Toxic pelagic harmful algal blooms impacting shellfish safety

71 pages, 13 figures, 2 tablesFollowing the IOC–UNESCO definition of harmful algal blooms (HABs) and the categorization of the impacts of harmful microalgae in the world’s oceans proposed by Lassus et al. (2016), this chapter will focus on pelagic species that affect shellfish safety by producing toxins and consequently causing various symptoms in humans by consuming poisoned food. Pelagic HABs that have a dormant benthic phase in their life cycle are also included (Table 4.1). [...]With the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S

The case for morphophonological intervention: Evidence from a Greek-speaking child with speech difficulties

Intervention with children with speech and language difficulties has been proven beneficial compared with no treatment yet, knowing what type of intervention to provide remains a challenge. Studies of English-speaking children indicate that intervention targeting the production of morphological targets may have a positive effect on phonological aspects and vice versa. However, studies have not reported on generalization effects to untreated morphemes and little is yet known about morphological intervention in the context of a highly inflected language. The purpose of the current intervention case study was to investigate the effect of intervention in relation to phonological and morphological targets in Greek, a language characterized by complex inflectional morphology. A single subject research design was used with pre- and post-intervention assessment carried out. The participant was a four-year-old Greek-speaking boy with speech difficulties. The production of /s/, a phoneme used in multiple phonological and morphological contexts was targeted with alternating focus of intervention between phonological and morphological targets. Assessment took place at two levels: macro-assessment to monitor broad changes in speech; micro-assessment to measure therapy-specific changes in the production of treated targets and generalization to untreated targets and control items. There were four phases of intervention with a total of 24 hours of therapy. Significant improvement in performance accuracy was found between assessment scores immediately pre- and post-intervention. Intervention targeting the production of a phoneme in the word stem was not sufficient to accomplish the accurate production of morphemes requiring the same phoneme; intervention directly targeting morphemes was successful. Within-domain generalization was observed in both domains. Improved naming accuracy was observed post-intervention that was maintained at follow-up. The present study supports the case for morphophonological intervention. Morphological elements should be addressed in a comprehensive intervention for speech sound disorders

Association of Genetic Variants With Primary Open-Angle Glaucoma Among Individuals With African Ancestry.

Importance:Primary open-angle glaucoma presents with increased prevalence and a higher degree of clinical severity in populations of African ancestry compared with European or Asian ancestry. Despite this, individuals of African ancestry remain understudied in genomic research for blinding disorders. Objectives:To perform a genome-wide association study (GWAS) of African ancestry populations and evaluate potential mechanisms of pathogenesis for loci associated with primary open-angle glaucoma. Design, Settings, and Participants:A 2-stage GWAS with a discovery data set of 2320 individuals with primary open-angle glaucoma and 2121 control individuals without primary open-angle glaucoma. The validation stage included an additional 6937 affected individuals and 14 917 unaffected individuals using multicenter clinic- and population-based participant recruitment approaches. Study participants were recruited from Ghana, Nigeria, South Africa, the United States, Tanzania, Britain, Cameroon, Saudi Arabia, Brazil, the Democratic Republic of the Congo, Morocco, Peru, and Mali from 2003 to 2018. Individuals with primary open-angle glaucoma had open iridocorneal angles and displayed glaucomatous optic neuropathy with visual field defects. Elevated intraocular pressure was not included in the case definition. Control individuals had no elevated intraocular pressure and no signs of glaucoma. Exposures:Genetic variants associated with primary open-angle glaucoma. Main Outcomes and Measures:Presence of primary open-angle glaucoma. Genome-wide significance was defined as P < 5 × 10-8 in the discovery stage and in the meta-analysis of combined discovery and validation data. Results:A total of 2320 individuals with primary open-angle glaucoma (mean [interquartile range] age, 64.6 [56-74] years; 1055 [45.5%] women) and 2121 individuals without primary open-angle glaucoma (mean [interquartile range] age, 63.4 [55-71] years; 1025 [48.3%] women) were included in the discovery GWAS. The GWAS discovery meta-analysis demonstrated association of variants at amyloid-β A4 precursor protein-binding family B member 2 (APBB2; chromosome 4, rs59892895T>C) with primary open-angle glaucoma (odds ratio [OR], 1.32 [95% CI, 1.20-1.46]; P = 2 × 10-8). The association was validated in an analysis of an additional 6937 affected individuals and 14 917 unaffected individuals (OR, 1.15 [95% CI, 1.09-1.21]; P < .001). Each copy of the rs59892895*C risk allele was associated with increased risk of primary open-angle glaucoma when all data were included in a meta-analysis (OR, 1.19 [95% CI, 1.14-1.25]; P = 4 × 10-13). The rs59892895*C risk allele was present at appreciable frequency only in African ancestry populations. In contrast, the rs59892895*C risk allele had a frequency of less than 0.1% in individuals of European or Asian ancestry. Conclusions and Relevance:In this genome-wide association study, variants at the APBB2 locus demonstrated differential association with primary open-angle glaucoma by ancestry. If validated in additional populations this finding may have implications for risk assessment and therapeutic strategies

Invited editorial: Nurse delivered endoscopy

The multicentre randomised controlled trial by Williams and colleagues (doi:10.1136/bmj.b231) compares the clinical effectiveness of doctors and nurses undertaking upper and lower gastrointestinal endoscopy. The study by Richardson and colleagues (doi:10.1136/bmj.b270) assesses the cost effectiveness of this approach. The studies found no significant difference in clinical outcomes, although doctors seemed to be more cost effective.1 2 Nurse led services in the United Kingdom have been encouraged by government policy, a shortage of doctors, a willingness of nurses to adopt expanded roles, and a salaried NHS workforce where professionals are not in competition for income from patients. Evaluations of substituting doctors with nurses have consistently found little difference in performance. In primary care, no appreciable differences between doctors and nurses have been found in health outcomes for patients, process of care, or use and cost of resources, whereas nurse led care has resulted in higher patient satisfaction.3 These findings have been reported across a wide range of diseases. Nurse endoscopists are firmly established in the UK, with 350 nurses currently in practice

The MINT Project - An evaluation of the impact of midwife teachers on the outcome of pre-registration midwifery education in the UK

OBJECTIVE: to explore the contribution of midwife teachers in preparing student midwives for competent practice. DESIGN: a three phase design using qualitative and quantitative approaches. Phase one involved UK wide on-line questionnaire surveys, phase two was a case study method in six UK approved education institutions and phase three was a diary study with newly qualified midwives. PARTICIPANTS: phase one included all UK Lead Midwives for Education (LMEs), midwife teachers and Local Supervising Authority Midwifery Officers; phase two participants were three year and shortened programme student midwives, midwife teachers, LMEs and programme leads from each of the four countries; and phase three included a sample of newly qualified midwives graduating from the case study sites and their preceptors and supervisors of midwives. FINDINGS: midwife teachers were valued for their unique and crucial role in supporting the application of knowledge to midwifery practice. Visibility and credibility were two key concepts that can explain the unique contribution of midwife teachers. These concepts included being able to support skills acquisition, understanding of contemporary midwifery practice, having a role in practice contexts and able to offer personal support. Visibility of teachers in practice was vital for students and mentors to assist students put their learning into practice and monitor learning and assessment decisions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: given the complexity of midwifery education a team approach is essential in ensuring the effectiveness of these programmes. This requires a sufficient differentiation of midwife teacher roles to deliver the pre-registration curriculum. A set of resource quality indicators is proposed to support midwife teacher teams achieving sufficient clinical and academic expertise to deliver effective education programmes

Is partners’ mental health and well-being affected by holding the baby after stillbirth? Mothers’ accounts from a national survey

Objective: This study aimed to assess the effects on partners’ health and well-being of holding a stillborn baby. Background: Findings from quantitative and qualitative studies have produced inconsistent results concerning the effects of holding a stillborn baby on parents. Methods: Secondary analyses were conducted on postal questionnaire data relating to 455 partners of women who had a stillbirth. Women answered questions about their partners’ behaviour, perceptions of care, mental health and well-being at three and nine months after the stillbirth. Demographic, clinical and care characteristics were compared between partners who, according to the mothers, did and did not hold their baby. Sub-group analyses assessed hypothesised moderating effects. Results: Mothers reported that most partners saw (92%) and held (82%) their stillborn baby. However, partners born outside the UK were less likely to have held their baby. Higher gestational age, shorter time interval between antepartum death and delivery, and mother’s holding the baby all predicted a higher rate of partner’s holding. There was a consistent negative effect of holding the baby across mental health and well-being outcomes, although after adjustment only higher odds of depression (OR 2.72, 95% CI 1.35–5.50) and post-traumatic stress type symptoms (OR 1.95, 95% CI 1.01–3.78) at 3 months were significantly associated with having held the baby following stillbirth. Conclusions: This study is the first to assess the impact of holding the baby on partners’ mental health and well-being. The prevalence of depression and anxiety were high, and the negative effects of holding the baby were significant 3 months later