Placental dysfunction is associated with altered microRNA expression in pregnant women with low folate status

Scope: Low maternal folate status during pregnancy increases the risk of delivering small for gestational age (SGA) infants, but the mechanistic link between maternal folate status, SGA, and placental dysfunction is unknown. microRNAs (miRNAs) are altered in pregnancy pathologies and by folate in other systems. We hypothesized that low maternal folate status causes placental dysfunction, mediated by altered miRNA expression. Methods and results: A prospective observational study recruited pregnant adolescents and assessed third trimester folate status and placental function. miRNA array, QPCR, and bioinformatics identified placental miRNAs and target genes. Low maternal folate status is associated with higher incidence of SGA infants (28% versus 13%, p < 0.05) and placental dysfunction, including elevated trophoblast proliferation and apoptosis (p < 0.001), reduced amino acid transport (p < 0.01), and altered placental hormones (pregnancy-associated plasma protein A, progesterone, and human placental lactogen). miR-222-3p, miR-141-3p, and miR-34b-5p were upregulated by low folate status (p < 0.05). Bioinformatics predicted a gene network regulating cell turnover. Quantitative PCR demonstrated that key genes in this network (zinc finger E-box binding homeobox 2, v-myc myelocytomatosis viral oncogene homolog (avian), and cyclin-dependent kinase 6) were reduced (p < 0.05) in placentas with low maternal folate status. Conclusion: This study supports that placental dysfunction contributes to impaired fetal growth in women with low folate status and suggests altered placental expression of folate-sensitive miRNAs and target genes as a mechanistic link

Learning from practice: how East Lancashire hospitals' pharmacy service has embraced information technology

The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as ‘let’s make things better’. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings.

Purpose: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in ten Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. Method: Ten rehabilitation centres took part in a multifaceted implementation of conversation partner training over thirteen months. Each centre selected two speech and language therapists to act as knowledge brokers whose role it was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans. Results: Successful implementation was described as 1) four dyads included during the intervention period, 2) two more dyads included after the intervention period, before the end of the study and 3) inclusion of Partners of Aphasic Clients Conversation Training (PACT) in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of 6 dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation of PACT study (ImPACT). Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for PACT within existing care routines. Conclusions: The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support

Imaginary homelessness prevention with prison leavers in Wales

Despite a move towards more preventative practices, we have reported that policy objectives to help prison leavers find accommodation on release in Wales have not translated into improved outcomes for this group. In this article we engage in a critical examination of why this might be and how local authority Housing Solutions staff in Wales, newly placed centre stage in the process, go about preventing homelessness amongst prison leavers. Drawing on Carlen’s concept of ‘imaginary penalities’, we suggest that practice with this group is performed only ritualistically. Drawing on Ugelvik’s notion of ‘legitimation work’ we suggest this state of affairs is legitimised by focusing on prison leavers’ responsibility for their homelessness over their rights to housing, and public protection over promoting resettlement. In response we advocate for less-punitive justice and housing policies, underpinned by the right to permanent housing for all and wherein stable accommodation is understood as the starting point for resettlement for prison leavers. The analysis presented in this article provides insights to how homelessness policies could play out in jurisdictions where more joint working between housing and criminal justice agencies are being pursued and/or preventative approaches to managing homelessness are being considered

People with aphasia’s perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach

Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke. Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis. Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me. Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population

UK Ag Equine Programs 2015 Calendar: A 12-Month Planning Calendar for the Care and Use of Your Horses

The information in this calendar is provided to aid owners in planning for the care and use of their horses. When necessary, information is discussed in the month prior to application to allow horse owners adequate time to plan for activities such as weed control, soil testing, and vaccinations. Contact your local veterinarian for health-related issues and your county extension agent for further information. Phone numbers are listed at the end of the calendar

UK Ag Equine Programs 2016 Calendar: A 12-Month Planning Calendar for the Care and Use of Your Horses

The information in this calendar is provided to aid owners in planning for the care and use of their horses for the whole year. When necessary, information is discussed in the month prior to application to allow horse owners adequate time to plan for activities such as weed control, soil and feed testing, vaccinations, etc. Contact your local veterinarian for health-related issues and your county extension ANR, 4-H, or FCS agent for further information. County office phone numbers are listed at the end of the calendar

UK Ag Equine Programs 2014 Calendar: A 12-Month Planning Calendar for the Care and Use of Your Horses

The information in this calendar is provided to aid owners in planning for the care and use of their horses. When necessary, information is discussed in the month prior to application to allow horse owners adequate time to plan for activities such as weed control, soil testing, and vaccinations. Contact your local veterinarian for health-related issues and your county extension agent for further information. Phone numbers are listed at the end of the calendar

American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: Quality assurance for clinical radiotherapy treatment planning

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134846/1/mp8373.pd

Guidelines on the management of abnormal liver blood tests

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.</p