Young people, political participation and trust in Britain

Young people in Britain are often characterised as disconnected from the formal political process and from democratic institutions. Certainly their rate of abstention in general election contests over the last decade has led to concerns amongst the political classes that they have a disaffection from politics that is deeply entrenched and more so than was the case with previous youth generations, and may in the future become habit-forming. In this article, we consider the results from an online national survey of 1,025 British 18 year olds conducted in 2011, and compare these with the results from a similar study conducted by one of the authors in 2002. In doing so, our aim is to assess the extent to which young people's levels of political engagement have changed over the course of the intervening years, and if so, how they have changed. The results from this comparison indicate that, contrary to popular wisdom, today's generation of young people are interested in political affairs, and they are keen to play a more active role in the political process. However, their recent experience of their first general election in 2010 has left them feeling frustrated. Indeed, our study has revealed a considerable aversion to formal, professional politics which is as deep today as it was for the predecessor 2002 youth cohort

Adolescent Strength and Body Composition Changes One Year Post Gastric-Band Surgery

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Psychological adjustment of men with prostate cancer: A review of the literature

OBJECTIVE: Prostate cancer (PCA) is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patient's psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications. METHOD: We searched 5 databases for the period 1994 - July 2006, during which most of the work in the field has been done. RESULTS: We found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled. DISCUSSION: Aspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research

A peer evaluation of the community-based education programme for medical students at the University of Zimbabwe College of Health Sciences: A southern African Medical Education Partnership Initiative (MEPI) collaboration

Background. The University of Zimbabwe College of Health Sciences (UZCHS), Harare, which has a long tradition of community-based education (CBE), has not been evaluated since 1991. An innovative approach was used to evaluate the programme during 2015. Objectives. To evaluate the CBE programme, using a peer-review model of evaluation and simultaneously introducing and orientating participating colleagues from other medical schools in southern Africa to this review process. Methods. An international team of medical educators, convened through the Medical Education Partnership Initiative, worked collaboratively to modify an existing peer-review assessment method. Data collection took the form of pre-visit surveys, on-site and field-visit interviews with key informants, a review of supporting documentation and a post-review visit. Results. All 5 years of the medical education curriculum at UZCHS included some form of CBE that ranged from community exposure in the 1st year to district hospital-based clinical rotations during the clinical years. Several strengths, including the diversity of community-based activities and the availability of a large teaching platform, were identified. However, despite the expression of satisfaction with the programme, the majority of students indicated that they do not plan to work in rural areas in Zimbabwe. Several key recommendations were offered, central to which was strengthening the academic co-ordination of the programme and curriculum renewal in the context of the overall MB ChB curriculum. Conclusion. This evaluation demonstrated the value of peer review to bring a multidimensional, objective assessment to a CBE programme

Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease

AbstractThe consecutive 2 year experience with patients undergoing first-time surgery for mitral regurgitation with and without coronary artery disease was reviewed. From January 1988 to January 1990, 127 patients with pure mitral regurgitation undergoing first-time operation were surgically treated. No other valve lesion, no reoperation and no congenital defects were included. The mean patient age was 62 years with 26% of the patients > 70 years. Twenty-six percent of the entire group was in functional class IV. Seventy-five patients received mitral valve repair and 52 underwent mitral valve replacement with a St. Jude or Hancock valve. In patients undergoing mitral valve repair, there was a higher incidence of those > 70 years old and of coronary artery disease and in patients undergoing mitral valve replacement there was a higher incidence of functional class IV.The operative mortality rate was 2.3% (3 of 127 patients). No patient failed to be discontinued from cardiopulmonary bypass and all three deaths occurred after mitral valve replacement, with one from complications of chronic renal failure and dialysis. There was no significant difference in patients who either did or did not have a concomitant coronary artery bypass graft and there was no difference related to age or functional class. Postoperative complications occurred in five patients in the valve repair group, including recurrent mitral regurgitation in two necessitating reoperation, and in three patients in the valve replacement group.With newer operative and postoperative management techniques, especially preservation of the papillary muscle annular continuity, the risk of mitral valve surgery, particularly of valve repair, is considerably lower than in previous years

Psychosocial adjustment in newly diagnosed prostate cancer

Objective: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers. Methods: A longitudinal observational study in which 367 men recently diagnosed with early (n =211) or advanced stage (n = 156), prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment. Results: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning. Conclusions: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient group

Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm : a randomised controlled feasibility trial (COMPRESS-RCT)

Background Mechanical chest compression devices consistently deliver high-quality chest compressions. Small very low-quality studies suggest mechanical devices may be effective as an alternative to manual chest compressions in the treatment of adult in-hospital cardiac arrest patients. The aim of this feasibility trial is to assess the feasibility of conducting an effectiveness trial in this patient population. Methods COMPRESS-RCT is a multi-centre parallel group feasibility randomised controlled trial, designed to assess the feasibility of undertaking an effectiveness to compare the effect of mechanical chest compressions with manual chest compressions on 30-day survival following in-hospital cardiac arrest. Over approximately two years, 330 adult patients who sustain an in-hospital cardiac arrest and are in a non-shockable rhythm will be randomised in a 3:1 ratio to receive ongoing treatment with a mechanical chest compression device (LUCAS 2/3, Jolife AB/Stryker, Lund, Sweden) or continued manual chest compressions. It is intended that recruitment will occur on a 24/7 basis by the clinical cardiac arrest team. The primary study outcome is the proportion of eligible participants randomised in the study during site operational recruitment hours. Participants will be enrolled using a model of deferred consent, with consent for follow-up sought from patients or their consultee in those that survive the cardiac arrest event. The trial will have an embedded qualitative study, in which we will conduct semi-structured interviews with hospital staff to explore facilitators and barriers to study recruitment. Discussion The findings of COMPRESS-RCT will provide important information about the deliverability of an effectiveness trial to evaluate the effect on 30-day mortality of routine use of mechanical chest compression devices in adult in-hospital cardiac arrest patients

IFN-γ-producing CD4+ T cells promote experimental cerebral malaria by modulating CD8+ T cell accumulation within the brain.

It is well established that IFN-γ is required for the development of experimental cerebral malaria (ECM) during Plasmodium berghei ANKA infection of C57BL/6 mice. However, the temporal and tissue-specific cellular sources of IFN-γ during P. berghei ANKA infection have not been investigated, and it is not known whether IFN-γ production by a single cell type in isolation can induce cerebral pathology. In this study, using IFN-γ reporter mice, we show that NK cells dominate the IFN-γ response during the early stages of infection in the brain, but not in the spleen, before being replaced by CD4(+) and CD8(+) T cells. Importantly, we demonstrate that IFN-γ-producing CD4(+) T cells, but not innate or CD8(+) T cells, can promote the development of ECM in normally resistant IFN-γ(-/-) mice infected with P. berghei ANKA. Adoptively transferred wild-type CD4(+) T cells accumulate within the spleen, lung, and brain of IFN-γ(-/-) mice and induce ECM through active IFN-γ secretion, which increases the accumulation of endogenous IFN-γ(-/-) CD8(+) T cells within the brain. Depletion of endogenous IFN-γ(-/-) CD8(+) T cells abrogates the ability of wild-type CD4(+) T cells to promote ECM. Finally, we show that IFN-γ production, specifically by CD4(+) T cells, is sufficient to induce expression of CXCL9 and CXCL10 within the brain, providing a mechanistic basis for the enhanced CD8(+) T cell accumulation. To our knowledge, these observations demonstrate, for the first time, the importance of and pathways by which IFN-γ-producing CD4(+) T cells promote the development of ECM during P. berghei ANKA infection

B-mode ultrasound common carotid artery intima-media thickness and external diameter: cross-sectional and longitudinal associations with carotid atherosclerosis in a large population sample

<p>Abstract</p> <p>Background</p> <p>Arterial diameter and intima-media thickness (IMT) enlargement may each be related to the atherosclerotic process. Their separate or combined enlargement may indicate different arterial phenotypes with different atherosclerosis risk.</p> <p>Methods</p> <p>We investigated cross-sectional (baseline 1987–89: n = 7956) and prospective (median follow-up = 5.9 years: n = 4845) associations between baseline right common carotid artery (RCCA) external diameter and IMT with existing and incident carotid atherosclerotic lesions detected by B-mode ultrasound in any right or left carotid segments. Logistic regression models (unadjusted, adjusted for IMT, or adjusted for IMT and risk factors) were used to relate baseline diameter to existing carotid lesions while comparably adjusted parametric survival models assessed baseline diameter associations with carotid atherosclerosis progression (incident carotid lesions). Four baseline arterial phenotypes were categorized as having 1) neither IMT nor diameter enlarged (reference), 2) isolated IMT thickening, 3) isolated diameter enlargement, and 4) enlargement of both IMT and diameter. The association between these phenotypes and progression to definitive carotid atherosclerotic lesions was assessed over the follow-up period.</p> <p>Results</p> <p>Each standard deviation increment of baseline RCCA diameter was associated with increasing carotid lesion prevalence (unadjusted odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.47–1.62) and with progression of carotid atherosclerosis (unadjusted hazards ratio (HR) = 1.37, 95% CI = 1.28–1.46); and the associations remained significant even after adjustment for IMT and risk factors (prevalence OR = 1.11, 95% CI = 1.04–1.18; progression HR = 1.11, 95% CI = 1.03–1.19). Controlling for gender, age and race, persons with both RCCA IMT and diameter in the upper 50^thpercentiles had the greatest risk of progressing to clearly defined carotid atherosclerotic lesions (all HR = 1.71, 95% CI = 1.47–2.0; men HR = 1.88, 95% CI = 1.48–2.39; women HR = 1.59, 95% CI = 1.31–1.95) while RCCA IMT or diameter alone in the upper 50^thpercentile produced significantly lower estimated risks.</p> <p>Conclusion</p> <p>RCCA IMT and external diameter provide partially overlapping information relating to carotid atherosclerotic lesions. More importantly, the RCCA phenotype of coexistent wall thickening with external diameter enlargement indicates higher atherosclerotic risk than isolated wall thickening or diameter enlargement.</p

Borneo stalagmite evidence of significantly reduced El Niño-Southern Oscillation variability at 4.1 kyBP

The timing and geographic extent of a potential “4.2 ky event” remain highly contested. Here we present records of ENSO variability at 3.8 kyBP and 4.1 kyBP derived from a Borneo stalagmite, which suggest a significant change in ENSO properties between these time intervals. The Borneo records show evidence of significantly reduced ENSO activity at 4.1 kyBP, relative to other measured windows within the Holocene. This reduced ENSO activity coincides with a period of drier conditions and enhanced dust events in the Middle East that took place ∼4.0–4.3 kyBP. The Borneo records show evidence of enhanced ENSO activity at 3.8 kyBP. Various hydroclimate changes attributed to the “4.2 ky event” in many regions may thus be reflecting a shift from reduced to enhanced El Niño activity that occurred between 3.8 kyBP to 4.0 kyBP