Accommodative dysfunction in children with cerebral palsy: a population based study

Purpose. To determine the prevalence, nature, and degree of accommodative dysfunction among children with different types and severities of cerebral palsy (CP) in Northern Ireland. Methods. Ninety subjects with CP (aged 4–15 years) were recruited through the Northern Ireland CP Register (NICPR). Modified Nott dynamic retinoscopy was used to measure lag and lead of accommodation at three test distances: 25 cm (4 D), 16.7 cm (6 D), and 10 cm (10 D) with the distance correction in place. Accommodative function was also assessed in an age-matched control group (n = 125) for comparison. Each subject’s neurologic status was derived from the NICPR. Results. Children with CP demonstrate significantly reduced accommodative responses compared with their neurologically normal peers. Of the subjects with CP, 57.6% demonstrated an accommodative lag outside normal limits at one or more distances. Reduced accommodative responses were significantly associated with more severe motor and intellectual impairments (ANOVA P = 0.001, P < 0.01, respectively). Conclusions. Brain injury such as that present in CP has a significant impact on accommodative function. These findings have implications for the optometric care of children with CP and inform our understanding of the impact of early brain injury on visual development.

Vegetation history at the multi-period prehistoric complex at Ballynahatty, Co. Down, Northern Ireland.

Palaeoecological methods can provide an environmental context for archaeological sites, enabling the nature of past human activity to be explored from an indirect but alternative perspective. Through a palynological study of a small fen wetland located within the catchment of a multi-period prehistoric complex at Ballynahatty, Co. Down, Northern Ireland, we reconstruct the vegetation history of the area during the early prehistoric period. The pollen record reveals tentative evidence for Mesolithic activity in the area at 6410-6220 cal. BC, with woodland disturbance identified during the Mesolithic-Neolithic transitional period ca. 4430-3890 cal. BC. A more significant impact on the landscape is observed in the Early Neolithic from 3944-3702 cal. BC, with an opening up of the forests and the establishment of a mixed agricultural economy. This activity precedes and continues to be evident during the Mid-Neolithic during which megalithic tombs and related burial sites were constructed at Ballynahatty. Due to chronological uncertainties and a possible hiatus in peat accumulation in the fen, the contemporary environment of the Ballynahatty timber circle complex (constructed and used ca. 3080-2490 cal. BC) and henge (dating to the third millennium cal. BC) cannot certainly be established. Nevertheless, the pollen record suggests that the landscape remained open through to the Bronze Age, implying a long continuity of human activity in the area. These findings support the idea that the Ballynahatty prehistoric complex was the product of a gradual and repeated restructuring of the ritual and ceremonial landscape whose significance continued to be recognised throughout the early prehistoric period.

Influence of prolonged hospitalization on overall bed occupancy: a five-year single-centre study

Background: Effective bed use is crucial to an efficient NHS. Current targets suggest a decrease in mean occupancy as the most appropriate method of improving overall efficiency. The elderly and those suffering from complex medical problems are thought to account for a high proportion of overall bed occupancy.

Aim: To assess the effect of prolonged hospital stay (>100 days) on overall bed occupancy in a modern teaching hospital.

Design: Retrospective analysis.

Methods: Analysis of all admission episodes (n = 117 178) over a five-year period in a large teaching hospital in a single UK region, serving a population of approximately 200 000. A logistic regression multi-factorial model was used to assess the effect of demographic and diagnostic variables on duration of stay.

Results: A prolonged stay (>100 days) was seen in 648 admission episodes (0.6%). These accounted for 11% of the overall bed occupancy over the 5-year period. Excluding all prolonged admission episodes from our analysis made no difference to the overall median length of stay.

Discussion: Prolonged hospitalizations have a significant impact on bed occupancy. Targeting these very long (>100 days) hospital stays may better improve overall efficiency, compared to targeting mean or median length of stay.

Modeling energy consumption in error-prone IEEE 802.11-based wireless ad-hoc networks

In the IEEE 802.11 MAC layer protocol, there are different trade-off points between the number of nodes competing for the medium and the network capacity provided to them. There is also a trade-off between the wireless channel condition during the transmission period and the energy consumption of the nodes. Current approaches at modeling energy consumption in 802.11 based networks do not consider the influence of the channel condition on all types of frames (control and data) in the WLAN. Nor do they consider the effect on the different MAC and PHY schemes that can occur in 802.11 networks. In this paper, we investigate energy consumption corresponding to the number of competing nodes in IEEE 802.11's MAC and PHY layers in error-prone wireless channel conditions, and present a new energy consumption model. Analysis of the power consumed by each type of MAC and PHY over different bit error rates shows that the parameters in these layers play a critical role in determining the overall energy consumption of the ad-hoc network. The goal of this research is not only to compare the energy consumption using exact formulae in saturated IEEE 802.11-based DCF networks under varying numbers of competing nodes, but also, as the results show, to demonstrate that channel errors have a significant impact on the energy consumption.

Modification of chitin properties for enzymatic deacetylation

Chitins produced via a conventional chemical route as well as from a new biological process were modified to increase the efficiency of enzymatic deacetylation reactions for the production of novel biological chitosan. These modified chitins were reacted for 24h with extracellular fungal enzymes from Colletotrichum lindemuthianum. The chemical and physical properties of the various substrates were analysed and their properties related to the effectiveness in the deacetylation reaction. Modifications of the chitins affected the degree of deacetylation with varied effects. Without further modification to reduce crystallinity and to open up the solid substrate structure, the chitins were found to be poor substrates for the heterogeneous solid-liquid enzymatic catalysis. It was found that the solvent and drying method used in modifying the chitins had significant impact on the final efficiency of the enzymatic deacetylation reaction. The most successful modifications through freeze drying of a colloidal chitin suspension increased the degree of enzymatic deacetylation by 20 fold. These processes reduce the crystallinity of the chitin making it easier for the enzymes to access their internal structure. X-ray diffraction, scanning electron microscopy, thermogravimetric analysis, and BET isotherm analysis are employed to characterise the modified chitins to ascertain the degree of crystallinity, porous structure, surface area, and morphology.

Antifungal photodynamic therapy

In photodynamic antimicrobial chemotherapy (PACT), a combination of a sensitising drug and visible light causes selective destruction of microbial cells. The ability of light-drug combinations to kilt microorganisms has been known for over 100 years. However, it is only recently with the beginning of the search for alternative treatments for antibiotic-resistant pathogens that the phenomenon has been investigated in detail. Numerous studies have shown PACT to be highly effective in the in vitro destruction of viruses and protozoa, as well as Gram-positive and Gram-negative bacteria and fungi. Results of experimental investigations have demonstrated conclusively that both dermatomycetes and yeasts can be effectively killed by photodynamic action employing phenothiazinium, porphyrin and phthatocyanine photosensitisers. Importantly, considerable setectivity for fungi over human cells has been demonstrated, no reports of fungal resistance exist and the treatment is not associated with genotoxic or mutagenic effects to fungi or human cells. In spite of the success of cell culture investigations, only a very small number of in vivo animal. and human trials have been published. The present paper reviews the studies published to date on antifungal applications of PACT and aims to raise awareness of this area of research, which has the potential to make a significant impact in future treatment of fungal infections. (c) 2007 Elsevier GmbH. All rights reserved.

Ambiguity, social opinion and the use of common property resources

In this paper we argue that ambiguity, combined with social opinion formation, can be used as the foundation of a game-theoretic equilibrium concept that transcends the standard Nash equilibrium concept, applied to a model of the tragedy of the commons. Our approach sheds light on the international environmental crisis and the relevant ongoing international negotiations. We conclude that social opinion formation in most cases has a significant impact on equilibrium common property resource usage.

Propensity to Apply for Judicial Office under the new Northern Ireland Judicial Appointments System::A qualitative study for the Northern Ireland Judicial Appointments Commission October

The study of representation and participation in the judiciary is hardly novel. There have been substantial studies in a number of countries – often these have preceded the setting up of judicial appointment commissions – which have looked at the continuing problem of female representation in judicial posts. Prior to the setting up of the Northern Ireland Judicial Appointments Commission a study carried out by Dermot Feenan for the Commissioner for Judicial Appointments for Northern Ireland also looked into this topic and produced a large number of recommendations. What differs from the Feenan project, in this project, has been the number of individuals consulted in interviews and focus groups. This has allowed us to provide a detailed qualitative attitudinal perspective to enhance the questionnaire study undertaken as Stage 1 in this research project. Further, we have carried out this study after many of the recommendations made in previous research have been implemented.
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Our interviews and focus groups covered a broad range of individuals – solicitors outwith and within Belfast (private and public service), barristers in private practice and public service and also barristers no longer in practice. We also sought responses from student lawyers. In total there were 71 respondents, with a typical interview/focus group length of 60 minutes. The group included candidates who had little interest in applying for judicial office, those who might consider this in future, and candidates who had applied for one or more judicial posts and who may or may not consider reapplication. We did not seek the views of successful candidates for judicial posts under the new NIJAC process.
The timing of this project, with interviews and focus groups held between December 2007 and March 2008, offers an early perspective on the whether the creation of a NI Judicial Appointments Commission has affected, and if so, in what way, the decision to apply for a judicial post. Generally, we found that there was a significant impact upon attitudes to judicial application which had arisen from the creation of NIJAC and that this was more positive than negative.

A computational model of cellular response to modulated radiation fields

Purpose:
To develop a model to describe the response of cell populations to spatially modulated radiation exposures of relevance to advanced radiotherapies.

Materials and Methods:
A Monte Carlo model of cellular radiation response was developed. This model incorporated damage from both direct radiation and intercellular communication including bystander signaling. The predictions of this model were compared to previously measured survival curves for a normal human fibroblast line (AGO1522) and prostate tumor cells (DU145) exposed to spatially modulated fields.

Results:
The model was found to be able to accurately reproduce cell survival both in populations which were directly exposed to radiation and those which were outside the primary treatment field. The model predicts that the bystander effect makes a significant contribution to cell killing even in uniformly irradiated cells. The bystander effect contribution varies strongly with dose, falling from a high of 80% at low doses to 25% and 50% at 4 Gy for AGO1522 and DU145 cells, respectively. This was verified using the inducible nitric oxide synthase inhibitor aminoguanidine to inhibit the bystander effect in cells exposed to different doses, which showed significantly larger reductions in cell killing at lower doses.

Conclusions:
The model presented in this work accurately reproduces cell survival following modulated radiation exposures, both in and out of the primary treatment field, by incorporating a bystander component. In addition, the model suggests that the bystander effect is responsible for a significant portion of cell killing in uniformly irradiated cells, 50% and 70% at doses of 2 Gy in AGO1522 and DU145 cells, respectively. This description is a significant departure from accepted radiobiological models and may have a significant impact on optimization of treatment planning approaches if proven to be applicable in vivo.

Pharmacogenomic Profiling and Pathway Analyses Identify MAPK-Dependent Migration as an Acute Response to SN38 in p53 Null and p53-Mutant Colorectal Cancer Cells.

The topoisomerase I inhibitor irinotecan is used to treat advanced colorectal cancer and has been shown to have p53-independent anticancer activity. The aim of this study was to identify the p53-independent signaling mechanisms activated by irinotecan. Transcriptional profiling of isogenic HCT116 p53 wild-type and p53 null cells was carried out following treatment with the active metabolite of irinotecan, SN38. Unsupervised analysis methods showed that p53 status had a highly significant impact on gene expression changes in response to SN38. Pathway analysis indicated that pathways involved in cell motility [adherens junction, focal adhesion, mitogen-activated protein kinase (MAPK), and regulation of the actin cytoskeleton] were significantly activated in p53 null cells, but not p53 wild-type cells, following SN38 treatment. In functional assays, SN38 treatment increased the migratory potential of p53 null and p53-mutant colorectal cancer cell lines, but not p53 wild-type lines. Moreover, p53 null SN38-resistant cells were found to migrate at a faster rate than parental drug-sensitive p53 null cells, whereas p53 wild-type SN38-resistant cells failed to migrate. Notably, cotreatment with inhibitors of the MAPK pathway inhibited the increased migration observed following SN38 treatment in p53 null and p53-mutant cells. Thus, in the absence of wild-type p53, SN38 promotes migration of colorectal cancer cells, and inhibiting MAPK blocks this potentially prometastatic adaptive response to this anticancer drug.

Micro-Environmental monitoring of temperature and moisture changes in building stone

The monitoring of temperature and moisture changes in response to different micro-environment of building stones is essential to understand the material behaviour and the degradation mechanisms. From a practical point of view, having a continuous and detailed understanding of micro-environmental changes in building stones helps to assist in their maintenance and repair strategies. Temperature within the stone is usually monitored by means of thermistors, whereas wide ranges of techniques are available for monitoring the moisture. In the case of concrete an electrical resistance method has previously been used as an inexpensive tool for monitoring moisture changes. This paper describes the adaptation of this technique and describes its further development for monitoring moisture movement in building stones.
In this study a block of limestone was subjected to intermittent infrared radiation with programmed cycles of ambient temperature, rainfall and wind conditions in an automated climatic chamber. The temperature and moisture changes at different depths within the stone were monitored by means of bead thermistors and electrical resistance sensors. This experiment has helped to understand the thermal conductivity and moisture transport from surface into deeper parts of the stone at different simulated extreme climatic conditions. Results indicated that variations in external ambient conditions could substantially affect the moisture transport and temperature profile within the micro-environment of building stones and hence they could have a significant impact on stone decay.

Can we meet targets for biofuels and renewable energy in transport given the constraints imposed by policy in agriculture and energy?

The deployment of biofuels is significantly affected by policy in energy and agriculture. In the energy arena, concerns regarding the sustainability of biofuel systems and their impact on food prices led to a set of sustainability criteria in EU Directive 2009/28/EC on Renewable Energy. In addition, the 10% biofuels target by 2020 was replaced with a 10% renewable energy in transport target. This allows the share of renewable electricity used by electric vehicles to contribute to the mix in achieving the 2020 target. Furthermore, only biofuel systems that effect a 60% reduction in greenhouse gas emissions by 2020 compared with the fuel they replace are allowed to contribute to meeting the target. In the agricultural arena, cross-compliance (which is part of EU Common Agricultural Policy) dictates the allowable ratio of grassland to total agricultural land, and has a significant impact on which biofuels may be supported. This paper outlines the impact of these policy areas and their implications for the production and use of biofuels in terms of the 2020 target for 10% renewable transport energy, focusing on Ireland. The policies effectively impose constraints on many conventional energy crop biofuels and reinforce the merits of using biomethane, a gaseous biofuel. The analysis shows that Ireland can potentially satisfy 15% of renewable energy in transport by 2020 (allowing for double credit for biofuels from residues and ligno-cellulosic materials, as per Directive 2009/28/EC) through the use of indigenous biofuels: grass biomethane, waste and residue derived biofuels, electric vehicles and rapeseed biodiesel. © 2010 Elsevier Ltd. All rights reserved.

Hierarchy as a barrier to advancement for women in academic medicine

Background: Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. Methods: As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Results: Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. Conclusions: The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine. © 2010 Copyright Mary Ann Liebert, Inc.

Steps to a better Belfast: physical activity assessment and promotion in primary care

BACKGROUND: Low physical activity (PA) levels which increase the risk of chronic disease are reported by two-thirds of the general UK population. Promotion of PA by primary healthcare professionals is advocated but more evidence is needed regarding effective ways of integrating this within everyday practice. This study aims to explore the feasibility of a randomised trial of a pedometer-based intervention, using step-count goals, recruiting patients from primary care. METHOD: Patients, aged 35-75, attending four practices in socioeconomically deprived areas, were invited to complete a General Practice PA Questionnaire during routine consultations. Health professionals invited 'inactive' individuals to a pedometer-based intervention and were randomly allocated to group 1 (prescribed a self-determined goal) or group 2 (prescribed a specific goal of 2500 steps/day above baseline). Both groups kept step-count diaries and received telephone follow-up at 1, 2, 6 and 11 weeks. Step counts were reassessed after 12 weeks. RESULTS: Of the 2154 patients attending, 192 questionnaires were completed (8.9%). Of these, 83 were classified as 'inactive'; 41(10 men; 31 women) completed baseline assessments, with the mean age of participants being 51 years. Mean baseline step counts were similar in group 1 (5685, SD 2945) and group 2 (6513, SD 3350). The mean increase in steps/day was greater in groups 1 than 2 ((2602, SD 1957) vs (748, SD 1997) p=0.005). CONCLUSIONS: A trial of a pedometer-based intervention using self-determined step counts appears feasible in primary care. Pedometers appear acceptable to women, particularly at a perimenopausal age, when it is important to engage in impact loading activities such as walking to maintain bone mineral density. An increase of 2500 steps/day is achievable for inactive patients, but the effectiveness of different approaches to realistic goal-setting warrants further study.

Surface-Enhanced Raman Scattering from Metallic Nanostructures: Bridging the Gap between the Near-Field and Far-Field Responses

We present here a detailed study of the complex relationship between the electromagnetic near-field and far-field responses of "real" nanostructured metallic surfaces. The near-field and far-field responses are specified in terms of (spectra of) the surface-enhanced Raman-scattering enhancement factor (SERS EF) and optical extinction, respectively. First, it is shown that gold nanorod- and nanotube-array substrates exhibit three distinct localized surface plasmon resonances (LSPRs): a longitudinal, a transverse, and a cavity mode. The cavity mode simultaneously has the largest impact on the near-field behavior (as observed through the SERS EF) and the weakest optical interaction: It has a "near-field-type" character. The transverse and longitudinal modes have a significant impact on the far-field behavior but very little impact on SERS: They have a "far-field-type" character. We confirm the presence of the cavity mode using a combination of SERS EF spectra, electron microscopy, and electromagnetic modeling and thus clearly illustrate and explain the (lack of) correlation between the SERS EF spectra and the optical response in terms of the contrasting character of the three LSPRs. In doing so, we experimentally demonstrate that, for a surface that supports multiple LSPRs, the near-field and far-field properties can in fact be tuned almost independently. It is further demonstrated that small changes in geometrical parameters that tune the spectral location of the LPSRs can also drastically influence the character of these modes, resulting in certain unusual behavior, such as the far-field resonance redshift as the near-field resonance blueshifts. DOI: 10.1103/PhysRevX.3.011001