More or Less of Me and You : Self-Relevance Augments the Effects of Item Probability on Stimulus Prioritization

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Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception

BackgroundThyroid peroxidase antibodies are associated with an increased risk of miscarriage and preterm birth, even when thyroid function is normal. Small trials indicate that the use of levothyroxine could reduce the incidence of such adverse outcomes.MethodsWe conducted a double-blind, placebo-controlled trial to investigate whether levothyroxine treatment would increase live-birth rates among euthyroid women who had thyroid peroxidase antibodies and a history of miscarriage or infertility. A total of 19,585 women from 49 hospitals in the United Kingdom underwent testing for thyroid peroxidase antibodies and thyroid function. We randomly assigned 952 women to receive either 50 μg once daily of levothyroxine (476 women) or placebo (476 women) before conception through the end of pregnancy. The primary outcome was live birth after at least 34 weeks of gestation.ResultsThe follow-up rate for the primary outcome was 98.7% (940 of 952 women). A total of 266 of 470 women in the levothyroxine group (56.6%) and 274 of 470 women in the placebo group (58.3%) became pregnant. The live-birth rate was 37.4% (176 of 470 women) in the levothyroxine group and 37.9% (178 of 470 women) in the placebo group (relative risk, 0.97; 95% confidence interval [CI], 0.83 to 1.14, P=0.74; absolute difference, −0.4 percentage points; 95% CI, −6.6 to 5.8). There were no significant between-group differences in other pregnancy outcomes, including pregnancy loss or preterm birth, or in neonatal outcomes. Serious adverse events occurred in 5.9% of women in the levothyroxine group and 3.8% in the placebo group (P=0.14).ConclusionsThe use of levothyroxine in euthyroid women with thyroid peroxidase antibodies did not result in a higher rate of live births than placebo. (Funded by the United Kingdom National Institute for Health Research; TABLET Current Controlled Trials number, ISRCTN15948785.

Using visual methodology: Social work student's perceptions of practice and the impact on practice educators.

This is an Accepted Manuscript of an article published by Taylor & Francis in Practice: Social Work in Action on 21-6-18, available online: https://doi.org/10.1080/09503153.2018.1476477Practice learning within social work education plays a significant part in students’ educational journey. Little is understood about the emotional climate of placements. This paper presents a small scale qualitative study of 13 social work students’ perceptions of their relationship with a practice educator (PE) and 6 PE’s perceptions of these emotional experiences. Visual methodology was employed over a two-phased research project, first social work students were asked to draw an image of what they thought practice education looked like, phase two used photo eliciation, PEs were then asked to explore the meaning of these images. Results demonstrated that social work students focused on their own professional discourse, the identity of PEs, power relationship and dynamics between themselves and PEs, the disjointed journey and practice education in its entirity. Whilst the PEs shared their personal views of practice education and reflected on this, both groups had a shared understanding of practice education including its values and frustrations. Keywords: social work placements, visual methodology, practice educator

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

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

Social care and the law in Scotland An SVQ related reference guide for direct care staff

Previous ed.: 2001. Includes bibliographical references and index. Title from coverAvailable from British Library Document Supply Centre- DSC:02/42367 / BLDSC - British Library Document Supply CentreSIGLE4. ed.GBUnited Kingdo

More or less of me and you: self-relevance augments the effects of item probability on stimulus prioritization

Self-relevance exerts a powerful influence on information processing. Compared to material associated with other people, personally meaningful stimuli are prioritized during decision-making. Further exploring the character of this effect, here we considered the extent to which stimulus enhancement is impacted by the frequency of self-relevant versus friend-relevant material. In a matching task, participants reported whether shape-label stimulus pairs corresponded to previously learned associations (e.g., triangle = self, square = friend). Crucially however, before the task commenced, stimulus-based expectancies were provided indicating the probability with which both self- and friend-related shapes would be encountered. The results revealed that task performance was impacted by the frequency of stimulus presentation in combination with the personal relevance of the items. When self- and friend-related shapes appeared with equal frequencies, a self-prioritization effect emerged (Expt. 1). Additionally, in both confirmatory (Expt. 2) and dis-confirmatory (Expt. 3) task contexts, stimuli that were encountered frequently (vs. infrequently) were prioritized, an effect that was most pronounced for self-relevant (vs. friend-relevant) items. Further computational analyses indicated that, in each of the reported experiments, differences in performance were underpinned by variation in the rate of information uptake, with evidence extracted more rapidly from self-relevant compared to friend-relevant stimuli. These findings advance our understanding of the emergence and origin of stimulus-prioritization effects during decisional processing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00426-021-01562-x

Thrombotic Thrombocytopenic Purpura and Pregnancy: Presentation, Management, and Subsequent Pregnancy Outcomes

In women presenting with an initial diagnosis of TTP during pregnancy, cTTP was more common than acquired TTP.Active monitoring and management during pregnancy results in positive pregnancy outcomes.Pregnancy can precipitate thrombotic thrombocytopenic purpura (TTP). We present a prospective study of TTP cases from the United Kingdom Thrombotic Thrombocytopenic Purpura (UK TTP) Registry with clinical and laboratory data from the largest cohort of pregnancy-associated TTP and describe management through pregnancy, averting fetal loss and maternal complications. Thirty-five women presented with a first TTP episode during pregnancy: 23/47 with their first congenital TTP (cTTP) episode and 12/47 with acute acquired TTP in pregnancy. TTP presented primarily in the third trimester/postpartum, but fetal loss was highest in the second trimester. Fetal loss occurred in 16/38 pregnancies before cTTP was diagnosed, but in none of the 15 subsequent managed pregnancies. Seventeen of 23 congenital cases had a missense mutation, C3178T, within exon 24 (R1060W). There were 8 novel mutations. In acquired TTP presentations, fetal loss occurred in 5/18 pregnancies and 2 terminations because of disease. We also present data on 12 women with a history of nonpregnancy-associated TTP: 18 subsequent pregnancies have been successfully managed, guided by ADAMTS13 levels. cTTP presents more frequently than acquired TTP during pregnancy and must be differentiated by ADAMTS13 analysis. Careful diagnosis, monitoring, and treatment in congenital and acquired TTP have assisted in excellent pregnancy outcomes