The effect of Liver Transplantation on the quality of life of the recipient's main caregiver - a systematic review

Introduction: Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT on the Health Related Quality of Life (HRQL) of LT patients’ main caregivers. Methods: We searched 13 medical databases from 1996 to 2015. We included studies with HRQL data on caregivers of patients following LT then quality assessed and narratively synthesized the findings from these studies. Results: Of 7076 initial hits, only five studies fell within the scope of this study. In general, they showed caregiver burden persisted in the early period following LT. One study showed improvements, however the other four showed caregiver's levels of stress, anxiety and depression, remained similar or got worse post-LT and remained above that of the normal population. It was suggested that HRQL of the patient impacted on the caregiver and vice versa and may be linked to patient outcomes. No data was available investigating which groups were at particular risk of low HRQL following LT or if any interventions could improve this. Conclusion: The current information about LT caregivers’ needs and factors that impact on their HRQL are not adequately defined. Large studies are needed to examine the effects of LT on the patients’ family and caregivers in order to understand the importance of caregiver support to maximise outcomes of LT for the patient and their caregivers

Dating and relationship violence victimization and perpetration among 11-16 year olds in Wales: a cross-sectional analysis of the School Health Research Network (SHRN) survey

This is the final version. Available on open access from OUP via the DOI in this recordBACKGROUND: This study examines the prevalence of dating and relationship violence (DRV) victimization, perpetration and joint victimization and perpetration, and associations between DRV and socio-demographic characteristics. METHODS: Cross-sectional self-report data from 74 908 students aged 11-16 from 193 schools across Wales were collected and analysed using generalized estimating equations to examine prevalence and predictors of emotional and physical DRV victimization, perpetration and joint victimization and perpetration. RESULTS: More girls reported emotional victimization (28%) and perpetration (18%) than boys (20% and 16%, respectively). More girls (8%) than boys (7%) reported physical perpetration. However, boys (17%) reported more physical victimization than girls (12%). Age-related trajectories of DRV victimization and perpetration were stronger in girls than in boys. Students from single or step parent homes, those in care, and certain ethnic minority groups had increased odds of DRV. No association was found between socioeconomic status and DRV. CONCLUSIONS: Age-related trajectories and the lack of social patterning by socioeconomic status point to the value of early, universal interventions, while some evidence of ethnic patterning and family structure-related risk factors suggest areas for further research and targeted interventions. DRV continues to be a major public health problem for which little UK-specific intervention evidence exists.British Heart FoundationCancer Research UKEconomic and Social Research Council (ESRC)Medical Research Council (MRC)Welsh GovernmentWellcome Trus

Impacts of removing badgers on localised counts of hedgehogs

This is the final version of the article. Available from Public Library of Science via the DOI in this record.Experimental evidence of the interactions among mammalian predators that eat or compete with one another is rare, due to the ethical and logistical challenges of managing wild populations in a controlled and replicated way. Here, we report on the opportunistic use of a replicated and controlled culling experiment (the Randomised Badger Culling Trial) to investigate the relationship between two sympatric predators: European badgers Meles meles and western European hedgehogs Erinaceus europaeus. In areas of preferred habitat (amenity grassland), counts of hedgehogs more than doubled over a 5-year period from the start of badger culling (from 0.9 ha-1 pre-cull to 2.4 ha-1 post-cull), whereas hedgehog counts did not change where there was no badger culling (0.3-0.3 hedgehogs ha-1). This trial provides experimental evidence for mesopredator release as an outcome of management of a top predator.The study was funded by the United Kingdom Government’s Department for Environment, Food and Rural Affairs (http://www.defra.gov.uk). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Survey of ultrasound practice amongst podiatrists in the UK

Background: Ultrasound in podiatry practice encompasses musculoskeletal ultrasound imaging, vascular hand-held Doppler ultrasound and therapeutic ultrasound. Sonography practice is not regulated by the Health and Care Professions Council (HCPC), with no requirement to hold a formal qualification. The College of Podiatry does not currently define ultrasound training and competencies. This study aimed to determine the current use of ultrasound, training received and mentorship received and/or provided by podiatrists using ultrasound. Methods: A quantitative study utilising a cross-sectional, on-line, single-event survey was undertaken within the UK. Results: Completed surveys were received from 284 podiatrists; 173 (70%) use ultrasound as part of their general practice, 139 (49%) for musculoskeletal problems, 131 (46%) for vascular assessment and 39 (14%) to support their surgical practice. Almost a quarter (n=62) worked for more than one organisation; 202 (71%) were employed by the NHS and/or private sector (n=118, 41%). Nearly all (93%) respondents report using a hand-held vascular Doppler in their daily practice; 216 (82%) to support decisions regarding treatment options, 102 (39%) to provide diagnostic reports for other health professionals, and 34 (13%) to guide nerve blocks. Ultrasound imaging was used by 104 (37%) respondents primarily to aid clinical decision making (n=81) and guide interventions (steroid injections n=67; nerve blocks n=39). Ninety-three percent stated they use ultrasound imaging to treat their own patients, while others scan at the request of other podiatrists (n=28) or health professionals (n=18). Few use ultrasound imaging for research (n=7) or education (n=2). Only 32 (11%) respondents (n=20 private sector) use therapeutic ultrasound to treat patients presenting with musculoskeletal complaints, namely tendon pathologies. Few respondents (18%) had completed formal post-graduate CASE (Consortium for the Accreditation of Sonographic Education) accredited ultrasound courses. Forty (14%) respondents receive ultrasound mentorship; the majority from fellow podiatrists (n=17) or medical colleagues (n=15). Over half (n=127) who do not have ultrasound mentorship indicated they would like a mentor predominantly for ultrasound imaging. Fifty-five (19%) report they currently provide ultrasound mentorship for others. Conclusions: Understanding the scope of ultrasound practice, the training undertaken and the requirements for mentorship will underpin the development of competencies and recommendations defined by the College of Podiatry to support professional development and ensure safe practice.</p

Point-of-care screening for a current Hepatitis C virus infection: influence on uptake of a concomitant offer of HIV screening

Eliminating hepatitis C as a public health threat requires an improved understanding of how to increase testing uptake. We piloted point-of-care testing (POCT) for a current HCV infection in an inner-city Emergency Department (ED) and assessed the influence on uptake of offering concomitant screening for HIV. Over four months, all adults attending ED with minor injuries were first invited to complete an anonymous questionnaire then invited to test in alternating cycles offering HCV POCT or HCV+HIV POCT. Viral RNA was detected in finger-prick blood by GeneXpert. 814/859 (94.8%) questionnaires were returned and 324/814 (39.8%) tests were accepted, comprising 211 HCV tests and 113 HCV+HIV tests. Offering concomitant HIV screening reduced uptake after adjusting for age and previous HCV testing (odds ratio 0.51; 95% confidence interval [CI] 0.38–0.68; p < 0.001). HCV prevalence was 1/324 (0.31%; 95% CI 0.05–1.73); no participant tested positive for HIV. 167/297 (56.2%) POCT participants lived in the most deprived neighbourhoods in England. HCV RNA testing using finger-prick blood was technically feasible. Uptake was moderate and the offer of concomitant HIV screening showed a detrimental impact on acceptability in this low prevalence population. The findings should be confirmed in a variety of other community settings

Cliptography: Clipping the Power of Kleptographic Attacks

Kleptography, introduced 20 years ago by Young and Yung [Crypto ’96], considers the (in)security of malicious implementations (or instantiations) of standard cryptographic prim- itives that embed a “backdoor” into the system. Remarkably, crippling subliminal attacks are possible even if the subverted cryptosystem produces output indistinguishable from a truly secure “reference implementation.” Bellare, Paterson, and Rogaway [Crypto ’14] recently initiated a formal study of such attacks on symmetric key encryption algorithms, demonstrating a kleptographic attack can be mounted in broad generality against randomized components of cryptographic systems. We enlarge the scope of current work on the problem by permitting adversarial subversion of (randomized) key generation; in particular, we initiate the study of cryptography in the complete subversion model, where all relevant cryptographic primitives are subject to kleptographic attacks. We construct secure one-way permutations and trapdoor one-way permutations in this “complete subversion” model, describing a general, rigorous immunization strategy to clip the power of kleptographic subversions. Our strategy can be viewed as a formal treatment of the folklore “nothing up my sleeve” wisdom in cryptographic practice. We also describe a related “split program” model that can directly inform practical deployment. We additionally apply our general immunization strategy to directly yield a backdoor-free PRG. This notably amplifies previous results of Dodis, Ganesh, Golovnev, Juels, and Ristenpart [Eurocrypt ’15], which require an honestly generated random key. We then examine two standard applications of (trapdoor) one-way permutations in this complete subversion model and construct “higher level” primitives via black-box reductions. We showcase a digital signature scheme that preserves existential unforgeability when all algorithms (including key generation, which was not considered to be under attack before) are subject to kleptographic attacks. Additionally, we demonstrate that the classic Blum– Micali pseudorandom generator (PRG), using an “immunized” one-way permutation, yields a backdoor-free PRG. Alongside development of these secure primitives, we set down a hierarchy of kleptographic attack models which we use to organize past results and our new contributions; this taxonomy may be valuable for future work

The interstellar medium in Andromeda's dwarf spheroidal galaxies - I. Content and origin of the interstellar dust

Dwarf spheroidal galaxies are among the most numerous galaxy population in the Universe, but their main formation and evolution channels are still not well understood. The three dwarf spheroidal satellites (NGC147, NGC185, and NGC205) of the Andromeda galaxy are characterised by very different interstellar medium (ISM) properties, which might suggest them being at different galaxy evolutionary stages. While the dust content of NGC205 has been studied in detail by De Looze et al. (2012), we present new Herschel dust continuum observations of NGC147 and NGC185. The non-detection of NGC147 in Herschel SPIRE maps puts a strong constraint on its dust mass (< 128 Msun). For NGC185, we derive a total dust mass M_d = 5.1 x 10^3 Msun, which is a factor of ~2-3 higher than that derived from ISO and Spitzer observations and confirms the need for longer wavelength observations to trace more massive cold dust reservoirs. We, furthermore, estimate the dust production by asymptotic giant branch (AGB) stars and supernovae (SNe). For NGC147, the upper limit on the dust mass is consistent with expectations of the material injected by the evolved stellar population. In NGC185 and NGC205, the observed dust content is one order of magnitude higher compared to the estimated dust production by AGBs and SNe. Efficient grain growth, and potentially longer dust survival times (3-6 Gyr) are required to account for their current dust content. Our study confirms the importance of grain growth in the gas phase to account for the current dust reservoir in galaxies.DL gratefully acknowledge the support of the Science and Technology Facilities Council (STFC) and the Flemish Fund for Scientific Research (FWO-Vlaanderen). PACS has been developed by a consortium of institutes led by MPE (Germany) and including UVIE (Austria); KU Leuven, CSL, IMEC (Belgium); CEA, LAM (France); MPIA (Germany); INAFIFSI/OAA/OAP/OAT, LENS, SISSA (Italy); IAC (Spain). This development has been supported by the funding agencies BMVIT (Austria), ESA-PRODEX (Belgium), CEA/CNES (France), DLR (Germany), ASI/INAF (Italy), and CICYT/MCYT (Spain). SPIRE has been developed by a consortium of institutes led by Cardiff University (UK) and including Univ. Lethbridge (Canada); NAOC (China); CEA, LAM (France); IFSI, Univ. Padua (Italy); IAC (Spain); Stockholm Observatory (Sweden); Imperial College London, RAL, UCL-MSSL, UKATC, Univ. Sussex (UK); and Caltech, JPL, NHSC, Univ. Colorado (USA). This development has been supported by national funding agencies: CSA (Canada); NAOC (China); CEA, CNES, CNRS (France); ASI (Italy); MCINN (Spain); SNSB (Sweden); STFC and UKSA (UK); and NASA (USA). This research has made use of the NASA/IPAC Extragalactic Database (NED) which is operated by the Jet Propulsion Laboratory, California Institute of Technology, under contract with the National Aeronautics and Space Administration.This is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/mnras/stw86

UK Breastfeeding Helpline support: An investigation of influences upon satisfaction

Background Incentive or reward schemes are becoming increasingly popular to motivate healthy lifestyle behaviours. In this paper, insights from a qualitative and descriptive study to investigate the uptake, impact and meanings of a breastfeeding incentive intervention integrated into an existing peer support programme (Star Buddies) are reported. The Star Buddies service employs breastfeeding peer supporters to support women across the ante-natal, intra-partum and post-partum period. Methods In a disadvantaged area of North West England, women initiating breastfeeding were recruited by peer supporters on the postnatal ward or soon after hospital discharge to participate in an 8 week incentive (gifts and vouchers) and breastfeeding peer supporter intervention. In-depth interviews were conducted with 26 women participants who engaged with the incentive intervention, and a focus group was held with the 4 community peer supporters who delivered the intervention. Descriptive analysis of routinely collected data for peer supporter contacts and breastfeeding outcomes before and after the incentive intervention triangulated and retrospectively provided the context for the qualitative thematic analysis. Results A global theme emerged of 'incentives as connectors', with two sub-themes of 'facilitating connections' and 'facilitating relationships and wellbeing'. The incentives were linked to discussion themes and gift giving facilitated peer supporter access for proactive weekly home visits to support women. Regular face to face contacts enabled meaningful relationships and new connections within and between the women, families, peer supporters and care providers to be formed and sustained. Participants in the incentive scheme received more home visits and total contact time with peer supporters compared to women before the incentive intervention. Full participation levels and breastfeeding rates at 6-8 weeks were similar for women before and after the incentive intervention. Conclusion The findings suggest that whilst the provision of incentives might not influence women's intentions or motivations to breastfeed, the connections forged provided psycho-social benefits for both programme users and peer supporters

Study protocol for the optimisation, feasibility testing and pilot cluster randomised trial of Positive Choices: a school-based social marketing intervention to promote sexual health, prevent unintended teenage pregnancies and address health inequalities in England.

BACKGROUND: Since the introduction of the Teenage Pregnancy Strategy (TPS), England's under-18 conception rate has fallen by 55%, but a continued focus on prevention is needed to maintain and accelerate progress. The teenage birth rate remains higher in the UK than comparable Western European countries. Previous trials indicate that school-based social marketing interventions are a promising approach to addressing teenage pregnancy and improving sexual health. Such interventions are yet to be trialled in the UK. This study aims to optimise and establish the feasibility and acceptability of one such intervention: Positive Choices. METHODS: Design: Optimisation, feasibility testing and pilot cluster randomised trial.Interventions: The Positive Choices intervention comprises a student needs survey, a student/staff led School Health Promotion Council (SHPC), a classroom curriculum for year nine students covering social and emotional skills and sex education, student-led social marketing activities, parent information and a review of school sexual health services.Systematic optimisation of Positive Choices will be carried out with the National Children's Bureau Sex Education Forum (NCB SEF), one state secondary school in England and other youth and policy stakeholders.Feasibility testing will involve the same state secondary school and will assess progression criteria to advance to the pilot cluster RCT.Pilot cluster RCT with integral process evaluation will involve six different state secondary schools (four interventions and two controls) and will assess the feasibility and utility of progressing to a full effectiveness trial.The following outcome measures will be trialled as part of the pilot:Self-reported pregnancy and unintended pregnancy (initiation of pregnancy for boys) and sexually transmitted infections,Age of sexual debut, number of sexual partners, use of contraception at first and last sex and non-volitional sexEducational attainmentThe feasibility of linking administrative data on births and termination to self-report survey data to measure our primary outcome (unintended teenage pregnancy) will also be tested. DISCUSSION: This will be the first UK-based pilot trial of a school-wide social marketing intervention to reduce unintended teenage pregnancy and improve sexual health. If this study indicates feasibility and acceptability of the optimised Positive Choices intervention in English secondary schools, plans will be initiated for a phase III trial and economic evaluation of the intervention. TRIAL REGISTRATION: ISRCTN registry (ISCTN12524938. Registered 03/07/2017)