Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration:the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005)

Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the current-day clinical course of T1DM.

Familial hypocalciuric hypercalcaemia as a differential diagnosis of hyperparathyroidism:studies in a large kindred and a review of surgical experience in the condition

We have studied 46 members of a large kindred with familial hypocalciuric hypercalcaemia (FHH) after a neck exploration failed to cure hypercalcaemia in an asymptomatic patient. Serum calcium, serum phosphate, plasma parathormone and vitamin D metabolites do not distinguish affected members from patients with hyperparathyroidism. Because of the continuing debate as to whether or not FHH is a variant of, or distinct from, hyperparathyroidism, we have carried out a review of surgical experience with subtotal parathyroidectomy in hyperparathyroidism secondary to parathyroid hyperplasia and in FHH. Whereas the procedure is successful in 90 per cent of the former cases only one case of FHH has been cured by it. This provides evidence for the two conditions being aetiologically distinct. Before patients with asymptomatic hypercalcaemia are referred for parathyroid surgery the calcium:creatinine clearance ratio should be measured using a 2 h urine sample collected after an overnight fast and a fasting blood sample. If this ratio is less than 0.01 then screening of first degree relations should be undertaken before any parathyroid surgery is performed. Unnecessary surgery can therefore be avoided.

Cinematic Peripheries of Dublin

The term periphery is, most of the time, used with or in relation to the centre. The ‘zoning’ taken by granted by the architect is unlike the one portrayed by the director who frames the differences of places in a non-linear manner. Film offers a constructed urban experience, suggesting the city to be a local network composed of nodes and links, rather than a centre and the margin. It is possible to talk about the construction of a new kind of network in film through a temporal representation of space, of the distant as the close. In this way, film may be a tool to shift the gaze from the bird’s-eye view to the eye level to create ‘a unified perceptual image of the city’, in Christine Boyer’s words. The experienced surface of the city is two-dimensional neither in fiction nor in reality. In this chapter, the nodes of Dublin are examined through two Irish films, Goldfish Memory (Elizabeth Gill, 2003) and Adam and Paul (Leonard Abrahamson, 2004). Specific elements of the city of Dublin, including walls, houses, pubs, streets, bridges, and parks, are analysed to understand the nature of the network of the city composed of nodes and their connections.

The view from over there:reframing the OSCE through the experience of standardised patient raters

Ratings awarded by standardised patients (SPs) in UK objective structured clinical examinations (OSCEs) are typically based on humanistic (non-technical) skills and are complementary to clinician-examiner ratings. In psychometric terms, SP ratings appear to differ from examiner ratings and improve reliability. For the first time, we used qualitative methods from a constructivist perspective to explore SP experiences of rating, and consider how these impact our understanding of assessment.

The lived experience of patients receiving radiotherapy for head and neck cancer: A literature review

It is estimated that 60% of patients diagnosed with head and neck cancer will receive radiotherapy at some stage in their disease trajectory. The aim of this literature review was to find and analyse papers pertaining to the lived experiences of patients with head and neck cancer receiving radiotherapy. The review identified a limited number of high-quality research papers focusing on this topic, with only 10 papers fitting the inclusion/exclusion criteria. The majority of the investigative studies were not generalisable owing to small sample sizes and many of them being conducted in only one centre. However, the findings do highlight and contribute to the understanding of the lived experiences of this patient group and provide some insight into the unique physical, social, and psychological difficulties they encounter as a result of their treatment. There appears to be a need for further high-level research into these patients, particularly focusing on the provision of support and information prior to, during, and following radiotherapy. Further attention needs to be paid to preparing patients for the slow recovery following radiotherapy. Interventional studies are also required to develop clinical guidelines and protocols that can assist health professionals in meeting the holistic needs of this patient group.

Perceptual investigation of image placement with Ambisonics for non-centred listeners

Ambisonics is a scalable spatial audio technique that attempts to present a sound scene to listeners over as large an area as possi- ble. A localisation experiment was carried out to investigate the performance of a first and third order system at three listening positions - one in the centre and two off-centre. The test used a reverse target-pointer adjustment method to determine the error, both signed and absolute, for each combination of listening posi- tion and system. The signed error was used to indicate the direc- tion and magnitude of the shifts in panning angle introduced for the off-centre listening positions. The absolute error was used as a measure of the performance of the listening position and systems combinations for a comparison of their overall performance. A comparison was made between the degree of image shifting be- tween the two systems and the robustness of their off-centre per- formance.

How does involvement of a hospice nurse specialist impact on the experience on informal caring in palliative care? Perspectives of middle-aged partners bereaved through cancer

The aim of this study was to retrospectively explore partners' understandings and experiences in relation to caring for a loved one with a terminal illness, with a particular focus on the role of the hospice nurse specialist (HNS). Participants were purposively sampled and recruited through HNS gatekeepers. Seven middle-aged, bereaved partners participated in semi-structured, qualitative interviews. The interviews were audio recorded and transcribed verbatim and data were analysed using thematic content analysis. Five main themes emerged regarding the impact of the HNS on informal caring: ‘the ambivalence of caring’, ‘the HNS as a “confidante” in caring’, ‘the HNS as a “champion” in support’, ‘the work of the HNS – an unseen benefit’ and ‘being prepared for death and bereavement’. Findings from this study offer new insights into how involvement of a HNS impacts on the ability of carers to perform their role as an informal caregiver. Results highlight a crucial need for carers to have a clear understanding of all aspects of the HNS role so that full benefit is derived from their input. Recruitment of experienced and knowledgeable nurses is paramount, but equally important for carers is the supportive aspect of the role for which nurses need to demonstrate excellent communication skills and an intuitive, caring approach.

The detection of repetitions in noise before and after perceptual learning.

In noise repetition-detection tasks, listeners have to distinguish trials of continuously running noise from trials in which noise tokens are repeated in a cyclic manner. Recently, it has been shown that using the exact same noise token across several trials (“reference noise”) facilitates the detection of repetitions for this token [Agus et al. (2010). Neuron 66, 610–618]. This was attributed to perceptual learning. Here, the nature of the learning was investigated. In experiment 1, reference noise tokens were embedded in trials with or without cyclic presentation. Naïve listeners reported repetitions in both cases, thus responding to the reference noise even in the absence of an actual repetition. Experiment 2, with the same listeners, showed a similar pattern of results even after the design of the experiment was made explicit, ruling out a misunderstanding of the task. Finally, in experiment 3, listeners reported repetitions in trials containing the reference noise, even before ever hearing it presented cyclically. The results show that listeners were able to learn and recognize noise tokens in the absence of an immediate repetition. Moreover, the learning mandatorily interfered with listeners' ability to detect repetitions. It is concluded that salient perceptual changes accompany the learning of noise.

Examining the Spectator Experience

Drawing on a model of spectator understanding of error in
performance in the literature, we document a qualitative
experiment that explores the relationships between domain
knowledge, mental models, intention and error recognition
by spectators of performances with electronic instruments.
Participants saw two performances with contrasting instruments,
with controls on their mental model and understanding
of intention. Based on data from a subsequent structured
interview, we identify themes in participants’ judgements
and understanding of performance and explanations
of their spectator experience. These reveal both elements
of similarity and difference between the two performances,
instruments and between domain knowledge groups. From
these, we suggest and discuss implications for the design of
novel performative interactions with technology

Rethinking German identity after the Nazi experience: French memories of Germans in Sartre’s Roads to freedom

UK Sartre Studies conference
Institut français in London
September 2007