Vulnerability and abuse: an exploration of views of care staff working with people who have learning disabilities.

In recent years there has been increased focus on vulnerability and abuse however greater attention has been paid to this in relation to children, elders and in domestic situations. Within learning disability service there has been increasing attention on physical and sexual abuse as well as attention being given to abuse as it is perceived by people with learning disabilities. The aim of this study was to explore the views of staff working within learning disability services regarding their views of vulnerability and abuse. A phenomenological approach was adopted, as this is a subject about which little is known and the lived experiences of care staff and the meanings that they attach to them were being explored. Semi-structured interview was the chosen method for data collection. Twenty informants shared their views in this study. The data generated were themed and the findings were presented in two different but complementary styles: case studies and themes representative across the entire sample. This research has highlighted a number of important issues. There is considerable difference in the meanings given to vulnerability by care staff and the range of meanings are further complicated when notions of risk are considered. A model is presented that illustrates experiences of vulnerability and confidence of the individual the impact of various experiences on those states. For example negative experience of bullying might increase vulnerability whilst positive family support might engender feelings of confidence. The study showed that staff are more influenced by personal and family values than by policy. Though this study focused on adult protection policy it was evident that this also applied in the case of other policy. The strong influence of personal values pervades all aspects of care. This was evident in the views of informants regarding abuse. Abuse is considered to range in severity from bullying, which is seen as prevalent but to an extent unpreventable, to sexual abuse which is considered by most to be taboo. Neglect and infringement of rights were in the main not seen as abuse with both being attributed to ignorance. Power, authority and/or control are felt to be essential in the management behaviour that challenges and is justified to that end. In the context of adult protection a model for safety planning is proposed that shifts the emphasis away from risk avoidance toward an enabling person centred approach that recognises the importance to the individual of excitement in life that also may involve risk

Placental dysfunction is associated with altered microRNA expression in pregnant women with low folate status

Scope: Low maternal folate status during pregnancy increases the risk of delivering small for gestational age (SGA) infants, but the mechanistic link between maternal folate status, SGA, and placental dysfunction is unknown. microRNAs (miRNAs) are altered in pregnancy pathologies and by folate in other systems. We hypothesized that low maternal folate status causes placental dysfunction, mediated by altered miRNA expression. Methods and results: A prospective observational study recruited pregnant adolescents and assessed third trimester folate status and placental function. miRNA array, QPCR, and bioinformatics identified placental miRNAs and target genes. Low maternal folate status is associated with higher incidence of SGA infants (28% versus 13%, p < 0.05) and placental dysfunction, including elevated trophoblast proliferation and apoptosis (p < 0.001), reduced amino acid transport (p < 0.01), and altered placental hormones (pregnancy-associated plasma protein A, progesterone, and human placental lactogen). miR-222-3p, miR-141-3p, and miR-34b-5p were upregulated by low folate status (p < 0.05). Bioinformatics predicted a gene network regulating cell turnover. Quantitative PCR demonstrated that key genes in this network (zinc finger E-box binding homeobox 2, v-myc myelocytomatosis viral oncogene homolog (avian), and cyclin-dependent kinase 6) were reduced (p < 0.05) in placentas with low maternal folate status. Conclusion: This study supports that placental dysfunction contributes to impaired fetal growth in women with low folate status and suggests altered placental expression of folate-sensitive miRNAs and target genes as a mechanistic link

Control of gag-pol gene expression in the Candida albicans retrotransposon Tca2

Non peer reviewedPublisher PD

Influence of Plant Species, Tissue Type, and Temperature on the Capacity of Shiga-Toxigenic Escherichia coli To Colonize, Grow, and Be Internalized by Plants

N.J.H. and S.M. were supported by an FSA grant (FS101056); B.M. was supported by a Ph.D. award to N.J.H., N.J.C.S., F.B., and K.J.F.; and N.J.H. was partly funded by the Rural & Environment Science & Analytical Services Division of the Scottish government. We are grateful to Susan Verrall and Raymond Campbell (Hutton Institute) for assistance with GC-MS and HPLC and David Gally (University of Edinburgh) for the use of CL3 facilities. We declare no conflicts of interest.Peer reviewedPostprin

Relating growth potential and biofilm formation of Shigatoxigenic Escherichia coli to in planta colonisation and the metabolome of ready- to-eat crops

preprintContamination of fresh produce with pathogenic Escherichia coli, including Shigatoxigenic E. coli (STEC), represents a serious risk to human health. Colonisation is governed by multiple bacterial and plant factors that can impact on the probability and suitability of bacterial growth. Thus, we aimed to determine whether the growth potential of STEC for plants associated with foodborne outbreaks (two leafy vegetables and two sprouted seed species), is predictive for colonisation of living plants as assessed from growth kinetics and biofilm formation in plant extracts. Fitness of STEC was compared to environmental E. coli, at temperatures relevant to plant growth. Growth kinetics in plant extracts varied in a plant-dependent and isolate-dependent manner for all isolates, with spinach leaf lysates supporting the fastest rates of growth. Spinach extracts also supported the highest levels of biofilm formation. Saccharides were identified as the major driver of bacterial growth, although no single metabolite could be correlated with growth kinetics. The highest level of in planta colonisation occurred on alfalfa sprouts, though internalisation was 10-times more prevalent in the leafy vegetables than in sprouted seeds. Marked differences in in planta growth meant that growth potential could only be inferred for STEC for sprouted seeds. In contrast, biofilm formation in extracts related to spinach colonisation. Overall, the capacity of E. coli to colonise, grow and internalise within plants or plant-derived matrices were influenced by the isolate type, plant species, plant tissue type and temperature, complicating any straight-forward relationship between in vitro and in planta behaviours. Importance Fresh produce is an important vehicle for STEC transmission and experimental evidence shows that STEC can colonise plants as secondary hosts, but differences in the capacity to colonise occur between different plant species and tissues. Therefore, an understanding of the impact of these plant factors have on the ability of STEC to grow and establish is required for food safety considerations and risk assessment. Here, we determined whether growth and the ability of STEC to form biofilms in plants extracts could be related to specific plant metabolites or could predict the ability of the bacteria to colonise living plants. Growth rates for sprouted seeds (alfalfa and fenugreek) exhibited a positive relationship between plant extracts and living plants, but not for leafy vegetables (lettuce and spinach). Therefore, the detailed variations at the level of the bacterial isolate, plant species and tissue type all need to be considered in risk assessment

Promoting early presentation of breast cancer in older women during the seasonal influenza vaccination campaign

Background: Older women are at high risk of presenting with late stage of breast cancer, which may be partly because of poor breast cancer awareness. Aims: The aim of this project was to implement and evaluate a new way of delivering the Promoting Early Presentation (PEP) Intervention during flu vaccination appointments in primary care. The PEP intervention is a 1-minute intervention, accompanied by a booklet and delivered by primary care health professionals to provide older women with the knowledge, confidence and skills to present promptly on discovering symptoms of breast cancer. Methods: Health professionals delivered the PEP Intervention to older women at six general practices in South London. We measured changes in breast cancer awareness after the intervention and interviewed practice staff about their experiences of the intervention. Findings: Knowledge of breast symptoms and breast checking was greater in women aged 70+ after the implementation than before. Health professionals’ found the intervention acceptable and feasible to implement. Conclusion: This intervention is a novel way of increasing breast cancer awareness in older women, which could contribute to promoting earlier presentation and diagnosis of breast cancer in the UK

Promoting Early Presentation intervention sustains increased breast cancer awareness in older women for three years: A randomized controlled trial

Objective In a randomized controlled trial, the Promoting Early Presentation intervention increased older women’s breast cancer awareness after two years. We investigated whether this increase was sustained at three years, and the effect on breast screening self-referral. Methods We randomly allocated 867 women attending their final invited breast screening appointment to the Promoting Early Presentation intervention or usual care. We examined breast cancer awareness after three years and breast screening self-referrals after four years. Results Women in the Promoting Early Presentation intervention arm had higher breast cancer awareness at three years than the usual care arm (odds ratio: 10.4; 95% confidence interval: 3.1 to 34.8). There were no differences in proportions self-referring for breast screening between arms, but statistical power was limited. Conclusion The Promoting Early Presentation intervention has a sustained effect on breast cancer awareness in older women. The effect on self-referral for breast screening is unclear

Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)