Human papillomaviruses and their association with cervical disease

The overall aim of the project was to establish whether human papillomaviruses (HPV) are associated with cervical intraepithelial neoplasia (CIN) and cervical carcinoma and examine the use of HPV 16 as an indicator of cervical disease. For this purpose, a Southern blot hybridization system was developed to detect HPV DNA in cervical scrape samples. However, following the description of the polymerase chain reaction for detection of nucleic acid a PCR system for detection of HPV DNA was developed. The ability of Southern blot hybridization and PCR to detect HPV DNA in cervical scrape samples was compared to determine the most suitable method for use as a diagnostic test for HPV. The PCR method was 100,000 times more sensitive than Southern blot and was more accurate in identifying women with cervical disease. The PCR system was used to analyse cervical scrape samples from two study groups for the presence of HPV 16 DNA. The first group (Study A) consisted of 200 women from a General Practice population who were expected to have normal cervical cytology.HPV 16 was present in 17% of women with no cervical abnormalities. In those women from Study A who had cervical disease (n = 22) the prevalence of HPV 16 increased with greater severity of disease from 15.4% in those with CIN 1, 40% in those with CIN 2, to 75% of those with CIN 3. The presence of HPV 16 DNA was significantly associated with CIN 2 and 3 (p = 0.009) and was therefore useful as an indicator of severe cervical disease in this population. The ability of PCR for HPV 16 to identify women with disease was compared with that of standard cytological analysis. There was no significant difference between the two methods, although a combination of screening by cytology and PCR resulted in the identification of a higher proportion of women with disease and PCR was associated with a higher false positive rate. The second group (Study B) consisted of 200 women who had been referred to the Royal Free Hospital colposcopy clinic with a smear report suggesting mild dyskaryosis. Within this group there were 54 women who were cytologically normal, 59 women who had CIN 1 or WVI and 66 women with severe cervical disease (CIN 2 or 3). The results of Study B concurred with Study A in demonstrating an increasing prevalence of HPV 16 with greater severity of disease from 53% in women with CIN 1, 64% of women with CIN 2 to 74% of patients with CIN 3. However, the prevalence of HPV 16 in the normal women in Study B was 63%, and this high value precludes the use of HPV 16 as an indicator of severe cervical disease in this population. Duplicate analysis of each cervical scrape sample from Study A and Study B allowed the reproducibility of the HPV 16 PCR system to be determined. The false positive rate was 0.1% and the false negative rate was 0.77%. The long control region (LCR) of HPV 16 was cloned from a woman without cervical disease (CO) and a woman with CIN 3 (C3). The DNA sequence of each isolate was determined and compared with the prototype HPV 16 sequence. Nucleotide variations were evident in both isolates, but LCRC3 shared less homology with the prototype sequence than LCRCO. A single nucleotide mutation occurred within the glucocorticoid responsive element of LCRC3, which disrupts the palindrome of the protein binding domain. The level of expression from the HPV 16 LCR was determined using a chloramphenicol acetyltransferase assay and found to be 5-fold lower than that of the SV40 early promoter

Beyond the trial: A systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety

Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, that is, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported. Objective: We aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter ‘usage data’ or, for brevity, ‘engagement’) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood. Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions. Results: After the removal of duplicates, 970 papers were identified, of which ten met the inclusion criteria. Hand-searching identified one additional article. The included articles reported on seven publically available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from eight to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (e.g. used the intervention at least once or completed one module or assessment), while 7–42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after four weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%. Conclusions: Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs which have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health

A Study of Aerodynamic Drag of Contemporary Footballs

AbstractMost modern footballs possess varied surface characteristics which can affect the flight trajectory of the football. Although the aerodynamic behavior of other sports balls have been studied well, little information is available about the aerodynamic behavior of newly introduced footballs with varied seam configurations and number of panels. Therefore, the primary objective of this study is to understand the surface characteristics mainly the seam depth and seam height and their effects on aerodynamic of a range of new generation balls. Four new generation footballs: Kapanya, Cafusa, Tango and Brazuca were selected for this study. Seam length and depth of seam for each ball were measured using 3D scanning technology and also manual measurement. Additionally, the aerodynamic drag forces were measured using wind tunnel over a range of wind speeds for two positions of each ball. It was found that the seam length and depth of seam have influence on the aerodynamic drag of these modern footballs. Results also indicate that the sideway variation of aerodynamic drag is minimal for the Brazuca ball. As a result, this ball may have better stability in flight. The lowest aerodynamic drag was found for the Cafusa ball at high speeds which indicates that this ball is suitable for long distance pass. However, it has highest sideway drag variation that may cause instability in flight

Young Children with ASD Use Lexical and Referential Information During On-line Sentence Processing

Research with adults and older children indicates that verb biases are strong influences on listeners’ interpretations when processing sentences, but they can be overruled. In this paper, we ask two questions: (i) are children with Autism Spectrum Disorder (ASD) who are high functioning sensitive to verb biases like their same age typically developing peers?, and (ii) do young children with ASD and young children with typical development (TD) override strong verb biases to consider alternative interpretations of ambiguous sentences? Participants were aged 5–9 years (mean age 6.65 years): children with ASD who were high functioning and children with TD. In task 1, biasing and neutral verbs were included (e.g., eat cake versus move cake). In task 2, the focus was on whether the prepositional phrase occurring with an instrument biasing verb (e.g., ‘Chop the tree with the axe’) was interpreted as an instrument even if the named item was an implausible instrument (e.g., candle in ‘Cut the cake with the candle’). Overall, the results showed similarities between groups but the ASD group was generally slower. In task 1, both groups looked at the named object faster in the biasing than the non-biasing condition, and in the biasing condition the ASD group looked away from the target more quickly than the TD group. In task 2, both groups identified the target in the prepositional phrase. They were more likely to override the verb instrument bias and consider the alternative (modification) interpretation in the implausible condition (e.g., looking at the picture of a cake with a candle on it’). Our findings indicate that children of age 5 years and above can use context to override verb biases. Additionally, an important component of the sentence processing mechanism is largely intact for young children with ASD who are high functioning. Like children with TD, they draw on verb semantics and plausibility in integrating information. However, they are likely to be slower in processing the language they hear. Based on previous findings of associations between processing speed and cognitive functioning, the implication is that their understanding will be negatively affected, as will their academic outcomes

Elementary School Based Health Centers as Providers of School Entry Health Exams: Do They Meet the Standards?

The health of today\u27s children is crucial for the future of our society. There are many children without access to healthcare in these turbulent economic times; times that are increasingly uncertain as society maneuvers its way through the maze of healthcare reform. School based health centers (SBHCs) provide a safety net for children needing basic healthcare who are otherwise underserved. School entry health examinations (SEHE) are legal requirements in many states, and are a proven method for identifying health conditions early enough in a child\u27s life that they can be corrected. Treating identified health conditions facilitates academic success for children, leading to a healthier society. The purpose of this capstone project was to complete a program evaluation of an elementary level safety net type of SBHC, specifically evaluating SEHE to determine if national guidelines are met. The Shuler Nurse Practitioner Practice Model (SNPPM) was utilized for the practice segment; the Plan-Do-Study-Act model was used for the evaluation segment. A retrospective chart review was completed to determine if three major outcomes were met: * Are all components of the SEHE completed as outlined in national guidelines? * Are all health conditions identified treated, followed up or referred? * Are results of the SEHE communicated to the school of attendance? The comprehensive literature review includes information on importance of SEHE, history of the SBHC movement (both medical home and safety net types), evaluation of outcomes of SBHCs related to attendance, healthcare access, and academic achievement. Literature relevant to program evaluation criteria and quality improvement programs are identified for pediatric public health providers, such as pediatric nurse practitioners. Data collection and analysis demonstrated that SBHCs provide SEHE comparable to national guidelines. Results were shared with the program staff after analysis, leading to changes within the evaluated program that will facilitate better care over time. These changes will insure more positive outcomes in child health. Healthy children learn better and become more productive members of society when they have a positive start

The reflective labyrinth: An innovative tool for exploring, developing and scaffolding reflection skills at UCLan

Reflection is increasingly being embedded into higher education curricula, not only due to the benefits it has for long-term learning, but also due to it becoming a key requirement in professional competencies beyond the university context. However, due to assumptions that reflection is an innate ability already at students’ disposal, the necessary scaffolding of the thought processes involved are often overlooked. This study therefore aimed to demonstrate how the use of a labyrinth could stimulate and deepen the learning and teaching of critical reflection skills within UCLan. Reporting on initial findings from five labyrinth workshops with staff and students, this paper identified that both groups appreciated the wellbeing effect the labyrinth afforded, but differed in their evaluation of the sessions’ most valued quality. Whereas staff welcomed the opportunity, time and space to stop and reflect on their practice, students acknowledged the labyrinth’s effectiveness for learning about reflection, its models and its application to their assessments and practice. Potentially signalling their differing familiarity with the processes and goals of reflection, this study concluded that the labyrinth is a useful scaffolding tool for the learning and teaching of reflection which can be used across different subject areas, year groups and levels of expertise

Natural History of Stuttering to 4 Years of Age: A Prospective Community-Based Study

These findings from a community-ascertained cohort refute long-held views suggesting that developmental stuttering is associated with a range of poorer outcomes. If anything, the reverse was true, with stuttering predicting subsequently better language,nonverbal skills, and psychosocial health-related quality of life at 4 years of age.Future research with this cohort will support a more complete longitudinal understanding of when and in whom recovery occurs. Current best practice recommends waiting for 12 monthsbefore commencing treatment, unlessthe child is distressed, there is parental concern, or the child becomes reluctant to communicate. It may be that for many children treatment could be deferred even longer. Treatment is efficacious15 but is both intensive (median of 15.4o ne-hour clinical sessions followedby 10 one-hour clinical maintenance sessions) and expensive; this "watchful waiting" recommendation would therefore help target allocation of scarce resources to the small number of children who do not resolve and experience adverse outcomes, secure in the knowledge that delaying treatment by a year or more has been shown not to compromise treatment efficac

Gesture production and comprehension in children with specific language impairment

Children with specific language impairment (SLI) have difficulties with spoken language. However, some recent research suggests that these impairments reflect underlying cognitive limitations. Studying gesture may inform us clinically and theoretically about the nature of the association between language and cognition. A total of 20 children with SLI and 19 typically developing (TD) peers were assessed on a novel measure of gesture production. Children were also assessed for sentence comprehension errors in a speech-gesture integration task. Children with SLI performed equally to peers on gesture production but performed less well when comprehending integrated speech and gesture. Error patterns revealed a significant group interaction: children with SLI made more gesture-based errors, whilst TD children made semantically based ones. Children with SLI accessed and produced lexically encoded gestures despite having impaired spoken vocabulary and this group also showed stronger associations between gesture and language than TD children. When SLI comprehension breaks down, gesture may be relied on over speech, whilst TD children have a preference for spoken cues. The findings suggest that for children with SLI, gesture scaffolds are still more related to language development than for TD peers who have out-grown earlier reliance on gestures. Future clinical implications may include standardized assessment of symbolic gesture and classroom based gesture support for clinical groups