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Objective To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD.Design A two-round Delphi consensus process was used to develop the COS.Patients, Participants The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD.Interventions A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled “not important,” 4 to 6 labeled “important but not critical,” and 7 to 9 labeled “critical.”Main outcome measure Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS.Results A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD.Conclusions Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.

Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim To describe Māori women’s journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women’s decisions regarding MVs and enablers and barriers to uptake. Results Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women’s journeys. Women’s decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs’ discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient knowledge of benefits, late presentation to the midwife and other commitments or challenges in the women’s lives affecting prioritisation of the vaccine. Misconceptions, seasonality, and lower HCP emphasis impaired influenza vaccination uptake. Discussion With multiple barriers to accessing MVs, HCPs who see pregnant women are the primary resource to improve awareness, knowledge, and access through kōrero (discussions) with the woman and, where possible, being able to administer the vaccinations. These HCPs need to be well-informed, aware of likely concerns women may have and how to address them, encourage these discussions and preferably be trusted.

ABSTRACTThe COVID-19 pandemic has impacted individuals across the world and disrupted societal systems, including educational institutions. The aim of the current cross-sectional survey of U.S. social work students was to describe: (1) students’ experiences of COVID-19-related stress, academic stress, and access to supports; (2) changes in academic stress following the onset of the COVID-19 pandemic; and (3) factors that contributed to a change in academic stress following the onset of the COVID-19 pandemic. An independent samples t-test identified an increase in students’ academic stress following the onset of the COVID-19 pandemic and multivariate regression determined factors contributing to levels of student stress, including program support and access to academic resources. Implications for social work programs’ responses to disasters are discussed.

ABSTRACTMeningococcal group B outer membrane vesicle vaccines have been used widely in Cuba, New Zealand, and Brazil. They are immunogenic and initially assessed largely by their ability to induce serum bactericidal activity. Measures of efficacy indicate good protection against homologous strains in older children and adults. Effectiveness appears broader than predicted by immunogenicity and efficacy studies. The recent discovery that meningococcal group B OMVs may protect against the related Neisseriaspecies N.gonorrhoeaesuggests more to these interesting antigen collections than meets the eye.Currently there are two OMV-containing group B vaccines available, the new recombinant protein-based Bexsero® developed by Novartis and VA-MENGOC-BC® developed by the Finlay institute in Cuba. Also, a third group B vaccine based on two recombinant factor H binding proteins (Trumenba®, Pfizer), has recently been licenced but it does not include OMV. This commentary explores the population impact that group B OMV vaccines have had on meningococcal and gonorrhoea diseases. Given the heterologous effect against diverse strains of the meningococcus observed in older children and adults, and recent evidence to suggest moderate protection against gonorrhoea, there may be a role for these vaccines in programmes targeting adolescents and groups high at risk for both meningococcal disease and gonorrhoea.

Gonorrhoea is a major global public health problem that is exacerbated by drug resistance. Effective vaccine development has been unsuccessful, but surveillance data suggest that outer membrane vesicle meningococcal group B vaccines affect the incidence of gonorrhoea. We assessed vaccine effectiveness of the outer membrane vesicle meningococcal B vaccine (MeNZB) against gonorrhoea in young adults aged 15–30 years in New Zealand.

Objective.Seropositive rheumatoid arthritis (RA) is strongly linked to cigarette smoking, and smoking cessation is an essential step in RA management. Our objectives were to develop RA and smoking awareness materials and to evaluate the influence of the materials on awareness about the links between RA and smoking and on motivation to quit smoking.Methods.A group of patients with seropositive RA in Fife, Scotland, were telephoned before the campaign, and the results of the precampaign questionnaire were used to develop the image for the campaign. After the campaign a second group of patients were questioned to ascertain the effect of the campaign.Results.The 320 patient responses to the precampaign questionnaire revealed that many ex-smokers with RA had quit when they developed a known smoking-related disease such as emphysema. This concept was used to develop an image illustrating that RA is a smoking-related disease. The campaign was launched in Fife in 2011. The postcampaign questionnaire involving 380 patients revealed that there was 21% higher awareness of a link between RA and smoking and 45% higher awareness that smoking could interfere with treatment of RA. In total, 13/75 smokers who had cut down since the campaign had been influenced by the new information.Conclusion.The new materials have successfully increased patients’ knowledge of the link between RA and smoking and the effect of smoking on RA therapy. RA smokers’ attitudes to smoking may have been affected by the campaign.

Pain on vaccine injection and subsequent site reactions of pain and swelling may influence confidence in vaccines and their uptake. This study aimed to identify factors associated with reported pain on injection and reactogenicity following administration of a strain specific meningococcal B outer membrane vesicle vaccine. A retrospective analysis of data was conducted from a phase II single center randomized observer-blind study that evaluated the safety, reactogenicity and immunogenicity of this vaccine in 2 cohorts of healthy 8 to 12 y old children. Vaccine administration technique was observed by an unblinded team member and the vaccine administrator instructed on standardized administration. Participants kept a daily diary to record local reactions (erythema, induration and swelling) and pain for 7 d following receipt of the vaccine. Explanatory variables were cohort, vaccine, age, gender, ethnicity, body mass index, atopic history, history of frequent infections, history of drug reactions, pain on injection, vaccinator, school population socioeconomic status, serum bactericidal antibody titer against the vaccine strain NZ98/254, and total IgG. Univariate and multivariable analyses were conducted using ordinal logistic regression for factors relating to pain on injection and reactogenicity. Perceived pain on injection was related to vaccine formulation, vaccine administrator and ethnicity. Reactogenicity outcomes varied with ethnicity and vaccine administrator. Maintaining community and parental confidence in vaccine safety without drawing attention to differences between individuals and groups is likely to become increasingly difficult. Vaccine administration technique alone has the potential to significantly reduce pain experienced on injection and local vaccine reactions.

To examine the expression of personality in virtual worlds (VWs), the authors tracked the behavioral and linguistic output of 76 students continuously over a 6-week period in the VW Second Life(SL). Behavioral metrics in SL were consistent over time, but low stabilities were observed for linguistic metrics. To examine the ways in which personality manifested in SL, participant’s Big Five scores were correlated with their virtual behavioral and linguistic metrics. For example, Conscientiousness was correlated with many metrics related to geographical movement; however, there was low overlap with findings from previous studies. The authors provide some reasons for this low concordance. Their study hints at the potential of leveraging VWs to understand the link not only between personality and behavior but also among other social and psychological phenomena as well.

Objective:To explore New Zealand's four major daily newspapers' coverage of immunisation with regards to errors of fact and fallacy in construction of immunisation‐related arguments.

To explore New Zealand's four major daily newspapers' coverage of immunisation with regards to errors of fact and fallacy in construction of immunisation‐related arguments.

OBJECTIVE: Accelerated atherosclerosis and premature coronary heart disease (CHD) are recognized complications of systemic lupus erythematosus (SLE), but the exact etiology remains unclear and is likely to be multifactorial. We hypothesized that SLE patients with CHD have increased exposure to traditional risk factors as well as differing disease phenotype and therapy-related factors compared to SLE patients free of CHD. Our aim was to examine risk factors for development of clinical CHD in SLE in the clinical setting. METHODS: In a UK-wide multicenter retrospective case-control study we recruited 53 SLE patients with verified clinical CHD (myocardial infarction or angina pectoris) and 96 SLE patients without clinical CHD. Controls were recruited from the same center as the case and matched by disease duration. Charts were reviewed up to time of event for cases, or the same "dummy-date" in controls. RESULTS: SLE patients with clinical CHD were older at the time of event [mean (SD) 53 (10) vs 42 (10) yrs; p < 0.001], more likely to be male [11 (20%) vs 3 (7%); p < 0.001], and had more exposure to all classic CHD risk factors compared to SLE patients without clinical CHD. They were also more likely to have been treated with corticosteroids (OR 2.46; 95% CI 1.03, 5.88) and azathioprine (OR 2.33; 95% CI 1.16, 4.67) and to have evidence of damage on the pre-event SLICC damage index (SDI) (OR 2.20; 95% CI 1.09, 4.44). There was no difference between groups with regard to clinical organ involvement or autoantibody profile. CONCLUSION: Our study highlights the need for clinical vigilance to identify modifiable risk factors in the clinical setting and in particular with male patients. The pattern of organ involvement did not differ in SLE patients with CHD events. However, the higher pre-event SDI, azathioprine exposure, and pattern of damage items (disease-related rather than therapy-related) in cases suggests that a persistent active lupus phenotype contributes to CHD risk. In this regard, corticosteroids and azathioprine may not control disease well enough to prevent CHD. Clinical trials are needed to determine whether classic risk factor modification will have a role in primary prevention of CHD in SLE patients and whether new therapies that control disease activity can better reduce CHD risk.

We describe a rapid, simple, and efficient method for recovering glutathione S-transferase (GST)- and His6-tagged maltose binding protein (MBP) fusion proteins from inclusion bodies. Incubation of inclusion bodies with 10% sarkosyl effectively solubilized >95% of proteins, while high-yield recovery of sarkosyl-solubilized fusion proteins was obtained with a specific ratio of Triton X-100 and CHAPS. We demonstrate for the first time that this combination of three detergents significantly improves binding efficiency of GST and GST fusion proteins to gluthathione (GSH) Sepharose.

The current study tracked 80 participants who spent an average of six hours per week in Second Life over six consecutive weeks. Objective measures of movement and chat were automatically collected in real time when participants logged in to Second Life. Data regarding the number of groups and friends was self-reported through online questionnaires on a weekly basis. Results demonstrated that although the social networks of users continued to broaden over the course of the study, users became less inclined to explore regions, decreased their use of high-energy actions such as flying or running, and chatted less. We discuss implications for theories of virtual social interaction as well as the use of Second Life as a social science research platform.

Our aim was to describe characteristics of general practitioners (GPs) working in practices that achieve higher immunisation coverage and more timely delivery. We conducted computer-assisted telephone interviews with randomly selected GPs from randomly selected practices. Most GPs believed immunisation to be important and were confident about their knowledge of immunisation although assessment revealed their knowledge to be incomplete. A minority considered six weeks is too young to immunise. Greater GP knowledge and confidence in their knowledge was associated with higher practice immunisation coverage, whereas immunisation delivery was more timely at practices where GPs perceived parental access difficulties a barrier.

To describe hepatitis C virus (HCV)–related liver disease in a national cohort of patients who acquired their infections in childhood or adolescence and to assess risk factors for progressive disease and response to antiviral therapy.

To describe hepatitis C virus (HCV)–related liver disease in a national cohort of patients who acquired their infections in childhood or adolescence and to assess risk factors for progressive disease and response to antiviral therapy. Demographic, laboratory, and clinical outcome data on 246 individuals who acquired HCV infection before the age of 16 years were extracted from the UK HCV National Register database. Logistic regression analysis was used to investigate the independent effects of sex, age, duration and route of infection, and comorbidity on histological stage of liver disease. Median ages at enrollment and follow-up were 14.0 years (range, 2.2–29.6 years) and 19.2 years (range, 2.3–35.5 years), respectively. Mean duration of infection at enrollment was 8.5 years (standard deviation [SD], 3.3 years), and mean duration of follow-up was 4.5 years (SD, 4.5 years). Fifty-nine (24%) had persistently abnormal liver aminotransferase levels; 22% reported physical signs and symptoms of liver disease. Among 123 individuals with liver biopsies, 117 (95%) had abnormal histological findings. Ninety-eight individuals had biopsies referred for independent blind scoring; median Ishak grade and stage scores were 3 and 1, respectively. Presence of comorbidities (odds ratio [OR], 7.19; 95% CI, 2.00–26.17; P= 0.003) and female sex (OR, 0.31; 95% CI, 0.10–1.00; P= 0.05) were independently associated with histological stage scores greater than the median. A total of 110 individuals received antiviral therapy; 47% achieved a sustained response. HCV-related liver disease in those who acquired the infection in childhood or adolescence was mild for most, although comorbidity and female sex were associated with more advanced disease. Antiviral therapy in childhood or adolescence successfully eradicates the virus for many patients.

The effect of the presequence peptide of cytochrome coxidase subunit IV (p25) on supported phospholipid bilayers (SPBs) was visualized using atomic force microscopy (AFM). The presequence was found to cause the complete disruption of supported bilayers containing neutral lipids. At relatively low concentrations of presequence, the peptide was found to bind to the membrane, coalescing to form microdomains within the liquid−crystalline bilayer that were located predominantly at bilayer−mica boundaries. Further increases in peptide concentration resulted in the formation of holes within the SPB that were spanned by an interpenetrating network of narrower regions of the bilayer, which, at higher applied peptide concentrations, were observed to disappear through a budding process, ultimately leading to the formation of spherical structures at yet higher peptide concentrations. Within this paper, the impact the presequence has upon the structure and order of the membrane is discussed, as is the potential implication of this apparent solubilization process on the translocation of cytochrome coxidase into the inner mitochondrial membrane.

Aim: To determine timeliness and completeness of MMR immunisation uptake and general immunisation status of egg-allergic children referred to hospital for MMR vaccine who were referred back to their primary care providers with explanatory information that community-based vaccination is safe in these children.Method: Referred children’s immunisation status obtained from referring practices. Where the practice had no record parents were contacted. Parents whose children had not received MMR were asked reasons for their choice. Timeliness of immunisations was examined for both MMR and the primary schedule. Practices referring more than one child to immunisation clinic were analysed to determine whether previous letters from the immunisation clinic influenced their referring practice.Results: 82 children were eligible from 67 practices. MMR status was obtained for 78 (95% response rate). Of these 78, 73 (94%) received MMR vaccination with no reported adverse events: 8 (11%) on time, 54 (69%) late and 11 (14%) timeliness unknown. Five (6%) children had not received MMR vaccination. Three practices were unwilling to carry out MMR immunisation of egg-allergic children, even after recommendation from the immunisation clinic. Of the five parents whose children had not received MMR, two had actively decided against vaccination.Discussion: 94% children received their MMR in primary care with no reported adverse effects. The current strategy utilised by the immunisation clinic appears to result in MMR immunisation of egg-allergic children. While the referral process may result in delayed immunisations, continued education of health professionals may improve timeliness and immunisation rates.

OBJECTIVE: To determine the clinical course of hepatitis C virus in the first decade of infection in a group of patients who acquired their infections on a known date. DESIGN: Cohort study. SETTING: Clinical centres throughout the United Kingdom. PARTICIPANTS: 924 transfusion recipients infected with the hepatitis C virus (HCV) traced during the HCV lookback programme and 475 transfusion recipients who tested negative for antibodies to HCV (controls). MAIN OUTCOME MEASURES: Clinical evidence of liver disease and survival after 10 years of infection. RESULTS: All cause mortality was not significantly different between patients and controls (Cox's hazards ratio 1.41, 95% confidence interval 0.95 to 2.08). Patients were more likely to be certified with a death related to liver disease than were controls (12.84, 1.73 to 95.44), but although the risk of death directly from liver disease was higher in patients than controls this difference was not significant (5.78, 0.72 to 46.70). Forty per cent of the patients who died directly from liver disease were known to have consumed excess alcohol. Clinical follow up of 826 patients showed that liver function was abnormal in 307 (37.2%), and 115 (13.9%) reported physical signs or symptoms of liver disease. Factors associated with developing liver disease were testing positive for HCV ribonucleic acid (odds ratio 6.44, 2.67 to 15.48), having acquired infection when older (at age > or = 40 years; 1.80, 1.14 to 2.85), and years since transfusion (odds ratio 1.096 per year, 1.00 to 1.20). For patients with severe disease, sex was also significant (odds ratio for women 0.38, 0.17 to 0.88). Of the 362 patients who had undergone liver biopsy, 328 (91%) had abnormal histological results and 35 (10%) of these were cirrhotic. CONCLUSIONS: Hepatitis C virus infection did not have a great impact on all cause mortality in the first decade of infection. Infected patients were at increased risk of dying directly from liver disease, particularly if they consumed excess alcohol, but this difference was not statistically significant.

FORMAL nursing education traditionally has been concerned with the diadic nursepatient relationship. In the past several years there has been a rapid development and use of group processes and techniques in psychiatric hospitals. However, the majority of nurses in these institutions have not had significant formal instruction in group dynamics, milieu therapy, or general group therapy. The absence of knowledge and practical experience minimizes the nurses' contributions possible within a therapeutic milieu.5Cognizant of this lack of knowledge of group processes and the increasing awareness of its significance in patient care, the nursing section of the Institute for Psychosomatic and Psychiatric Research and Training of Michael Reese Hospital approached the hospital's social group worker for a series of formal lectures on group processes. Subsequently a modified Training Group evolved.A common definition of a training group is: A relatively unstructured group in which individuals participate as learners utilizing the

The article offers information on the etiology of gout, an inflammatory arthritic condition. It is said that gout occurs when urate crystals accumulate in joints and other tissues. Gout is said to be the most common form of inflammatory arthritis in men. Studies have found that there is significant increases in the prevalence of gout compared with 20 years ago.

Explores professional literature available to Christian congregations and pastors interested in increasing service and outreach to those who are bereaved. 'Grieving a Suicide: A Loved One's Search for Comfort, Answers and Hope,' by Albert Hsu; 'Men Don't Cry, Women Do: Transcending Gender Stereotypes of Grief,' by Terry Martin and Kenneth J. Doka; 'Helping Bereaved Children,' by Nancy Body Webb.

Presents the author's thoughts on her and her female friends' experiences with being touched. Attitudes toward touching her female friends; Responses to body contacts; Friends' views on being touched by men.

The article offers information on several vaccine-preventable diseases in New Zealand. It says that diphtheria has been a highly endemic pediatric disease in New Zealand before the immunisation was introduced. It adds that the measles, which is one of the most infectious diseases, occurs as outbreak in communities including New Zealand, which have low immunisation rate. Moreover, haemophilus influenzae type B (Hib) can be treated with Hib vaccine.

The article focuses on the need for preterm infants to have on-time vaccination. It states that regardless of prematurity, preterm infants should be immunised at the right age since they are more at risk to serious illnesses as compared to full-term babies. It adds that targeted immunisation or cocooning requires that siblings are updated with the vaccinations.

The article explores the safety of quadrivalent human papillomavirus (HPV) vaccine, Gardasil, in New Zealand. It mentions the vast amount of data on Gardasil's safety accrued from the doses delivered for many years and the unsupported claims of HPV vaccine causing a range of vague fatigue and pain conditions. It also notes the role of coincidence in cases of girls with pain and fatigue after receiving the HPV vaccine.

The article offers information on a series of events of the North American Association of Christians in Social Work (NACSW) to be held from March 8-11, 2007 in Dallas, Texas. The events will include several entertainment programs such as professional fellowship, fun, food and dance parties. This year's event will provide opportunity to prepare to work with growing population of the Hispanics in the U.S. through a special track for work with Hispanic/Latino families.

The article offers information on the 2007 North American Association of Christian Social Workers' Conference to be held in Dallas, Texas.

Presents a letter to the editor regarding the pros and cons of vaccination, featured on the "Letters," section published in the October 23, 2004 issue of "Listener."

The article focuses on the opposition of immunisation programmmes in New Zealand. Topics discussed include the effect of anti-immunisation efforts on public health, the introduction of the human papilloma virus (HPV) vaccine in the country in 2007 which is made for girls and women born after 1990, and the false information about the vaccine that circulated around the country.

The article presents guidelines on how physicians can control the spread of pertussis or whooping cough. Pertussis is a bacterial infection commonly diagnosed in children. It spreads through respiratory secretions. Some of strategies to keep infants safe from whooping cough include vaccinating pregnant women, ensuring that all people in close contact with babies are vaccinated, and vaccinating infants on time.

The article focuses on the risks and benefits from rotavirus vaccines observed in four countries. It notes that post-marketing surveillance has tracked a reduction in rotavirus associated illness and death. A small increase in the risk of intussusception following the vaccine is also detected in Mexico and Australia but not in U.S. and Brazil. The transmission of rotavirus vaccine and the exception of those with severe combined immunodeficiency (SCID) from rotavirus vaccination are also noted.

The article focuses on the influenza (flu) vaccination in New Zealand. It states that immune system's priming from earlier infection of flu improves vaccination response. It adds that trivalent inactivated flu virus (TIV) vaccine's effectiveness is higher in mortality reduction in those at intermediate and low risk.