitative and qualitative methods: a cross-sectional survey of CEE migrants based on three convenience samples (recruited from community venues, sexual health clinics and from the Internet) and semi-structured in-depth interviews with a purposively selected sample of CEE migrants. A detailed social mapping exercise of the CEE community was conducted prior to commencement of the survey to identify places where CEE migrants could be recruited. A total of 3,005 respondents took part in the cross-sectional survey, including 2,276 respondents in the community sample, 357 in the clinic sample and 372 in the Internet sample. 40 in-depth qualitative interviews were undertaken with a range of individuals, as determined by the interview quota matrix. Discussion: The SALLEE project has benefited from using quantitative research to provide generalisable data on a range of variables and qualitative research to add in-depth understanding and interpretation. The social mapping exercise successfully located a large number of CEE migrants for the community sample and is recommended for other migrant populations, especially when little or no official data are available for this purpose. The project has collected timely data that will help us to understand the sexual lifestyles, reproductive health risks and health service needs of CEE communities in the UK. [ABSTRACT FROM AUTHOR]

Objectives: To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain. Methods: The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001. Results: No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064). Conclusions: The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population. [ABSTRACT FROM AUTHOR]

The article reports on the competence of doctors to accurately self-assess their strengths and weaknesses in their practice in Great Britain. The current postgraduate system of appraisal, continuing professional development and, indeed, re-accreditation is based on the ability of doctors to accurately identify learning and developmental needs and to address them honestly. However, some are skeptical regarding the solid evidence to support the data generated by doctors.

Random case analysis (RCA) is a commonly used method of one-to-one teaching in general practice, having the advantages that it may identify unsuspected learning needs, is directly related to the general practitioner's (GP's) work, and encourages continuing reflection and lifelong learning. Development and assessment of GP trainers' skills in this method of teaching are an important part of their teacher training. The aim of this project was to develop a profile or rating scale for RCA with good content validity, that will help teachers to recognise, understand and develop the teaching skills needed for RCA. Initial steps were to modify an existing unpublished scale, drawing on the experience of senior educators and on the existing literature on tutorial rating scales and one-to-one teaching. The resulting profile was sent to GP educators in Yorkshire with a questionnaire on its content and usefulness. The profile was also used by the authors to rate a selection of videotapes of RCA. Modifications were made to the profile in the light of the questionnaire results and the rating exercise. [ABSTRACT FROM AUTHOR]

The poverty reduction strategy paper (PRSP) approach has taken centre stage in development asssistance over the past five years. International endorsement of the approach has led to important gains in government focus on poverty reduction, civil society participation and donor behaviour. Yet PRSPs also potentially offer a much greater contribution to aid effectiveness, good governance and poverty reduction in developing countries. With a second generation of PRSPs now set to appear, this article examines the technical and political challenges that need addressing to realise their potential over time. Emerging issues include how to respond to political transitions, alternative design approaches, how to assess financing needs, and ways of enhancing the predictability of aid. [ABSTRACT FROM AUTHOR]

The written submission for summative assessment of UK general practice registrars (GPRs) may either take the form of an audit (Committee of General Practice Education Directors, COGPED) or one of a range of different types of project (National Project Marking Schedule, NPMS). Concern has been expressed that these two methods may not be measuring the same level of competence in written skills. This study compares the outcomes of audit marking using the two methods between two deaneries and four national markers, and explores the differences between the results. Examination of the projects where the results were different suggested that GPRs needed to be exact in their use of terminology for the COGPED schedule. In both cases, the message for GPRs is that they should pay close attention to the marking criteria of the method they have chosen. [ABSTRACT FROM AUTHOR]

Random case analysis (RCA) is a commonly used teaching tool in general practice, but there is very little published literature about it. Trainers in Yorkshire are asked to submit a videotape of teaching using RCA as part of trainer reappointment. The wide range of teaching ability demonstrated prompted us to rethink our program for teaching trainers about the use of random case analysis. This paper describes an action research project to define what we consider to be good practice in RCA, and the development of our new teaching package for trainers to promote this. Evaluation so far has been mainly at the level of participant reaction, although there has been an informal review of new trainers' performance using videos of them teaching whilst using RCA. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the use of personal education plans (PEPs) as a method of continuing professional development (CPD), by means of a questionnaire, analysis of completed PEP reports, and in-depth interviews. The setting was the Yorkshire Deanery, and the participants were general practitioners (GPs) who had completed a PEP. The main outcome measures were reported identification of learning needs, educational methods used, and support received. GPs' views were received on their experiences of undertaking PEPs, personal and professional development, and changes in patient care that resulted from their PEPs. Personal impression was the most frequently used method of deciding on learning needs. A variety of educational methods were used, the most frequent being personal reading, practical sessions, and taught courses. The majority of respondents felt that they were well supported by their GP tutors, and that the PEP had helped them to enhance their personal knowledge and skills, as well as to improve service to patients. There were gains in terms of increased confidence and self-awareness. Most were keen to use PEPs in future, and hoped to involve other members of the practice. Our results suggest that PEPs are an effective method of CPD in that they frequently lead to reported changes in patient care, and personal and professional development of the learner. [ABSTRACT FROM AUTHOR]

Examines insulin resistance and beta-cell dysfunction as therapeutic targets in type 2 diabetes. Molecular mechanisms of insulin resistance; Islet beta-cell function; Defects in the kinetics of insulin secretion.

In this study, we investigated whether a type of retroviral interference might be one mechanism that mediates the powerful protection induced by live attenuated SIVC8. Our results show that retroviral interference could be demonstrated between SIV and SHIV-HXBc2 in human T-cell lines chronically infected with either SIVC8 or SIVJ5. Lymphocytes from macaques infected with live attenuated SIVC8 were significantly less sensitive (P < 0.05) to in vitro infection by virulent SIVJ5 and SHIV-HXBc2 than were lymphocytes from naïve controls. However, this significant difference in the sensitivity of lymphocytes to virus infection was not observed for more efficiently replicating viruses such as SHIV[SUBSF33] and SIVsm3. Virus growth was significantly enhanced (P < 0.01) by depletion of CD8+ T-cell, suggesting a role for these cells in the control of SIV replication, both in vitro and in vivo. We found that levels of the β-chemokines regulated upon activation, normal T-cell expressed and secreted, macrophage inflammatory protein-1α and macrophage inflammatory protein-1β did not correlate with inhibition of virus replication. Taken together, our findings do not support the hypothesis that retroviral interference is the mechanism by which live attenuated SIVC8 induces protection. [ABSTRACT FROM AUTHOR]

Describes the characteristics of patients consulting their general practitioners with the main complaint of fatigue in England. Prediction of fatigue symptoms; Association of psychological disturbances with the duration of fatigue; Factors contributing to the low yield of laboratory tests.

Determines the criteria used for the admission of general practitioners to child health surveillance lists in Great Britain. Basis of the criteria; Guidelines of the Department of Health on child health surveillance; Importance of agreed policies between family practitioner committees and district health authorities.

The author reflects on research which examined retinopathy, plasma glucose, and the diagnosis of diabetes. He suggests that with data derived from the research the practice of using the presence of signs of retinopathy to determine a cutoff to define diabetes should be questioned. He argues that physicians should focus less on a single universal cutoff and instead target resources based on individual risk scores where measures of glycemia are combined with other risk factors..

Background Consultation skills are vitally important in general practice (GP), and now form part of the summative assessment of GP registrars in the UK. GP trainers need to be skilled in teaching consultation skills, and also need the time and resources to ensure that their registrars are competent in consultation skills. Aims To describe the teaching methods used by GP trainers in one deanery, the frequency of teaching of consultation skills, the problems encountered and the training that GP trainers have themselves received both in consultation skills and how to teach them. Method Postal questionnaire survey of all the 164 trainers in the Yorkshire Deanery. Results Replies were received from 129 trainers (response rate 79%) of which 123 could be analysed. Of these trainers, 45 (37%) trainers taught consultation skills fewer than five times a year, 45 (37%) five to 10 times, and 14 (11%) more than 10 times a year. A total of 24 trainers reported problems with teaching consultation skills, most commonly lack of time, technical difficulties, and unreceptive registrars, and 97 (79%) trainers had had some postgraduate training in consultation skills with 112 (91%) reporting some form of teacher training. Conclusion There is considerable variation in the reported frequency of teaching consultation skills, the models used, and the preparation of trainers for teaching, despite a systematic approach to teacher training in the Yorkshire Deanery. [ABSTRACT FROM AUTHOR]

Describes two cases in which myelinolysis followed recurrent vomiting due to diabetic gastroparesis in the absence of documented electrolyte changes. Background information on the diabetic patients; Mechanisms underlying myelinolysis; Factors that may contribute to the development of myelinolysis.

As part of the risk management plan in Europe, this study was conducted to characterize drug utilization patterns of Seasonique, a 91 day extended levonorgestrel-containing combined oral contraceptive (COCLNG). A retrospective observational study was conducted in France, Italy and Belgium using electronic medical record databases obtained from general practitioners (GPs) in all participating countries and gynecologists in France from 2015 to 2018. The study population included women receiving ≥1 prescription of 91 day COCLNG during the study period. Prescribing patterns of 91 day COCLNG were examined including: (1) treatment duration; (2) indication; (3) use of combined oral contraceptive (COC) before 91 day COCLNG initiation; and (4) switch from and to combined hormonal contraceptives (CHCs) or other contraceptives. Totals of 235, 220, 207 and 659 women using 91 day COCLNG were identified in French, Italian and Belgian GP, and French gynecologist databases, respectively. Across databases, 46–76% of women were prescribed a single 91 day COCLNG prescription and median treatment duration ranged from 3 to 6 months. The most common indication was contraception (42–81%), followed by menstrual migraines (2–14%). Use of COC during the 6 months prior to 91 day COCLNG initiation was 14% across GP databases, but was lower (8%) in the French gynecologist database. The frequency of switching from 91 day COCLNG to CHCs or other contraceptives was generally low (5–12%), with the highest proportion being among patients of French gynecologists. Findings indicate that 91 day COCLNG was prescribed for relatively short durations and predominantly as indicated for contraception. Most results were comparable across all participating countries. Findings from this drug utilization study in European databases across general practitioners and French gynecologists confirmed that 91 day extended levonorgestrel-containing combined oral contraceptive (COCLNG) was prescribed for relatively short durations (median 3–6 months); predominantly for the intended indication of contraception. Combined oral contraceptive use during the 6 months prior to 91 day COCLNG initiation, and switching from 91 day COCLNG to combined hormonal contraceptives or other contraceptives, were generally low (14% or less). These findings were mostly consistent across participating countries. [ABSTRACT FROM AUTHOR]

Background: Fontan surgery, a palliative procedure for single ventricle patients, often leads to the need for permanent pacing. Epicardial pacing has limitations, while transvenous pacing carries risks in the Fontan circulation. This case series introduces a novel approach of leadless pacemaker implantation in the extra‐cardiac Fontan (ECF) cohort to overcome these limitations. Methods: The study includes four cases of leadless pacemaker (Micra™) implantation in patients with ECF. Procedures were performed under general anesthesia with guidance from trans‐esophageal echocardiography. Various access routes were used, including trans‐carotid and trans‐fenestration approaches. Procedural details, parameters, and follow‐up data were collected. Results: All leadless pacemaker implantations were successful, with satisfactory electrical parameters and stable pacing postprocedural outcomes during short‐term follow‐up. One patient required closure of their fenestration for symptomatic desaturation post procedurally. Conclusions: Leadless pacemaker implantation via trans‐carotid and trans‐fenestration approaches appears to be a feasible back up option for pacing in Fontan patients where other options have been exhausted or there is a patient choice to avoid surgery. These techniques provide an option to avoid leaded systems or epicardial pacing, reducing the need for multiple thoracotomies and addressing challenges associated with surgical pacing leads. Further studies are needed to evaluate long‐term outcomes and assess the broader application of leadless pacemakers in the Fontan population. [ABSTRACT FROM AUTHOR]

Introduction: The Advisory Committee on Immunization Practices recommends administering the first dose of hepatitis B vaccine at birth, making it the first vaccine that many children receive. However, few studies examine whether children who miss the birth dose are at increased risk of vaccination delay. This study investigates birth dose as a determinant of up-to-date immunization status at age 18 months, considering 7 core childhood vaccine series: diphtheria, tetanus, and acellular pertussis; polio; measles, mumps, and rubella; Haemophilus influenzae type B; varicella; hepatitis B; and pneumococcal conjugate vaccine.Methods: Cross-sectional data were collected in 2017 by National Immunization Survey-Child, a nationally representative survey of children aged 19-35 months living in the U.S., and were analyzed in 2019. The primary outcome was combined 7-vaccine series (4:3:1:3:3:1:4) up-to-date status at 18 months. Doubly robust estimates of association were calculated using survey logistic regression and propensity scores estimated with boosted classification and regression trees.Results: Children who received the birth dose had 2.01 (95% CI=1.74, 2.33) times the odds of being up-to-date on the combined 7-vaccine series as children who did not. ORs for all the 7 individual vaccine series were positive, ranging from 1.59 (95% CI=1.28, 1.97) for measles, mumps, and rubella to 4.97 (95% CI=3.97, 6.24) for hepatitis B.Conclusions: Receiving the birth dose is positively associated with up-to-date status later in childhood, highlighting the importance of starting vaccination early. The association is insensitive to confounding by factors observed in National Immunization Survey-Child, but investigation of unobserved factors such as vaccine hesitancy could provide critical information to guide intervention strategy. [ABSTRACT FROM AUTHOR]

The Engineering Education Research Network in Africa (EERN-Africa) was created to enable connections between practitioners and researchers with a shared interest in African engineering education contexts. Recognising the importance of developing an African voice in the engineering education research space, the EERN-Africa community has interacted in a dynamic and dialogic way with our own teaching and research practices across diverse African contexts, with an ethical commitment to democratic and inclusive community-building. The objective of this paper is to reflect on the current status of the Community of Practice (CoP), and the challenges and opportunities in sustaining and growing the CoP. A collaborative analysis of perspectives on this emerging identity is presented, using an Appreciative Inquiry (AI) methodology and drawing on collective written reflections and discussions. Six broad themes on the value that the CoP has for both individuals and the group were identified: networking, capacity development, emotional support, impact on professional identity, social and environmental impact, and breaking borders. This paper contributes an approach for collaborative capacity-building in EER through a virtual CoP, underpinned by the spirit of ubuntu. [ABSTRACT FROM AUTHOR]

Looks at abnormalities closely related to reduced insulin-mediated glucose disposal which constitutes the principal components of metabolic syndrome. The cause of the syndrome remaining obscure; The obesity studies that support the theory; The importance of antihypertensive agents; The selective imidazoline-I-receptor agonists that offer a innovative therapeutic approach to the treatment of hypertension.

Objective: The aims of this study were: (i) to determine the factors associated with HRQOL at baseline in our cohort, and (ii) to evaluate if there are differences in baseline HRQOL measures by antiretroviral treatment. Methods: The Short Form 36 (SF-36) was administered between 2006 and 2010 among members of the United States HIV Natural History Study cohort (NHS), and participants who completed the SF-36 were included in the study. Physical component summary (PCS) and mental component summary (MCS) scores were computed based on standard algorithms. Multivariate linear regression models were constructed for PCS and MCS to estimate the association between selected variables and HRQOL scores. Results: Antiretroviral therapy (ART) was not independently associated with HRQOL scores. Factors associated with PCS were CD4+ count < 200 cells/mm3 (β = -5.84, 95% CI: -7.63, -4.06), mental comorbidity (β = -2.82, 95% CI: -3.79, -1.85), medical comorbidity (β = -2.51, 95% CI: -3.75, -1.27), AIDS diagnosis (β = -2.38, 95% CI: -3.79, -0.98). Others were gender, military rank, marital status, and age. Factors independently associated with MCS were CD4+ count < 200 cells/mm3 (β = -1.93, 95% CI: -3.85, -0.02), mental comorbidity (β = -6.25, 95% CI: -7.25, -5.25), age (β = 0.37, 95% CI: 0.14, 0.60), and being African American (β = 1.55, 95% CI: 0.63, 2.47). Conclusion: Among military active duty and beneficiaries with HIV, modifiable factors associated with HRQOL measures included advanced HIV disease, and mental or medical comorbidity. Addressing these factors may improve quality of life of HIV-infected individuals in the NHS cohort. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Average energy intake among pregnant women carrying a boy compared with a girl," by R.M. Tamimi et al. in the June 7, 2003 issue.

Focuses on the gene mapping of primary congenital lymphedema to the 5q35.3 region. Evidences suggesting a major locus in 5q35.3; Manifestations of lymphedema; Probability of heterogeneity for primary lymphedema.

Presents a letter to the editor which comments on an article comparing two methods of repairing a groin hernia using the mesh-plug hernioplasty technique.

Background Vaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection. Methods City-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis. Results Being UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group. Conclusion Examining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure. [ABSTRACT FROM AUTHOR]

Objectives: To compare the safety profile of Seasonique, a 91-day levonorgestrel-containing combined oral contraceptive (COCLNG), to 28-day COCLNG regarding the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE).Study Design: A new user cohort study was conducted in a US health care database from 2006 to 2017. Each 91-day COCLNG treatment episode in females was matched to up to four 28-day COCLNG treatment episodes by propensity score. We identified VTE cases in either (1) an inpatient setting with ICD-9 and ICD-10 diagnosis codes of PE and/or DVT in the primary position, or (2) an outpatient setting with ICD-9 or ICD-10 diagnosis codes of DVT in conjunction with an anticoagulant medication dispensing or alteplase (thrombolytic) during the 30-day period following the date of DVT diagnosis. VTE was validated using medical records. We assessed the study endpoints in the two cohorts using incidence rates and Cox proportional hazards models adjusted for potential confounders.Results: Of the 25,593 treatment episodes in 91-day COCLNG and 76,586 treatment episodes in 28-day COCLNG, 35 and 68 patients had VTEs, respectively, corresponding to a hazard ratio (HR) of 1.40 (95% confidence interval [CI], 0.90-2.19). The VTE algorithm had a positive predictive value of 76.4% (95% CI, 66.2%-84.8%). ATEs were recorded in 13 and 28 episodes, respectively, with a corresponding HR of 1.21 (95% CI, 0.58-2.53).Conclusions: These results do not indicate a significant difference between 91-day COCLNG and 28-day COCLNG in terms of VTE or ATE risk.Implications: Compared to use of 28-day COCLNG, use of 91-day extended COCLNG was not associated with a significant difference in risk of venous and arterial thromboembolism. [ABSTRACT FROM AUTHOR]

Abstract: Fumonisin B1 (FB1), a mycotoxin that contaminates corn in certain climates, has been demonstrated to cause hepatocellular cancer (HCC) in animal models. Whether a relationship between FB1 and HCC exists in humans is not known. To examine the hypothesis, we conducted case-control studies nested within two large cohorts in China; the Haimen City Cohort and the General Population Study of the Nutritional Intervention Trials cohort in Linxian. In the Haimen City Cohort, nail FB1 levels were determined in 271 HCC cases and 280 controls. In the General Population Nutritional Intervention Trial, nail FB1 levels were determined in 72 HCC cases and 147 controls. In each population, odds ratios and 95% confidence intervals (95%CI) from logistic regression models estimated the association between measurable FB1 and HCC, adjusting for hepatitis B virus infection and other factors. A meta-analysis that included both populations was also conducted. The analysis revealed no statistically significant association between FB1 and HCC in either Haimen City (OR=1.10, 95%CI=0.64–1.89) or in Linxian (OR=1.47, 95%CI=0.70–3.07). Similarly, the pooled meta-analysis showed no statistically significant association between FB1 exposure and HCC (OR=1.22, 95%CI=0.79–1.89). These findings, although somewhat preliminary, do not support an associated between FB1 and HCC. [Copyright &y& Elsevier]