Goals and Expectations of Continuation High School Students Transitioning to Postsecondary Education

Background: Students at a continuation high school (CHS) attended an occupational therapy program to acquire life skills in preparation for their transition from secondary education. Most of the students who participated in the OT program planned to pursue a postsecondary education (PSE), but the CHS students encountered many barriers in negotiating the requirements of PSE. Discernment of these barriers encountered by the CHS students may enable the occupational therapy practitioners to better prepare the students for PSE. Method: This was a qualitative phenomenological study based on analyses of interview data. Semi-structured one-on-one interviews were conducted with eight CHS senior students and five CHS graduates with the aim to explore the students’ beliefs and knowledge regarding their transition to PSE. Results: The CHS students consistently reported PSE to be essential for successful adulthood but were unable to describe basic PSE entry requirements and processes. The students did not report concerns regarding their intellectual aptitude for PSE but reported entrenched negative behaviors, particularly truancy, as potential barriers to success. The students acknowledged responsibility for their successes and/or failures without blaming either others or the social environment. Conclusion: It is recommended that OT interventions focus on guiding the students to access knowledge of the PSE process and set realistic personal, education, and career goals with incremental action steps leading to goal achievement

Accumulation of Sellafield-derived radiocarbon (14C) in Irish Sea and West of Scotland intertidal shells and sediments

The nuclear energy industry produces radioactive waste at various stages of the fuel cycle. In the United Kingdom, spent fuel is reprocessed at the Sellafield facility in Cumbria on the north west coast of England. Waste generated at the site comprises a wide range of radionuclides including radiocarbon (14C) which is disposed of in various forms including highly soluble inorganic carbon within the low level liquid radioactive effluent, via pipelines into the Irish Sea. This 14C is rapidly incorporated into the dissolved inorganic carbon (DIC) reservoir and marine calcifying organisms, e.g. molluscs, readily utilise DIC for shell formation. This study investigated a number of sites located in Irish Sea and West of Scotland intertidal zones. Results indicate 14C enrichment above ambient background levels in shell material at least as far as Port Appin, 265 km north of Sellafield. Of the commonly found species (blue mussel (Mytilus edulis), common cockle (Cerastoderma edule) and common periwinkle (Littorina littorea)), mussels were found to be the most highly enriched in 14C due to the surface environment they inhabit and their feeding behaviour. Whole mussel shell activities appear to have been decreasing in response to reduced discharge activities since the early 2000s but in contrast, there is evidence of continuing enrichment of the carbonate sediment component due to in-situ shell erosion, as well as indications of particle transport of fine 14C-enriched material close to Sellafield

Ecosystem uptake and transfer of Sellafield-derived radiocarbon (14C). Part 1. The Irish Sea

Ecosystem uptake and transfer processes of Sellafield-derived radiocarbon (14C) within the Irish Sea were examined. Highly variable activities in sediment, seawater and biota indicate complex 14C dispersal and uptake dynamics. All east basin biota exhibited 14C enrichments above ambient background while most west basin biota had 14C activities close to background, although four organisms including two slow-moving species were significantly enriched. The western Irish Sea gyre is a suggested pathway for transfer of 14C to the west basin and retention therein. Despite ongoing Sellafield 14C discharges, organic sediments near Sellafield were significantly less enriched than associated benthic organisms. Rapid scavenging of labile, 14C-enriched organic material by organisms and mixing to depth of 14C-enriched detritus arriving at the sediment/water interface are proposed mechanisms to explain this. All commercially important fish, crustaceans and molluscs showed 14C enrichments above background; however, the radiation dose from their consumption is extremely low and radiologically insignificant

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Ecosystem uptake and transfer of Sellafield-derived radiocarbon (14C) part 2 : the west of Scotland

Ecosystem uptake and transfer of Sellafield-derived radiocarbon (14C) were examined within the West of Scotland marine environment. The dissolved inorganic carbon component of seawater, enriched in14C, is transported to the West of Scotland where it is transferred through the marine food web. Benthic and pelagic biota with variable life-spans living in the North Channel and Clyde Sea show comparable14C activities. This suggests that mixing of14C within the Irish Sea results in a relatively constant northwards dispersal of activity. Benthic species in the Firth of Lorn have similar14C enrichments, demonstrating that Irish Sea residual water is the dominant source to this area. Measured14C activities in biota show some similarity to western Irish Sea activities, indicating that dispersion to the West of Scotland is significant with respect to the fate of Sellafield14C releases. Activities measured in commercially important species do not pose any significant radiological risk

Hepatitis C – Assessment to Treatment Trial (HepCATT) in primary care:study protocol for a cluster randomised controlled trial

BACKGROUND: Public Health England (PHE) estimates that there are upwards of 160,000 individuals in England and Wales with chronic hepatitis C virus (HCV) infection, but until now only around 100,000 laboratory diagnoses have been reported to PHE and of these 28,000 have been treated. Targeted case-finding in primary care is estimated to be cost-effective; however, there has been no robust randomised controlled trial evidence available of specific interventions. Therefore, this study aims to develop and conduct a complex intervention within primary care and to evaluate this approach using a cluster randomised controlled trial. METHODS/DESIGN: A total of 46 general practices in South West England will be randomised in a 1:1 ratio to receive either a complex intervention comprising: educational training on HCV for the practice; poster and leaflet display in the practice waiting rooms to raise awareness and encourage opportunistic testing; a HCV risk prediction algorithm based on information on possible risk markers in the electronic patient record run using Audit + software (BMJ Informatica). The audit will then be used to recall and offer patients a HCV test. Control practices will follow usual care. The effectiveness of the intervention will be measured by comparing number and rates of HCV testing, the number and proportion of patients testing positive, onward referral, rates of specialist assessment and treatment in control and intervention practices. Intervention costs and health service utilisation will be recorded to estimate the NHS cost per new HCV diagnosis and new HCV patient initiating treatment. Longer-term cost-effectiveness of the intervention in improving quality-adjusted life years (QALYs) will be extrapolated using a pre-existing dynamic health economic model. Patients' and health care workers' experiences and acceptability of the intervention will be explored through semi-structured qualitative interviews. DISCUSSION: This trial has the potential to make an important impact on patient care and will provide high-quality evidence to help general practitioners make important decisions on HCV testing and onward referral. If found to be effective and cost-effective the intervention is readily scalable and can be used to support the implementation of NICE recommendations on HCV case-finding. TRIAL REGISTRATION: ISRCTN61788850 . Registered on 24 April 2015; Protocol Version: 2.0, 22 May 2015

Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT):cluster randomised controlled trial in primary care

Objective To evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment. Design Pragmatic, two armed, practice level, cluster randomised controlled trial and economic evaluation. Setting and participants 45 general practices in South West England (22 randomised to intervention and 23 to control arm). Outcome data were collected from all intervention practices and 21/23 control practices. Total number of flagged patients was 24 473 (about 5% of practice list). Intervention Electronic algorithm and flag on practice systems identifying patients with HCV risk markers (such as history of opioid dependence or HCV tests with no evidence of referral to hepatology), staff educational training in HCV, and practice posters/leaflets to increase patients’ awareness. Flagged patients were invited by letter for an HCV test (with one follow-up) and had on-screen pop-ups to encourage opportunistic testing. The intervention lasted one year, with practices recruited April to December 2016. Main outcome measures Primary outcome: uptake of HCV testing. Secondary outcomes: number of positive HCV tests and yield (proportion HCV positive); HCV treatment assessment at hepatology; cost effectiveness. Results Baseline HCV testing of flagged patients (six months before study start) was 608/13 097 (4.6%) in intervention practices and 380/11 376 (3.3%) in control practices. During the study 2071 (16%) of flagged patients in the intervention practices and 1163 (10%) in control practices were tested for HCV: overall intervention effect as an adjusted rate ratio of 1.59 (95% confidence interval 1.21 to 2.08; P<0.001). HCV antibodies were detected in 129 patients from intervention practices and 51 patients from control practices (adjusted rate ratio 2.24, 1.47 to 3.42) with weak evidence of an increase in yield (6.2% v 4.4%; adjusted risk ratio 1.40, 0.99 to 1.95). Referral and assessment increased in intervention practices compared with control practices (adjusted rate ratio 5.78, 1.6 to 21.6) with a risk difference of 1.3 per 1000 and a “number needed to help” of one extra HCV diagnosis, referral, and assessment per 792 (95% confidence interval 558 to 1883) patients flagged. The average cost of HCV case finding was £4.03 (95% confidence interval £2.27 to £5.80) per at risk patient and £3165 per additional patient assessed at hepatology. The incremental cost effectiveness ratio was £6212 per quality adjusted life year (QALY), with 92.5% probability of being below £20 000 per QALY. Conclusion HepCATT had a modest impact but is a low cost intervention that merits optimisation and implementation as part of an NHS strategy to increase HCV testing and treatment

Rectal Prolapse: Review According to the Personal Experience

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence