Making Out-of-School Time Matter: Evidence for an Action Agenda

Presents findings from a review of literature that identifies and addresses the level of demand for OST services, the effectiveness of the offerings, quality in OST programs, how to encourage participation, and how to build further community capacity

An investigation into the factors that influence parental choice of early education and care

This study explores the factors that influence parents’ choice of early education and care in a local authority with high levels of deprivation. A questionnaire survey, which generated both quantitative and qualitative data, provides an insight into parents’ views. The study focuses on parents using their child’s entitlement to fifteen hours of free early education, in the private and voluntary sectors. Findings show that the main factor influencing choice is location, followed by staff attitudes and behaviours, reputation and the free entitlement. Sources of information include word-of-mouth recommendations and the internet. The study identifies the importance of parental engagement, with access to staff fundamental to the involvement of parents. The exchange of information helped to build relationships based on trust and co-operation which influenced parents’ satisfaction levels with the quality of both early education and care

Post-treatment survival difference between lobectomy and stereotactic ablative radiotherapy in stage I non-small cell lung cancer in England.

BACKGROUND: Approximately 15%-20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curative intent treatment option for patients who are not selected for or do not choose surgery. The aim of this study is to compare survival at 90 days, 6 months, 1 year and 2 years for patients who received either lobectomy or SABR. METHODS: We used data from the 2015 National Lung Cancer Audit database and linked with Hospital Episode Statistics and the radiotherapy dataset to identify patients with NSCLC stage IA-IB and performance status (PS) 0-2 who underwent surgery or SABR treatment. We assessed the likelihood of death at 90 days, 6 months, 1 year and 2 year after diagnosis and procedure date to observe survival between two patient groups. RESULTS: We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening PS were associated with having SABR rather than surgery. Survival between the two treatment modalities was similar early on but by 1-year people who had surgery did better than those who had SABR (adjusted ORs 2.12, 95% CI 1.35 to 2.31). This difference persisted at 2 years and when the analysis was restricted to patients aged <80 years and with PS 0 or 1 and stage IA only. CONCLUSION: Our analysis suggests that patients who have lobectomy have a better survival compared with SABR patients; however, we found considerable delays in patients receiving SABR which may contribute to poorer long-term outcomes with this treatment option. Reducing these delays should be a key focus in development and reorganisation of services

Apples and pears? A comparison of two sources of national lung cancer audit data in England

In 2014, the method of data collection from NHS trusts in England for the National Lung Cancer Audit (NLCA) was changed from a bespoke dataset called LUCADA (Lung Cancer Data). Under the new contract, data are submitted via the Cancer Outcome and Service Dataset (COSD) system and linked additional cancer registry datasets. In 2014, trusts were given opportunity to submit LUCADA data as well as registry data. 132 NHS trusts submitted LUCADA data, and all 151 trusts submitted COSD data. This transitional year therefore provided the opportunity to compare both datasets for data completeness and reliability. We linked the two datasets at the patient level to assess the completeness of key patient and treatment variables. We also assessed the interdata agreement of these variables using Cohen’s kappa statistic, κ. We identified 26 001 patients in both datasets. Overall, the recording of sex, age, performance status and stage had more than 90% agreement between datasets, but there were more patients with missing performance status in the registry dataset. Although levels of agreement for surgery, chemotherapy and external-beam radiotherapy were high between datasets, the new COSD system identified more instances of active treatment. There seems to be a high agreement of data between the datasets, and the findings suggest that the registry dataset coupled with COSD provides a richer dataset than LUCADA. However, it lagged behind LUCADA in performance status recording, which needs to improve over time

Standards of care in mesothelioma treatment

Summary: The UK has the highest incidence of mesothelioma in the world, but services vary across the country partly due to uneven geographical distribution of cases. The Mesothelioma UK-funded national organisational audit has highlighted challenges in accessing diagnostic procedures such as thoracoscopy, as well as identifying examples of best practice, including access to clinical trials and specialist therapeutic procedures. To ensure equitable and optimal patient care, cancer alliances should have established referral pathways to specialist multidisciplinary team (MDT) services for discussion of all mesothelioma patients

Alligators as West Nile Virus Amplifiers

Recent evidence suggests that American alligators (Alligator mississippiensis) may be capable of transmitting West Nile virus (WNV) to other alligators. We experimentally exposed 24 juvenile alligators to WNV parenterally or orally. All became infected, and all but three sustained viremia titers \u3e5.0 log10 PFU/mL (a threshold considered infectious for Culex quinquefasciatus mosquitoes) for 1 to 8 days. Noninoculated tankmates also became infected. The viremia profiles and multiple routes of infection suggest alligators may play an important role in WNV transmission in areas with high population densities of juvenile alligators

Capturing Saddam Hussein: How the full story got away, and what conflict journalism can learn from it

The capture of Saddam Hussein in December 2003 was reported with a sense of triumph which must have greatly satisfied the United States forces occupying Iraq. This was the victory they had been looking for; the seminal moment which signalled that the invasion had been a success. But the reporting of that event was also a missed opportunity: an example of incomplete story telling. In this article, I use my personal experience of reporting on the event for the BBC as a starting point to examine what it, and the way it was covered, tell us about the omissions which are frequently a feature of conflict reporting. The article argues that the way in which reporters had to work in Iraq then meant that they did not convey all of the event’s wider implications, and suggests how that might be improved

Advice for journalists covering Covid-19: Welsh NHS confederation

The outbreak of COVID-19 is placing an unprecedented strain on health services in Wales and across the world. At the same time, coverage of the outbreak is essential, and there is a great demand from media organisations and their audiences to receive information about the outbreak and its frontline. This can put additional pressures on health care organisations and staff and may in certain cases interfere with their operations in dealing with the outbreak. This document has been prepared by Professor Karin Wahl-Jorgensen, Cardiff University, to support the work of the Welsh NHS Confederation. It draws on input from leading academics, journalists and PR practitioners (full list of contributors on p. 9). The document provides a number of suggestions for media organisations designed to facilitate coverage in and around healthcare facilities in Wales. The experts involved in preparing this document are independent from the NHS, and the document does not reflect official NHS policy. Here is a summary of our advice: 1. Responsible, detailed, and accurate reporting of COVID-19 is an essential public service. 2. Use credible experts as sources and be wary of unverified rumour 3. News organisations should use pooled materials whenever possible. 4. If looking for information verification, check other sources first before contacting NHS. 5. Ensure compliance with procedures for risk assessment and consent. 6. Enforce social distancing and ensure safe use of equipment. 7. Ensure risk assessments have been carried out prior to hospital visits and face-toface interactions with NHS staff. 8. Obtain consent from anyone interviewed or filmed. 9. When making requests for interviews or information, be specific about who you need to speak to, and where, what and how the information will be used

Calcineurin/NFAT Signaling in Activated Astrocytes Drives Network Hyperexcitability in A\u3cem\u3eβ\u3c/em\u3e-Bearing Mice

Hyperexcitable neuronal networks are mechanistically linked to the pathologic and clinical features of Alzheimer\u27s disease (AD). Astrocytes are a primary defense against hyperexcitability, but their functional phenotype during AD is poorly understood. Here, we found that activated astrocytes in the 5xFAD mouse model were strongly associated with proteolysis of the protein phosphatase calcineurin (CN) and the elevated expression of the CN-dependent transcription factor nuclear factor of activated T cells 4 (NFAT4). Intrahippocampal injections of adeno-associated virus vectors containing the astrocyte-specific promoter Gfa2 and the NFAT inhibitory peptide VIVIT reduced signs of glutamate-mediated hyperexcitability in 5xFAD mice, measured in vivo with microelectrode arrays and ex vivo brain slices, using whole-cell voltage clamp. VIVIT treatment in 5xFAD mice led to increased expression of the astrocytic glutamate transporter GLT-1 and to attenuated changes in dendrite morphology, synaptic strength, and NMDAR-dependent responses. The results reveal astrocytic CN/NFAT4 as a key pathologic mechanism for driving glutamate dysregulation and neuronal hyperactivity during AD

Obesity and Diabetes Cause Cognitive Dysfunction in the Absence of Accelerated β-Amyloid Deposition in a Novel Murine Model of Mixed or Vascular Dementia

Mid-life obesity and type 2 diabetes mellitus (T2DM) confer a modest, increased risk for Alzheimer\u27s disease (AD), though the underlying mechanisms are unknown. We have created a novel mouse model that recapitulates features of T2DM and AD by crossing morbidly obese and diabetic db/db mice with APPΔNL/ΔNLx PS1P264L/P264L knock-in mice. These mice (db/AD) retain many features of the parental lines (e.g. extreme obesity, diabetes, and parenchymal deposition of β-amyloid (Aβ)). The combination of the two diseases led to additional pathologies-perhaps most striking of which was the presence of severe cerebrovascular pathology, including aneurysms and small strokes. Cortical Aβ deposition was not significantly increased in the diabetic mice, though overall expression of presenilin was elevated. Surprisingly, Aβ was not deposited in the vasculature or removed to the plasma, and there was no stimulation of activity or expression of major Aβ-clearing enzymes (neprilysin, insulin degrading enzyme, or endothelin-converting enzyme). The db/AD mice displayed marked cognitive impairment in the Morris Water Maze, compared to either db/db or APPΔNLx PS1P264L mice. We conclude that the diabetes and/or obesity in these mice leads to a destabilization of the vasculature, leading to strokes and that this, in turn, leads to a profound cognitive impairment and that this is unlikely to be directly dependent on Aβ deposition. This model of mixed or vascular dementia provides an exciting new avenue of research into the mechanisms underlying the obesity-related risk for age-related dementia, and will provide a useful tool for the future development of therapeutics