St. Anne's Health Centre

Wadelai, an isolated focus for onchocerciasis in northwest Uganda, was selected for piloting an onchocerciasis elimination strategy that was ultimately the precursor for countrywide onchocerciasis elimination policy. The Wadelai focus strategy was to increase ivermectin treatments from annual to semiannual frequency and expand geographic area in order to include communities with nodule rate of less than 20%. These communities had not been covered by the previous policy that sought to control onchocerciasis only as a public health problem. From 2006 to 2010, Wadelai program successfully attained ultimate treatment goal (UTG), treatment coverage of ≥90%, despite expanding from 19 to 34 communities and from 5,600 annual treatments to over 29,000 semiannual treatments. Evaluations in 2009 showed no microfilaria in skin snips of over 500 persons examined, and only 1 of 3011 children was IgG4 antibody positive to the OV16 recombinant antigen. No Simulium vectors were found, and their disappearance could have sped up interruption of transmission. Although twice-per-year treatment had an unclear role in interruption of transmission, the experience demonstrated that twice-per-year treatment is feasible in the Ugandan setting. The monitoring data support the conclusion that onchocerciasis has been eliminated from the Wadelai focus of Uganda.

The main aim of the present investigation was to evaluate whether there is an association between completion of orthodontic treatment and quality of life measures, i.e. age, gender, socio-economic status, type of appliance and need for orthodontic treatment. The secondary aim was to evaluate whether compliance with orthodontic treatment (missed appointments and appliance breakages) was associated with age, gender, socio-economic status, or type of appliance. This was a multi-centre longitudinal observational study carried out on 144 patients (65 males and 79 females) aged 10-19 years. Baseline data were collected: patient age, gender, socio-economic status, Index of Orthodontic Treatment Need (IOTN), and type of appliance. Quality of life information, including orthodontic utility values and oral aesthetic subjective impact score (OASIS), were also collected at the start of treatment. The main outcome measure was whether a patient completed treatment. Compliance was assessed by recording the number of failed appointments and appliance breakages. Multiple regression analysis was used to investigate the association between independent and dependent variables. None of the baseline variables, including quality of life measures, were associated with a patient completing treatment, or their compliance with treatment (P > 0.05). Thus, quality of life measures (utility values or OASIS) do not add to our knowledge of who may complete, or co-operate with, orthodontic treatment. In addition, neither age, gender, socio-economic status nor clinical treatment need (IOTN) were useful in helping a clinician to choose potentially co-operative patients.

Value, reasons and the structure of justification: how to avoid passing the buck Get access Roger Crisp Roger Crisp St Anne's CollegeOxford OX2 6HS, UKroger.crisp@st-annes.ox.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Analysis, Volume 65, Issue 1, January 2005, Pages 80–85, https://doi.org/10.1093/analys/65.1.80 Published: 01 January 2005

AIM: To assess the effectiveness of canine lacebacks on the proclination of the upper incisors with reference to pre-treatment canine tip. STUDY DESIGN: Randomized clinical trial. SAMPLE: Patients receiving upper and lower fixed appliances attending the orthodontic departments of five orthodontic treatment providers. Sixteen patients received canine lacebacks as part of their treatment and 19 patients did not have canine lacebacks. METHOD: Patients were randomly allocated to receive canine lacebacks or not receive canine lacebacks. Upper study models were collected at the initial archwire placement and then when the working 0.019 x 0.025-inch stainless steel archwire was placed. The start canine angulation, change in upper incisor proclination/overjet, and any mesial movement of the upper first permanent molars during levelling and aligning was measured with a reflex metrograph. STATISTICS: The effect of the use of canine lacebacks on upper incisor proclination and mesial molar movement was assessed using Student t-tests. Regression analysis was used to evaluate any effect of the initial angulation of the canine. RESULTS: A mean incisor retroclination of 0.5 mm was observed in the canine lacebacks compared with a mean proclination of 0.36 mm when canine lacebacks were not used (P = 0.025). There was no statistically significant difference between groups for mesial movement of upper first molars (P = 0.99). If the canine was more distally inclined at the start of treatment, the incisors was more likely to procline, regardless of whether or not canine lacebacks were used (P = 0.027). CONCLUSIONS: The effect of canine lacebacks on preventing upper incisor proclination at the start of treatment is in the order of 1 mm and their effect on mesial molar movement is insignificant. Canines lacebacks have similar effects that are independent of pre-treatment canine angulation.

OBJECTIVE: To assess the effectiveness of banding versus bonding of first permanent molars during fixed appliance treatment; in terms of attachment failure, patient discomfort and post-treatment enamel demineralization. DESIGN: Multi-centre randomized clinical trial. SETTING: One District General Hospital Orthodontic Department and two Specialist Orthodontic Practices. PARTICIPANTS: Orthodontic patients aged between 10 and 18 years old, randomly allocated to either receive molar bands (n=40) or molar bonds (n=40). METHOD: Bands were cemented with a conventional glass ionomer cement and tubes were bonded with light-cured composite to all four first permanent molar teeth for each subject. Attachments were reviewed at each recall appointment to assess loosening or loss. The clinical end point of the trial was the day of appliance debond. Enamel demineralization at debond was assessed using the modified International Caries Assessment and Detection System (ICDAS). RESULTS: The first time failure rate for molar bonds was 18·4% and 2·6% for molar bands (P=0·0002). Survival analysis demonstrated molar bonds were more likely to fail compared with molar bands. First permanent molars with bonded tubes experienced more demineralization than those with cemented bands (P=0·027). There was no statistically significant difference in discomfort experienced by patients after banding or bonding first permanent molars (P>0·05). CONCLUSION: This study shows that as part of fixed appliance therapy, American Orthodontics photoetched first permanent molar bands cemented with 3M ESPE Ketac-Cem perform better than American Orthodontics low profile photo-etched and mesh-based first permanent molar tubes bonded with 3M Unitek Transbond XT in terms of failure behaviour and molar enamel demineralization.

Podcasts are increasingly utilized in mental health contexts, such as communicating advice around improving wellbeing, guided meditations, psychoeducation, and translating research findings. This study aimed to explore demographics, motivations, behaviors, and attitudes of podcast listeners regarding podcasts dealing with content and themes related to mental health. Adult Australian podcast listeners (N = 629) completed a cross-sectional online survey including the Acquisition Questionnaire (AQ-9), the Mental Health Knowledge Schedule (MAKS) and the Internalised Stigma of Mental Illness scale (ISMI-9). Approximately one third had listened to a mental health-themed podcast in the last 12 months. Logistic regression models showed people who listened to a mental health-themed podcast held fewer stigmatizing attitudes toward people experiencing mental health issues on the AQ-9 (OR 1.0, 95% CI 0.9–1.0, p < .001), and had higher levels of mental health knowledge on the MAKS (OR 1.1, 95% CI 1.0–1.2, p < .01). However, there was no significant relationship with internalized stigma on the ISMI-9 (OR 1.4, 95% CI 0.9–2.3, p = .2). Future research is needed to determine if such podcasts indeed impact listeners’ attitudes and behaviors, and, if they do, how podcasts can be used for effective communication around mental health content.

Journal Article Utilitarianism and accomplishment Get access Roger Crisp Roger Crisp St Anne's CollegeOxford, OX2 6HS, UKroger.crisp@st-annes.ox.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Analysis, Volume 60, Issue 3, July 2000, Pages 264–268, https://doi.org/10.1093/analys/60.3.264 Published: 01 July 2000

Utilitarianism and accomplishment Roger Crisp Roger Crisp St Anne's CollegeOxford, OX2 6HS, UKroger.crisp@st-annes.ox.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Analysis, Volume 60, Issue 3, July 2000, Pages 264–268, https://doi.org/10.1093/analys/60.3.264 Published: 01 July 2000

Journal Article Utilitarianism and accomplishment revisited Get access Roger Crisp Roger Crisp St Anne's CollegeOxford OX2 6HS, UKroger.crisp@st-annes.ox.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Analysis, Volume 61, Issue 2, April 2001, Pages 162–164, https://doi.org/10.1093/analys/61.2.162 Published: 01 April 2001

Journal Article Utilitarianism and accomplishment revisited Get access Roger Crisp Roger Crisp St Anne’s CollegeOxford OX2 6HS, UKroger.crisp@st-annes.ox.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Analysis, Volume 61, Issue 2, April 2001, Pages 162–164, https://doi.org/10.1093/analys/61.2.162 Published: 01 April 2001

In the early 1990s the Sardinian warbler began nesting in Cyprus, and now has two breeding populations, in the west and north of the island. Observations of the western population show that its range is still expanding and that the endemic Cyprus warbler has declined in the areas colonized by the Sardinian warbler. However, the Cyprus warbler is still present in most of these areas, and hence, although the Cyprus warbler is a species of European Conservation Concern, the current situation requires further study rather than alarm. The Sardinian warbler is the more numerous species at lower altitudes, whilst the Cyprus warbler is more common at higher altitudes, especially above 500 m. Within their areas of overlap, both Cyprus and Sardinian warbler populations occur throughout almost all habitats; natural, semi-natural and agroecosystems. We recommend that monitoring should continue, with more detailed ecological studies.

Summary During 1998–2011, in an area of western Cyprus spanning about one-quarter of the global breeding range of the endemic Cyprus Warbler Sylvia melanothorax , the species declined at a rate of c.59% decade -1 , suggesting that there is an urgent need to review its global conservation status. This decline has coincided with the recent, rapid colonisation of western Cyprus by the Sardinian Warbler S. melanocephala , whose numbers have increased substantially within the study area, as might be expected of a newly colonising breeding species. To identify possible causes of the Cyprus Warbler’s decline we compared its rate of change with measures of land-cover, vegetation density, altitude, rainfall and the presence of Sardinian Warblers at survey sites. The rate of decline in the Cyprus Warbler’s abundance was strongly correlated with land-cover and with the duration of site occupancy by Sardinian Warbler; Cyprus Warbler abundance had declined more steeply on sites colonised by Sardinian Warblers early in the survey period than on sites colonised later. Furthermore, on sites surveyed by BirdLife Cyprus in 2006–2014, Cyprus Warbler abundance had continued to decline significantly (also by c.59% decade -1 ) in western Cyprus, while Sardinian Warbler abundance had continued to increase. In contrast, Cyprus Warbler abundance showed no significant change in central and eastern Cyprus, where Sardinian Warblers were sparse or absent during the breeding season. These findings are consistent with at least two contrasting scenarios: that changes have occurred in land-cover or climatic conditions in Cyprus, to the detriment of Cyprus Warbler and to the benefit of Sardinian Warbler; or that in western Cyprus at least, the two species may compete for similar resources, despite a lack of evidence of this in an earlier, more detailed study. In either case, we suggest the need for a thorough, nationwide breeding survey of the two species.

This article assesses the impact of recent legislation designed to enhance the role and responsibilities of governing bodies for SEN, with particular reference to comprehensive schools. The first phase of the research investigation—a questionnaire survey—challenges the findings of some earlier studies, concluding that headteachers and governing bodies are working collaboratively and responding positively to the challenge. A number of priorities for the policy makers, including the future training needs of governors, are also identified. The second phase of the research inquiry—an in-depth case study—is an illustration of good practice, highlighting both the cardinal features of effective governance for SEN, as well as the managerial processes behind their creation.

Improvements in the quality of news portrayals of mental illness and suicide can be attributed to the introduction of media guidelines, particularly the Mindframe guidelines in Australia. However, based on reports about problematic media content, there remains scope for improvement. This study sought to further investigate the experiences of Australian news media professionals in reporting on mental illness and suicide, including their experiences of using the Mindframe guidelines and developing news stories about people with lived experience. We conducted semi-structured interviews with 12 media professionals, including junior reporters, senior reporters, and news editors. Media professionals had an average of 10.1 years’ (SD = 9.4) experience and represented a range of work experiences. Three key themes were generated from participant responses about their experiences reporting on mental illness and suicide: 1. Awareness of responsible reporting guidelines and how to proactively increase this; 2. Newsroom processes, values and subjectivity in applying guidelines; and 3. The importance and challenge in sharing lived experience stories, and improving support for covering these stories. Further resources and education are needed across newsrooms and universities to increase awareness and use of the Mindframe guidelines, and ultimately improve the quality of Australian media portrayals of mental illness and suicide. Editors and managers should be targeted with this training to best influence organisational change. Media professionals require additional preparation and support to develop lived experience stories, particularly in working with people bereaved by suicide to ensure this is a safe engagement for both parties.

Sharp weapons have been one of the most common deadly tools in cases of homicide and suicide for a long time. Tentative incisions accompany the majority of suicides by sharp force and the absence of hesitation marks provokes questions about the manner of death. We present the bizarre fatality of a 41-year-old male with an isolated circumscribed incision on the right neck, where the body was found lying in a pool of blood in the shower of his apartment. The internal examination revealed a 4-cm-long channel-like defect running inwardly and downwardly along the right sternocleidomastoid region. The cause of death was external bleeding from an injured right carotid artery and internal jugular vein. The wound had clean non-contused margins without any conspicuous hesitation injuries. A fragment of a razor blade, found in blood splatters, was identified as the only potential injuring tool. The case was classified as a suicide.

# Children with breathing difficulties are being overlooked {#article-title-2} EDITOR—I was disappointed to see that once again children with sleep disorders are being lumped into a homogeneous group of children with “behavioural” problems, then “studied” without using polysomnography. I think it's presumptuous and dangerous to think that every child who has trouble sleeping has a behavioural problem. Few physicians are aware that breathing difficulty can cause night waking and bedtime resistance, and it is because of studies like that of Ramchandani et al.1 Doctors don't look for sleep disorders properly, don't know much about them, and are told repeatedly that behavioural treatments are the appropriate treatment. This is wrong unless we can guarantee that the children have behavioural problems. A study looking at obese children using polysomnography diagnosed unsuspected obstructive sleep apnoea in 75% of the children studied—meaning the physicians examining the children picked up only 1 in 4 cases. It therefore seems a big leap of faith not to be doing polysomnography more often. Some of the children waking at night could have upper airways resistance syndrome, which can also cause sleep problems. Most doctors can barely take a proper history for sleep disorders, let alone diagnose a subtle case of upper airways resistance syndrome causing repeated night waking or bedtime resistance. Studies like that of Ramchandani et al certainly don't help because they take the emphasis away from finding a “real physiological” problem and on to stress behavioural modification. Before we continue to send physicians out to behaviourally modify breathing difficulties or other subtle causes of sleep disorders that can mimic behavioural problems, we need to do polysomnography on these children. 1. 1.1. Ramchandani P, 2. Wiggs L, 3. Webb V, 4. Stores G . Systematic review of treatments for settling problems and night waking in young children. BMJ 2000; 320: 209–213. (22 January.) [OpenUrl][1][Abstract/FREE Full Text][2] # Night waking is natural behaviour {#article-title-4} EDITOR—The basic assumption of the study of Ramchandani et al that very young children should settle down to sleep away from their parents and not be seen or heard from again until morning is flawed.1 … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DRamchandani%26rft.auinit1%253DP.%26rft.volume%253D320%26rft.issue%253D7229%26rft.spage%253D209%26rft.epage%253D213%26rft.atitle%253DA%2Bsystematic%2Breview%2Bof%2Btreatments%2Bfor%2Bsettling%2Bproblems%2Band%2Bnight%2Bwaking%2Bin%2Byoung%2Bchildren%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.320.7229.209%26rft_id%253Dinfo%253Apmid%252F10642226%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=320/7229/209&atom=%2Fbmj%2F320%2F7250%2F1667.atom

Journal Article Osteman Get access Francis Bromley Francis Bromley 1St. Anne's, Newcastle-on-Tyne Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume s5-II, Issue 34, 22 August 1874, Page 152, https://doi.org/10.1093/nq/s5-II.34.152c Published: 22 August 1874

<bold>Background:</bold> Thymic stromal lymphopoietin (TSLP) is a validated therapeutic target in asthma. GB-0895 is a next-generation, subcutaneously administered anti-TSLP monoclonal antibody with ~20-fold higher affinity for TSLP compared to tezepelumab and YTE Fc modifications for extended half-life. <bold>Aims:</bold> To assess the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of GB-0895 in patients with mild to moderate asthma with blood eosinophils (EOS) ≥150 cells/µL. <bold>Methods and Results</bold> 96 patients received single or multiple subcutaneous doses of GB-0895 (10–1200 mg) or placebo, with 69 patients randomized to GB-0895. The trial remains blinded but group level PK/PD data are available. GB-0895 was well tolerated with no apparent trend in the incidence or severity of adverse events in relationship to dose. GB-0895 demonstrated dose proportional PK and sustained concentrations with a half-life of ~89 days. EOS reductions were observed as early as week 4 at all doses. These reductions were observed through at least 6 months at doses ≥30 mg. A dose-response relationship was evident, with deeper reductions from baseline observed at higher doses, exceeding 50%. Durable decreases were also observed in FeNO, IL-5, and IL-13 for at least 6 months. These biomarker effects are similar to monthly tezepelumab. <bold>Conclusions:</bold> GB-0895 was well tolerated with an extended half-life of ~89 days. A single dose of GB-0895 drives PD biomarker suppression for at least 6 months, reflecting the broad anti-inflammatory effects of the anti-TSLP mechanism seen with tezepelumab. These results support dosing GB-0895 every 6-months for the treatment of severe asthma.

Introduction In April 2016, we changed from TV culture to BD Viper NAATs testing and from testing all women to only testing women who were symptomatic, STI contacts, had previous TV and male contacts of TV. Methods Laboratory data and SHHAPT codes retrospectively identified all patients diagnosed with TV between 1 May – 30 November 2016. Electronic patient records (EPR) were reviewed and data analysed in Excel. Results There were 96 new diagnoses, 93 females and 3 males, median age 31 (IQR 24–40). 66% Black Afro-Caribbean; 3 were sex workers. 91% symptomatic, 22% had STI co-infection, 26% bacterial vaginosis, 7% candida and 32% previous TV. Wet prep microscopy (WPM) detected 65% of symptomatic cases. Treatments were Metronidazole or Tinidazole. The audit standards our service achieved (BASHH performance standards target- 97%) were: 100% received appropriate antibiotics, 51% written information receipt documented, 90% had partner notification recommended (PN) and 28% PN confirmation. Abstract P099 Table 1 Cost analysis summary 2015 (Culture) 2016 (NAATs) Tested 3054 1859 Positive 84 117 New infections 73 96 Cost £19,851 £15,486 Discussion TV NAATs cost more than culture but changing our protocol reduced the overall cost while increasing the number of new diagnoses; enabling us to target testing to patients at highest risk. 35% (27) were missed on WPM. 9.3% (9) were asymptomatic and detected because of testing as contacts of TV/sex worker/cervical cytology detection. Recommendations include: staff training to improve completion of PN and modifying our EPR fields to improve documentation of leaflets having been given.

The lifetime of the B± meson is measured using the decay channel B+ → $\bar{D}$0π+. The measurement is made using approximately 1.0 fb-1 of Tevatron proton-anti-proton collision data at √s = 1.96 TeV collected by the CDF detector. The data were collected using impact parameter based triggers that were designed to select events with a secondary vertex. The trigger selection criteria result in data rich in a variety of B hadron decays, but intrinsically bias the lifetime distribution of the collected signal events. The traditional way to compensate for the bias is to use information from simulation. Presented here is a new method for correction of the lifetime bias using an analytical technique that uses information from the data only. This eliminates measurement uncertainty due to data and simulation agreement, ultimately resulting in a smaller systematic measurement uncertainty. The B± lifetime measurement is the first measurement using this new technique and demonstrates its potential for use in future measurements. The B± lifetime is measured to be τ(B±) = 1.662 ± 0.023(stat) ± 0.015(syst)ps.