Long-term safety of unopposed estrogen used by women surviving myocardial infarction : 14 year follow-up of the ESPRIT randomised controlled trial

Peer reviewedPostprin

Post Mortem Computed Tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background There is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. Objectives The objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students’ perception of their understanding and learning experience of the subject area. Design A quasi-experimental within-subject design was chosen. Setting A School of Nursing and Midwifery within a Higher Education Institution in the UK. Participants Purposeful sampling of 57 voluntary informed consented pre-registration student nurses. Method Students were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. Results The quantitative findings proved highly significantly proved (P = < 0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases preregistration nursing students’ perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. Conclusion Including Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers

Evaluating the function of wildcat faecal marks in relation to the defence of favourable hunting areas

This is an Accepted Manuscript of an article published by Taylor & Francis in Ethology Ecology and Evolution on 2015, available online: http://www.tandfonline.com/10.1080/03949370.2014.905499To date, there have been no studies of carnivores that have been specifically designed to examine the function of scent marks in trophic resource defence, although several chemical communication studies have discussed other functions of these marks. The aim of this study was to test the hypothesis that faecal marks deposited by wildcats (Felis silvestris) serve to defend their primary trophic resource, small mammals. Field data were collected over a 2-year period in a protected area in northwestern Spain. To determine the small mammal abundance in different habitat types, a seasonal live trapping campaign was undertaken in deciduous forests, mature pine forests and scrublands. In each habitat, we trapped in three widely separated Universal Transverse Mercator (UTM) cells. At the same time that the trapping was being performed, transects were conducted on foot along forest roads in each trapping cell and in one adjacent cell to detect fresh wildcat scats that did or did not have a scent-marking function. A scat was considered to have a presumed marking function when it was located on a conspicuous substrate, above ground level, at a crossroad or in a latrine. The number of faecal marks and the small mammal abundance varied by habitat type but not by seasons. The results of the analysis of covariance (ANCOVA) indicated that small mammal abundance and habitat type were the factors that explained the largest degrees of variation in the faecal marking index (number of faecal marks in each cell/number of kilometres surveyed in each cell). This result suggests that wildcats defended favourable hunting areas. They mark most often where their main prey lives and so where they spend the most time hunting (in areas where their main prey is more abundant). This practice would allow wildcats to protect their main trophic resource and would reduce intraspecific trophic competitio

Survey and scoping of wildcat priority areas

This report summarises the findings of three complementary projects commissioned by SNH to inform the selection of Priority Areas for wildcat conservation; as proposed in the Scottish Wildcat Conservation Action Plan 2013. The scoping projects combined field surveys, taxonomic and genetic assessments, population modelling and a questionnaire survey of public attitudes to wildcat conservation measures. The report makes a recommendations for six wildcat Priority Areas from the nine areas pre-selected by SNH for survey. The sites recommended as Priority Areas all had evidence of cats that were classified as wildcats based on their appearance. However, domestic cats or hybrids (between domestic cats and wildcats) were also found, highlighting the need for conservation actions to reduce the risks they pose to wildcats from hybridisation and disease

HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study

BACKGROUND: Earlier pilot studies of human papillomavirus (HPV) triage concluded that HPV triage was feasible and cost-effective. The aim of the present study was to study the impact of wider rollout of HPV triage for women with low-grade cytology on colposcopy referral and outcomes. METHODS: Human papillomavirus testing of liquid-based cytology (LBC) samples showing low-grade abnormalities was used to select women for colposcopy referral at six sites in England. Samples from 10 051 women aged 25-64 years with routine call or recall cytology reported as borderline or mild dyskaryosis were included. RESULTS: Human papillomavirus-positive rates were 53.7% in women with borderline cytology and 83.9% in those with mild dyskaryosis. The range between sites was 34.8-73.3% for borderline cytology, and 73.4-91.6% for mild dyskaryosis. In the single site using both LBC technologies there was no difference in rates between the two technologies. The positive predictive value of an HPV test was 16.3% for CIN2 or worse and 6.1% for CIN3 or worse, although there was considerable variation between sites. CONCLUSION: Triaging women with borderline cytological abnormalities and mild dyskaryosis with HPV testing would allow approximately a third of these women to be returned immediately to routine recall, and for a substantial proportion to be referred for colposcopy without repeat cytology. Variation in HPV-positive rates results in differing colposcopy workload. British Journal of Cancer (2011) 105, 983-988. doi:10.1038/bjc.2011.326 www.bjcancer.com Published online 6 September 2011 (C) 2011 Cancer Research U

Prevalence of type-specific HPV infection by age and grade of cervical cytology: data from the ARTISTIC trial

Human papillomavirus (HPV) infection causes cervical cancer and premalignant dysplasia. Type-specific HPV prevalence data provide a basis for assessing the impact of HPV vaccination programmes on cervical cytology. We report high-risk HPV (HR-HPV) type-specific prevalence data in relation to cervical cytology for 24 510 women (age range: 20–64; mean age 40.2 years) recruited into the ARTISTIC trial, which is being conducted within the routine NHS Cervical Screening Programme in Greater Manchester. The most common HR-HPV types were HPV16, 18, 31, 51 and 52, which accounted for 60% of all HR-HPV types detected. There was a marked decline in the prevalence of HR-HPV infection with age, but the proportion due to each HPV type did not vary greatly with age. Multiple infections were common below the age of 30 years but less so between age 30 and 64 years. Catch-up vaccination of this sexually active cohort would be expected to reduce the number of women with moderate or worse cytology by 45%, but the number with borderline or mild cytology would fall by only 7%, giving an overall reduction of 12% in the number of women with abnormal cytology and 27% in the number with any HR-HPV infection. In the absence of broader cross-protection, the large majority of low-grade and many high-grade abnormalities may still occur in sexually active vaccinated women

Improved Survival from Ovarian Cancer in Patients Treated in Phase III Trial Active Cancer Centres in the UK

Aims: Ovarian cancer is the principal cause of gynaecological cancer death in developed countries, yet overall survival in the UK has been reported as being inferior to that in some Western countries. As there is a range of survival across the UK we hypothesised that in major regional centres, outcomes are equivalent to the best internationally. Materials and methods: Data from patients treated in multicentre international and UK-based trials were obtained from three regional cancer centres in the UK; Manchester, University College London and Leeds (MUL). The median progression-free survival (PFS) and overall survival were calculated for each trial and compared with the published trial data. Normalised median survival values and the respective 95% confidence intervals (ratio of pooled MUL data to trial median survival) were calculated to allow inter-trial survival comparisons. This strategy then allowed a comparison of median survival across the UK, in three regional UK centres and in international centres. Results: The analysis showed that the trial-reported PFS was the same in the UK, in the MUL centres and in international centres for each of the trials included in the study. Overall survival was, however, 45% better in major regional centre-treated patients (95% confidence interval 9–73%) than the median overall survival reported in UK trials, whereas the median overall survival in MUL centres equated with that achieved in international centres. Conclusion: The data suggest that international survival statistics are achieved in UK regional cancer centres

Distinct Roles of MicroRNA-1 and -499 in Ventricular Specification and Functional Maturation of Human Embryonic Stem Cell-Derived Cardiomyocytes

BACKGROUND: MicroRNAs (miRs) negatively regulate transcription and are important determinants of normal heart development and heart failure pathogenesis. Despite the significant knowledge gained in mouse studies, their functional roles in human (h) heart remain elusive. METHODS AND RESULTS: We hypothesized that miRs that figure prominently in cardiac differentiation are differentially expressed in differentiating, developing, and terminally mature human cardiomyocytes (CMs). As a first step, we mapped the miR profiles of human (h) embryonic stem cells (ESCs), hESC-derived (hE), fetal (hF) and adult (hA) ventricular (V) CMs. 63 miRs were differentially expressed between hESCs and hE-VCMs. Of these, 29, including the miR-302 and -371/372/373 clusters, were associated with pluripotency and uniquely expressed in hESCs. Of the remaining miRs differentially expressed in hE-VCMs, 23 continued to express highly in hF- and hA-VCMs, with miR-1, -133, and -499 displaying the largest fold differences; others such as miR-let-7a, -let-7b, -26b, -125a and -143 were non-cardiac specific. Functionally, LV-miR-499 transduction of hESC-derived cardiovascular progenitors significantly increased the yield of hE-VCMs (to 72% from 48% of control; p0.05). By contrast, LV-miR-1 transduction did not bias the yield (p>0.05) but decreased APD and hyperpolarized RMP/MDP in hE-VCMs due to increased I(to), I(Ks) and I(Kr), and decreased I(f) (p<0.05) as signs of functional maturation. Also, LV-miR-1 but not -499 augmented the immature Ca(2+) transient amplitude and kinetics. Molecular pathway analyses were performed for further insights. CONCLUSION: We conclude that miR-1 and -499 play differential roles in cardiac differentiation of hESCs in a context-dependent fashion. While miR-499 promotes ventricular specification of hESCs, miR-1 serves to facilitate electrophysiological maturation.published_or_final_versio