An interpretative research study focusing on the nature and impact of conversations between health visitors and parents relating to infant weight, in the delivery of the Healthy Child Programme (DH, DSCF 2009)

The purpose of the research is to describe and interpret the phenomenon of infant weight through the lens of parents and health visitors by revealing and understanding the interaction occurring between them. An infant is considered 0-2 years, and research context is the NHS and delivery of the Healthy Child Programme (HCP) (Department of Health, (DH), Department for Children, Schools and Families (DCSF), 2009). Research took place in a local Trust in the Northeast of England. Childhood obesity is a worldwide issue impacting on 41 million preschool children and is considered one of the most challenging areas to address (Redsell 2021). Categorising children as either overweight or obese is a complex activity because of gender, rate of growth and child development (NHS Digital 2021). This inspires the research and makes it an area worthy of focus. Less Interpretative research is available about infant weight and, sequentially with parents and health visitors (HV) specifically, to explore the interaction in time and place. The research paradigm is social construction, a superstructure conceptually framing the research. The research is Interpretative phenomenology relating directly to the interpretation of experiences of self and everyday situational encounters, or the lived experience of participants. Theoretical perspectives are hermeneutic phenomenology and symbolic interactionism, enabling the interaction between health visitors and parents to be illuminated. Recruitment is purposive sampling (4 focus groups and 8 semi-structured interviews) with 14 parents and 20 HVs participating. Data corpus is analysed using thematic analysis. Findings report that interactions between HVs and parents around infant weight are complex. Health visitors and parents make several assumptions leaving interaction open to misinterpretation. Furthermore, assumptions are never addressed in earnest. This impacts the integrity of the interaction. Managing infant weight is superseded by other public health needs of parents. There is no obvious or comprehensive approach to assessment, level of risk or approach that addresses excess weight of infants proactively or strategies for proactive whole family approaches. Both parents and health visitors demonstrate a defined emotional response to infant weight, and this impacts on how infant weight is addressed. The research identifies implications for health visiting, making several recommendations for future management of infant weight within the HCP (DH, DCSF 2009). Exploring the interaction between health visitors and parents around infant weight illuminates the interaction in detail, described and interprets it for meaning. The research is useful for HV practice with the potential of transfer to other areas of public health

Articulating and developing supervisory skills through collaborative action research

Postgraduate master’s dissertation supervision is one of the least understood aspects of academic practice. Using action research, twenty-five master’s supervisors aimed to develop a better understanding of the complexities and challenges involved in this role. Through focus groups, individual interviews and monthly workshops, they developed and piloted resources for new supervisors. The main complexities and challenges identified and articulated were: understanding the student; accepting the unpredictability of their progress; tailoring support; giving constructive feedback; developing their personal understanding of supervision. Following the project, those involved reported increased awareness and confidence in their supervisory role and changes in their academic practice

Invariants for the Smale space associated to an expanding endomorphism of a flat manifold

We study invariants associated to Smale spaces obtained from an expanding endomorphism on a (closed connected Riemannian) flat manifold. Specifically, the relevant invariants are the $K$-theory of the associated $C^*$-algebras and Putnam's homology theory for Smale spaces. The latter is isomorphic to the groupoid homology of the groupoids used to construct the $C^*$-algebras.Comment: 21 page

Significant survival improvement of patients with recurrent breast cancer in the periods 2001-2008 vs. 1992-2000

<p>Abstract</p> <p>Background</p> <p>It is unclear whether individualized treatments based on biological factors have improved the prognosis of recurrent breast cancer. The purpose of this study is to evaluate the survival improvement of patients with recurrent breast cancer after the introduction of third generation aromatase inhibitors (AIs) and trastuzumab.</p> <p>Methods</p> <p>A total of 407 patients who received first diagnosis of recurrent breast cancer and treatment at National Kyushu Cancer Center between 1992 and 2008 were retrospectively evaluated. As AIs and trastuzumab were approved for clinical use in Japan in 2001, the patients were divided into two time cohorts depending on whether the cancer recurred before or after 2001. Cohort A: 170 patients who were diagnosed between 1992 and 2000. Cohort B: 237 patients who were diagnosed between 2001 and 2008. Tumor characteristics, treatments, and outcome were compared.</p> <p>Results</p> <p>Fourteen percent of cohort A and 76% of cohort B received AIs and/or trastuzumab (P < 0.001). The median overall survival (OS) times after breast cancer recurrence were 1.7 years and 4.2 years for these respective cohorts (P < 0.001). Both the time period and treatment of AIs and/or trastuzumab for recurrent disease were significant prognostic factors in multivariate analysis (cohort B vs. cohort A: HR = 0.70, P = 0.01; AIs and/or trastuzumab for recurrent disease: yes vs. no: HR = 0.46, P < 0.001). When patients were categorized into 4 subgroups by the expression of hormone receptor (HR) and HER-2 status, the median OS times of the HR-positive/HER-2-negative, HR-positive/HER-2-positive, HR-negative/HER-2-positive, and HR-negative/HER-2-negative subtypes were 2.2, 2.4, 1.6, and 1.0 years in cohort A and 4.5, 5.1, 5.0, and 1.4 years in cohort B.</p> <p>Conclusions</p> <p>The prognosis of patients with recurrent breast cancer was improved over time following the introduction of AIs and trastuzumab and the survival improvement was apparent in HR- and/or HER-2-positive tumors.</p

Immunosuppressive therapy for pediatric aplastic anemia: a North American Pediatric Aplastic Anemia Consortium study

Quality of response to immunosuppressive therapy and long-term outcomes for pediatric severe aplastic anemia remain incompletely characterized. Contemporary evidence to inform treatment of relapsed or refractory severe aplastic anemia for pediatric patients is also limited. The clinical features and outcomes for 314 children treated from 2002 to 2014 with immunosuppressive therapy for acquired severe aplastic anemia were analyzed retrospectively from 25 institutions in the North American Pediatric Aplastic Anemia Consortium. The majority of subjects (n=264) received horse anti-thymocyte globulin (hATG) plus cyclosporine (CyA) with a median 61 months follow up. Following hATG/CyA, 71.2% (95%CI: 65.3,76.6) achieved an objective response. In contrast to adult studies, the quality of response achieved in pediatric patients was high, with 59.8% (95%CI: 53.7,65.8) complete response and 68.2% (95%CI: 62.2,73.8) achieving at least a very good partial response with a platelet count ≥50×109L. At five years post-hATG/CyA, overall survival was 93% (95%CI: 89,96), but event-free survival without subsequent treatment was only 64% (95%CI: 57,69) without a plateau. Twelve of 171 evaluable patients (7%) acquired clonal abnormalities after diagnosis after a median 25.2 months (range: 4.3-71 months) post treatment. Myelodysplastic syndrome or leukemia developed in 6 of 314 (1.9%). For relapsed/refractory disease, treatment with a hematopoietic stem cell transplant had a superior event-free survival compared to second immunosuppressive therapy treatment in a multivariate analysis (HR=0.19, 95%CI: 0.08,0.47; P=0.0003). This study highlights the need for improved therapies to achieve sustained high-quality remission for children with severe aplastic anemia

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Education for multi professional working

Chapter 10 looks at an example of accredited work based learning at Masters level as Maggie Coates and Andrew Mellon compare their experiences as student and clinical mentor in developing an aspect of Paediatric Practice while Maggie undertook the MA Advanced Practice. Reflecting on the learning that occurred and the professional working relationship that established between two health professionals from different professional backgrounds

School nursing , a priority for child-centred public health

This article relates to school nursing in the North East of England. It describes an evaluation of the public health role of the school nurse and explores current practice. It highlights some of the difficulties this group of practitioners encounter in terms of their public health role. It also explores why school nurses may find their role challenging in the context of everyday practice, government proposals, reduction in the training and education activities and pupil to school nurse ratios. The notion of a disparity between actual and potential practice is the focus for the discussio