The impact of National Institute for Health and Care Excellence Clinical Guideline 168 on the management of superficial venous disease

INTRODUCTION In 2013, NICE published new guidance (CG168) for the management of lower limb venous disease; these guidelines sought to improve access to secondary care and recognised newer endovenous treatment modalities sufficiently robust to recommend. No formal study had evaluated the effect of the introduction of Guideline CG168 on venous disease management; this prompted the research project embodying this thesis. METHODS The management of venous disease was investigated locally at a secondary care level with primary care management being studied via the Health Improvement Network Database. RESULTS Local secondary care has improved significantly since the introduction of CG168, demonstrating an increased use of endovenous treatments at earlier stage of venous disease. A significantly higher number of patients are being referred for specialist review with leg ulceration. An improvement in referral and management of varicose veins in the community setting was noted, however the increase in referral for leg ulceration was more modest, with patients often not referred at all for secondary care assessment. CONCLUSION Whilst current data presented here suggests enhanced management of superficial venous disease, nationwide primary care improvements have been less marked. Further efforts will be required to continue to publicise the importance of NICE Guideline CG168 in order to extend its beneficial effects on patient care

Predicting the spatial expansion of an animal population with presence-only data

Abstract Predictive models can improve the efficiency of wildlife management by guiding actions at the local, landscape and regional scales. In recent decades, a vast range of modelling techniques have been developed to predict species distributions and patterns of population spread. However, data limitations often constrain the precision and biological realism of models, which make them less useful for supporting decision‐making. Complex models can also be challenging to evaluate, and the results are often difficult to interpret for wildlife management practitioners. There is therefore a need to develop techniques that are appropriately robust, but also accessible to a range of end users. We developed a hybrid species distribution model that utilises commonly available presence‐only distribution data and minimal demographic information to predict the spread of roe deer (Capreolus caprelous) in Great Britain. We take a novel approach to representing the environment in the model by constraining the size of habitat patches to the home‐range area of an individual. Population dynamics are then simplified to a set of generic rules describing patch occupancy. The model is constructed and evaluated using data from a populated region (England and Scotland) and applied to predict regional‐scale patterns of spread in a novel region (Wales). It is used to forecast the relative timing of colonisation events and identify important areas for targeted surveillance and management. The study demonstrates the utility of presence‐only data for predicting the spread of animal species and describes a method of reducing model complexity while retaining important environmental detail and biological realism. Our modelling approach provides a much‐needed opportunity for users without specialist expertise in computer coding to leverage limited data and make robust, easily interpretable predictions of spread to inform proactive population management

A traffic light grading system of hip dysplasia to predict the success of arthroscopic hip surgery

Background: The role of hip arthroscopy in dysplasia is controversial. Purpose: Determine the 7-year joint preservation rate following hip arthroscopy in hip dysplasia and identify anatomical and intra-operative features that predict success of hip preservation with arthroscopic surgery allowing formulation of an evidence-based classification. Study Design: Cohort Study; Level of evidence: 3 Methods: Between 2008 and 2013, 111 hips with dysplastic features [acetabular index (AI) > 10° and/or centre-edge angle (CEA) <25°] having undergone an arthroscopy were identified. Clinical, radiological and operative findings and type of procedure performed were reviewed. Radiographic evaluations of the operated hip [acetabular index (AI), centre-edge angle (CEA), extrusion index] were performed. Outcome measures included whether the hip was preserved at follow-up, pre- and post-operative NAHS and HOOS scores. We calculated AI and CEA factored (AIf and CEAf respectively) by a measure of articular wear as follows: AIf = AI x (number of UCL wear zones +1) CEAf = CEA / (number of UCL zones + 1) A contour plot of the resulting probability value of failure for every combination of AIf and CEAf allowed for the determination of the zones with the lowest and highest incidence of failure to preserve the hip respectively. Results: The mean AI and CEA were 7.8° and 18.0°, respectively. At a mean follow-up of 4.4 years, 33 hips had failed requiring a hip arthroplasty. The 7- year joint survival was 68%. The mean improvement in NAHS and HOOS were 7.8 and 23 points respectively. The zone with the greatest chance of joint preservation (odds ratio: 10, p<0.001) was AIf: 0 – 15 and CEAf: 15 – 25 (Green Zone); on the contrary the zone with the greatest chance of failure (odds ratio: 10, p<0.001) was AIf: 20 – 100 and CEAf : 0 – 10 (Red Zone). Conclusion: Overall, the 7- year hip survival in hip dysplasia appears inferior compared to reports of Femoro-Acetabular Impingement cases. Hip arthroscopy is associated with excellent chance of hip preservation in mild (Green Zone) dysplasia (AI< 15° & CEA: 15 – 25°) and no (or little) articular wear. Hip arthroscopy should not be performed in cases with severe (Red Zone) dysplasia (AI> 20° & CEA< 10°)

Портативный детектор скрытой проводки

Объектом исследования являются искатели скрытой проводки с различными технологиями поиска и различными схемами построения. Цель работы – разработка универсального портативного детектора скрытой проводки со световой и звуковой индикацией. В процессе исследования проводились теоретические исследования методов поиска и способов реализации устройств, разработка и расчет принципиальной схемы устройства. В результате исследования была разработана принципиальная схема устройства, использующего два различных метода поиска – электростатический и электромагнитный. Был произведен расчет и выбор компонентов схемы.The object of the study are seekers flush with the various search technologies and construction of various schemes. Purpose - to develop a universal portable flush detector with audible and visual indication. The study carried out theoretical studies of search methods and ways of realization of devices, development and calculation of the fundamental scheme of the device. The study schematic diagram of the device has been developed that uses two different search methods - electrostatic and electromagnetic. calculation and selection of circuit components was performed

A traffic light grading system of hip dysplasia to predict the success of arthroscopic hip surgery

Background: The role of hip arthroscopic surgery in dysplasia is controversial. Purpose: To determine the 7-year joint preservation rate after hip arthroscopic surgery in hip dysplasia and identify anatomic and intraoperative features that predict the success of hip preservation with arthroscopic surgery, allowing the formulation of an evidence-based classification system. Study Design: Case-control study; Level of evidence, 3. Methods: Between 2008 and 2013, 111 hips with dysplastic features (acetabular index [AI] &gt;10° and/or lateral center-edge angle [LCEA] &lt;25°) that underwent arthroscopic surgery were identified. Clinical, radiological, and operative findings and the type of procedure performed were reviewed. Radiographic evaluations of the operated hip (AI, LCEA, extrusion index) were performed. Outcome measures included whether the hip was preserved (ie, did not require arthroplasty) at follow-up and the preoperative and postoperative Non-Arthritic Hip Score (NAHS) and Hip disability and Osteoarthritis Outcome Score (HOOS). The AI and LCEA were calculated, factored by a measure of articular wear (AIf and LCEAf, respectively), according to the University College Hospital, London (UCL) grading system as follows: AIf = AI × (number of UCL wear zones + 1), and LCEAf = LCEA / (number of UCL wear zones + 1). A contour plot of the resulting probability value of failure for every combination of AIf and LCEAf allowed for the determination of the zones with the lowest and highest incidences of failure to preserve the hip. Results: The mean AI and LCEA were 9.8° and 18.0°, respectively. At a mean follow-up of 4.5 years (range, 0.4-8.3 years), 33 hips had failed, requiring hip arthroplasty. The 7-year joint survival rate was 68%. The mean improvements in the NAHS and HOOS were 11 ( P = .001) and 22.8 ( P &lt; .001) points, respectively. The zone with the greatest chance of joint preservation (odds ratio, 10; P &lt; .001) was the green zone, with an AIf of 0° to 15° and an LCEAf of 15° to 25°; in contrast, the zone with the greatest chance of failure (odds ratio, 10; P &lt; .001) was the red zone, with an AIf of 20° to 100° and an LCEAf of 0° to 10°. Conclusion: Overall, the 7-year hip survival rate in hip dysplasia appears inferior compared with that reported in femoroacetabular impingement (78%). Hip arthroscopic surgery is associated with an excellent chance of hip preservation in mild dysplasia (green zone: AI = 0°-15°, LCEA = 15°-25°) and no articular wear. The authors advise that the greatest caution should be used when considering arthroscopic options in cases of severe dysplasia (red zone: AI &gt;20° and/or LCEA &lt;10°). </jats:sec

Calorie restriction activates new adult born olfactory‐bulb neurones in a ghrelin‐dependent manner but acyl‐ghrelin does not enhance subventricular zone neurogenesis

The ageing and degenerating brain show deficits in neural stem/progenitor cell (NSPC) plasticity that are accompanied by impairments in olfactory discrimination. Emerging evidence suggests that the gut hormone ghrelin plays an important role in protecting neurones, promoting synaptic plasticity and increasing hippocampal neurogenesis in the adult brain. In the present study, we investigated the role of ghrelin with respect to modulating adult subventricular zone (SVZ) NSPCs that give rise to new olfactory bulb (OB) neurones. We characterised the expression of the ghrelin receptor, growth hormone secretagogue receptor (GHSR), using an immunohistochemical approach in GHSR‐eGFP reporter mice to show that GHSR is expressed in several regions, including the OB but not in the SVZ of the lateral ventricle. These data suggest that acyl‐ghrelin does not mediate a direct effect on NSPC in the SVZ. Consistent with these findings, treatment with acyl‐ghrelin or genetic silencing of GHSR did not alter NSPC proliferation within the SVZ. Similarly, using a bromodeoxyuridine pulse‐chase approach, we show that peripheral treatment of adult rats with acyl‐ghrelin did not increase the number of new adult‐born neurones in the granule cell layer of the OB. These data demonstrate that acyl‐ghrelin does not increase adult OB neurogenesis. Finally, we investigated whether elevating ghrelin indirectly, via calorie restriction (CR), regulated the activity of new adult‐born cells in the OB. Overnight CR induced c‐Fos expression in new adult‐born OB cells but not in developmentally born cells, whereas neuronal activity was absent following re‐feeding. These effects were not present in ghrelin−/− mice, suggesting that adult‐born cells are uniquely sensitive to changes in ghrelin mediated by fasting and re‐feeding. In summary, ghrelin does not promote neurogenesis in the SVZ and OB; however, new adult‐born OB cells are activated by CR in a ghrelin‐dependent manner

Unacylated-Ghrelin Impairs Hippocampal Neurogenesis and Memory in Mice and Is Altered in Parkinson’s Dementia in Humans

Blood-borne factors regulate adult hippocampal neurogenesis and cognition in mammals. We report that elevating circulating unacylated-ghrelin (UAG), using both pharmacological and genetic methods, reduced hippocampal neurogenesis and plasticity in mice. Spatial memory impairments observed in ghrelin-O-acyl transferase-null (GOAT/) mice that lack acyl-ghrelin (AG) but have high levels of UAG were rescued by acyl-ghrelin. Acyl-ghrelin-mediated neurogenesis in vitro was dependent on non-cell-autonomous BDNF signaling that was inhibited by UAG. These findings suggest that post-translational acylation of ghrelin is important to neurogenesis and memory in mice. To determine relevance in humans, we analyzed circulating AG:UAG in Parkinson disease (PD) patients diagnosed with dementia (PDD), cognitively intact PD patients, and controls. Notably, plasma AG:UAG was only reduced in PDD. Hippocampal ghrelin-receptor expression remained unchanged; however, GOAT+ cell number was reduced in PDD. We identify UAG as a regulator of hippocampal-dependent plasticity and spatial memory and AG:UAG as a putative circulating diagnostic biomarker of dementia

Evaluating the Foundation Phase: Update and Technical Report 2012/13

The Foundation Phase (introduced in 2008) provides a developmentally appropriate experiential curriculum for children aged 3-7 in Wales. The Welsh Government commissioned independent evaluation (led by WISERD) aims to evaluate how well it is being implemented, what impact it has had, and ways in which it can be improved. The three-year evaluation utilises a range of mixed methods at a national and local scale