Elective versus symptomatic antibiotic treatment in cystic fibrosis patients with chronic Pseudomonas infection of the lungs

BACKGROUND:
A previous retrospective study suggested that a policy of regular anti-pseudomonal antibiotic treatment improved pulmonary function and increased survival in patients with cystic fibrosis chronically infected with Pseudomonas species. The results of a prospective multicentre study to compare the effects on pulmonary function and mortality of three monthly elective anti-pseudomonal antibiotic treatment with conventional symptomatic treatment are reported.

METHODS:
Sixty patients with cystic fibrosis, chronically infected with P aeruginosa, were randomised to the two treatment arms (elective or symptomatic) and followed clinically at yearly reviews. The major end points were changes in forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC). Survival was a secondary end point.

RESULTS:
Patients in the symptomatic group received a mean of three antibiotic treatments each year and those in the elective group received four antibiotic treatments during each year of the study. No significant differences in FEV(1) and FVC were found between the two groups after three years. There was a statistically non-significant higher rate of deaths in the elective group (n = 4), three of which were associated with B cepacia infection, compared with the symptomatic group (n = 0).

CONCLUSIONS:
This study did not demonstrate an advantage of a policy of elective antibiotic treatment over symptomatic treatment in patients with cystic fibrosis chronically infected with Pseudomonas species.

Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol

Background: It has been suggested that asthmatic subjects with persisting symptoms despite adequate maintenance therapy should be systematically evaluated to identify factors contributing to poor control. The aims of this study were to examine the prevalence of these factors in a cohort of sequentially referred poorly controlled asthmatics, and to determine if any factor or combination of factors predicted true therapy resistant asthma (TRA).

Methods: Patients were evaluated using a systematic evaluation protocol including induced sputum analysis, psychiatric assessment, ear, nose and throat examination, pulmonary function testing, high resolution CT scan of the thorax, and 24 hour dual probe ambulatory oesophageal pH monitoring; any identified provoking factor was treated. Asthma was managed according to BTS guidelines.

Results: Of 73 subjects who completed the assessment, 39 responded to intervention and 34 had TRA. Subjects with TRA had a greater period of instability, a higher dose of inhaled steroids at referral, more rescue steroid use, and a lower best percentage forced expiratory volume in 1 second (FEV1%). Oesophageal reflux, upper airway disease, and psychiatric morbidity were common (57%, 95%, 49%, respectively) but were not more prevalent in either group. Using multivariate logistic regression analysis, inhaled steroid dose >2000 µg BDP, previous assessment by a respiratory specialist, and initial FEV1% of <70% at referral predicted a final diagnosis of TRA.

Conclusions: In poorly controlled asthmatics there is a high prevalence of co-morbidity, identified by detailed systematic assessment, but no difference in prevalence between those who respond to intervention and those with TRA. Targeted treatment of identified co-morbidities has minimal impact on asthma related quality of life in those with therapy resistant disease.

Global and local contributions to the optical specification of time to contact: Observer sensitivity to composite tau

First-order time remaining until a moving observer will pass an environmental element is optically specified in two different ways. The specification provided by global tau (based on the pattern of change of angular bearing) requires that the element is stationary and that the direction of motion is accurately detected, whereas the specification provided by composite tau (based on the patterns of change of optical size and optical distance) does not require either of these. We obtained converging evidence,for our hypothesis. that observers are sensitive to composite tau in four experiments involving, relative judgments of, time to, passage with forced-choice methodology. Discrimination performance was enhanced in the presence of a local expansion component, while being unaffected when the detection of the direction of heading was impaired. Observers relied on the information carried in composite tau rather than on the information carried in its constituent components. Finally, performance was similar under conditions of observer motion and conditions of object motion. Because composite tau specifies first-order time remaining for a large number of situations, the different ways in which it may be detected are discussed.

The contested notion of a pluralist School Ethos

Debates around the importance of school ethos have gathered pace in recent years. Whilst it is not clear why this concept has become increasingly important in the educational vernacular the marketisation of education seems to have had some effect. As schools are forced to compete they have become concerned to identify and promote their 'Unique Selling Points' as a means of attracting and maintaining a long term 'customer' base. Defining a school in terms of its particular 'ethos' therefore offers a useful means of identifying and encapsulating the particular strengths of the school. It is thus not uncommon for heads to market their schools on the basis of their endorsing a 'liberal ethos' a 'caring ethos' or a 'sporting ethos' (Gardner, 2003).

The purpose of this chapter is to use empirical evidence to explore the meaning of a 'pluralist ethos' or 'integrated ethos', within the integrated school context in Northern Ireland.

Illicit Cycle of Narcotics from a Human Rights Perspective

The purpose of this article is to analyse the illicit cycle of narcotics within a human rights framework. It begins by illustrating the benefits of adopting a human rights framework, such as its ability to promote victim-centred and holistic approaches. The article then identifies key human rights issues such as poverty, forced labour, law enforcement practices and addiction to narcotics. It continues with an analysis of the nature and the extent of obligations imposed upon States. This article focuses on three categories of human rights obligations to address: 1) the supply of narcotics; 2) narcotics trafficking; and 3) the demand for narcotics. The main conclusion reached is that a human rights framework can strengthen the global action against the illicit cycle of narcotics.

Sublime Lessons: Education and Ambivalence in War Exhibitions

This paper examines how experiences of the sublime are regulated in the war exhibitions of modern museums. Ambivalence is a key feature of the sublime because subjects are forced to negotiate simultaneous feelings of terror and awe in the face of something unrepresentable like war. This paper analyses how war exhibitions dispel ambivalence by resuscitating a Kantian sublime full of resolution, catharsis and transcendence. In this context, potentially destabilising encounters with horrific objects (e.g. guns, bombs, shrapnel) are neutralised by didactic 'Lessons of War' and celebratory narratives of victory. Using examples from the United States Holocaust Memorial Museum, the Imperial War Museum in London and the Smithsonian Institution, this paper illustrates how conventional war exhibitions reproduce a politics of consensus by carefully managing the experience of the sublime.

Benevolent Patriotism: Art, Dissent and the American Effect

This article examines the role of contemporary art in a post-9/11 context through The American Effect exhibition at the Whitney Museum of American Art in New York in 2003. This exhibition displayed a range of artworks from around the world that specifically engaged with, commented upon and interrogated the USA's pre-eminent position as a global superpower. In the politically charged climate after 9/11, the exhibition offered itself as a critical voice amid the more obvious patriotic clamour: it was one of the places where Americans could ask (and answer) the question, `Why do they hate us so much?' Although The American Effect claimed to be a space of dissent, it ultimately failed to question, let alone challenge, US global hegemony. Instead, the exhibition articulated a benevolent patriotism that forced artwork from other nations into supplicating and abject positions, and it obscured the complex discursive networks that connect artists, curators, critics, audiences and art museums.

'A terrible danger to the morals of the country': The Irish hospitals' sweepstake in Great Britain, 1930-87

This paper examines the importance of British contributions to the success of the Irish hospitals sweepstake. In its early years, up to three-quarters of these tickets were sold in Britain, bringing millions of pounds into Ireland annually to improve and expand the state's hospitals. The vast amount of money leaving Britain in this way angered the British government and forced it to introduce new legislation to curtail the activities of the Irish sweep. The paper will highlight the extent to which the success of the sweepstake depended on the market for tickets in Britain; the threat to the sweep's survival posed by the restriction of its activities in Britain after 1935; the role of the sweepstake controversy in exacerbating further already strained relations between Britain and the Irish Free State in the 1930s; how the success of the sweep raised the issue of legalising a British lottery; and the eventual decline of the sweepstake as a force in British gambling in the post-war years.

Prograded Holocene beach-ridges with superimposed dunes in north-east Ireland: mechanisms and timescales of fine and coarse beach sediment decoupling and deposition

Two depositional models to account for Holocene gravel-dominated beach ridges covered by dunes, occurring on the northern coast of Ireland, are considered in the light of infrared-stimulated luminescence ages of sand units within beach ridges, and 14C ages from organic horizons in dunes. A new chronostratigraphy obtained from prograded beach ridges with covering dunes at Murlough, north-east Ireland, supports a model of mesoscale alternating sediment decoupling (ASD) on the upper beach, rather than macroscale sequential sediment sourcing to account for prograded beach ridges and covering dunes. The ASD model specifies storm or fair-weather sand beach ridges forming at high-tide positions (on an annual basis at minimum), which acted as deflationary sources for landward foredune development. Only a limited number of such late-Holocene beach ridges survive in the observed prograded series. Beach ridges only survive when capped by storm-generated gravel beaches that are deposited on a mesoscale time spacing of 50–130 years. The morphodynamic shift from a dissipative beach face for dune formation to a reflective beach face for gravel capping appears to be controlled by the beach sand volume falling to a level where reflective conditions can prevail. Sediment volume entering the beach is thought to have fluctuated as a function of a forced regression associated with the falling sea level from the mid-Holocene highstand (ca. 6000 cal. yr BP) identified in north-east Ireland. The prograded beach ridges dated at ca. 3000 to 2000 cal. yr BP indicate that the Holocene highstand’s regressive phase may have lasted longer than previously specified.

Challenging assumptions of future coastal habitat development around the UK

One habitat management requirement forced by 21st century relative sea-level rise (RSLR), will be the need to re-comprehend the dimensions of long-term transgressive behaviour of coastal systems being forced by such RSLR. Fresh approaches to the conceptual modelling and subsequent implementation of new coastal and peri-marine habitats will be required. There is concern that existing approaches to forecasting coastal systems development (and by implication their associated scarce coastal habitats) over the next century depend on a certain premise of orderly spatial succession of habitats. This assumption is shown to be questionable given the possible future rates of RSLR, magnitude of shoreline retreat and the lack of coastal sediment to maintain the protective morphologies to low-energy coastal habitats. Of these issues, sediment deficiency is regarded as one of the major problem for future habitat development. Examples of contemporary behaviour of UK coasts show evidence of coastal sediment starvation resulting from relatively stable RSLR, anthropogenic sealing of coastal sources, and intercepted coastal sediment pathways, which together force segmentation of coastal systems. From these examples key principles are deduced which may prejudice the existence of future habitats: accelerated future sediment demand due to RSLR may not be met by supply and, if short- to medium-term hold-the-line policies predominate, long-term strategies for managed realignment and habitat enhancement may prove impossible goals. Methods of contemporary sediment husbandry may help sustain some habitats in place but otherwise, instead of integrated coastal organization, managers may need to consider coastal breakdown, segmentation and habitat reduction as the basis of 21st century coastal evolution and planning.

Cathepsin S expression: An independent prognostic factor in glioblastoma tumours - A pilot Study

Cysteine proteinases have been implicated in astrocytoma invasion. We recently demonstrated that cathepsin S (CatS) expression is up-regulated in astrocytomas and provided evidence for a potential role in astrocytoma invasion (Flannery et al., Am J Path 2003;163(1):175–82). We aimed to evaluate the significance of CatS in human astrocytoma progression and as a prognostic marker. Frozen tissue homogenates from 71 patients with astrocytomas and 3 normal brain specimens were subjected to ELISA analyses. Immunohistochemical analysis of CatS expression was performed on 126 paraffin-embedded tumour samples. Fifty-one astrocytoma cases were suitable for both frozen tissue and paraffin tissue analysis. ELISA revealed minimal expression of CatS in normal brain homogenates. CatS expression was increased in grade IV tumours whereas astrocytoma grades I–III exhibited lower values. Immunohistochemical analysis revealed a similar pattern of expression. Moreover, high-CatS immunohistochemical scores in glioblastomas were associated with significantly shorter survival (10 vs. 5 months, p = 0.014). With forced inclusion of patient age, radiation dose and Karnofsky score in the Cox multivariate model, CatS score was found to be an independent predictor of survival. CatS expression in astrocytomas is associated with tumour progression and poor outcome in glioblastomas. CatS may serve as a useful prognostic indicator and potential target for anti-invasive therapy.

The regulation and role of osteopontin in malignant transformation and cancer.

Osteopontin (OPN) is a predominantly secreted extracellular matrix glycophosphoprotein which binds to alpha v-containing integrins and has an important role in malignant cell attachment and invasion. High OPN expression in the primary tumor is associated with early metastasis and poor outcome in human breast and other cancers. Forced OPN overexpression in benign cells may induce neoplastic-like cell behaviour including increased attachment and invasion in vitro as well as the ability to metastasize in vivo. Conversely, OPN inhibition by antisense cDNA impedes cell growth and tumor forming capacity. OPN is not mutationally activated in cancer but its expression is regulated by Wnt/Tcf signaling, steroid receptors, growth factors, ras, Ets and AP-1 transcription factors. Presumably these factors are implicated in induction of OPN overexpression in cancer. Greater understanding of the role of OPN in neoplastic change and its transcriptional regulation may enable development of novel cancer treatment strategies

Resting and daily energy expenditures of free-living field voles are positively correlated but reflect extrinsic rather than intrinsic effects

Resting metabolic rates at thermoneutral (RMRts) are unexpectedly variable. One explanation is that high RMRts intrinsically potentiate a greater total daily energy expenditure (DEE), but recent work has suggested that DEE is extrinsically defined by the environment, which independently affects RMRt. This extrinsic effect could occur because expenditure is forced upwards in poor habitats or enabled to rise in good habitats. We provide here an intraspecific test for an association between RMRt and DEE that separates intrinsic from extrinsic effects and forcing from enabling effects. We measured the DEE and RMRt of 75 free-living short-tailed field voles at two time points in late winter. Across all sites, there was a positive link between individual variation in RMRt and DEE. This correlation, however, emerged only because of an effect across sites, rather than because of an intrinsic association within sites. We defined site quality from the survivorship of voles at the sites and the time at which they commenced breeding in spring. The associations between DEE/RMRt and site quality suggested that in February voles in poorer sites had higher energy demands, indicating that DEE was forced upwards, but in March the opposite was true, with higher demands in good sites, indicating that high expenditure was enabled. These data show that daily energy demands are extrinsically defined, with a link to RMRt that is secondary or independent. Both forcing and enabling effects of the environment may pertain at different times of year.

Solar forcing of climate change during the mid-Holocene: indications from raised bogs in the Netherlands.

Two cores of mid-Holocene raised-bog deposits from the Netherlands were 14C wiggle-match dated at high precision. Changes in local moisture conditions were inferred from the changing species composition of consecutive series of macrofossil samples. Several wet-shifts were inferred, and these were often coeval with major rises in the D14C archive (probably caused by major declines in solar activity). The use of D14C as a proxy for changes in solar activity is validated. This paper adds to the increasing body of evidence that solar variability forced climatic changes during the Holocene.

Exile or emigrant? Female ex-prisoners who left Ireland 1850-1921

In the popular mind, the concept of 'emigration' usually refers to people voluntarily leaving one country to go to another in search of a new and better life. It presupposes some degree of choice, although it is accepted that for many emigrants, such as those who left Ireland during the nineteenth century, there were few incentives to stay at home. Current scholarship on voluntary and forced movements of people demonstrates that the distinction between the categories of 'voluntary emigrant' and 'forced exile' is often blurred. Orm Overland's study of refugee communities in the United States highlights the fact that, although the differences between the 'emigrant' and the 'exile' may be clear in extreme cases, this is not always true, as there may be 'pressing political or economic reasons behind a decision to emigrate'. Migration scholars Jan Lucassen and Leo Lucassen also question the adequacy of conceptual models of migration based on what Lindsay Proudfoot and Dianne Hall refer to as the 'straightforward binarism between free and unfree emigration'. The questions raised by these scholars are very relevant to the study of Irish people who left their country during the second half of the nineteenth century immediately after they had been discharged from prison or from Dundrum. Their stories are discussed here against a background of substantial scholarship on emigration from Ireland and on the criminal justice system within Ireland. According to David Fitzpatrick, at least eight million men, women and children emigrated from Ireland between 1801 and 1921. This large-scale movement of people was generally characterised by the voluntary emigration of individuals who funded their own passages. However, it also included schemes of assisted emigration, funded variously by governments, landlords, the poor law authorities, earlier emigrants, and philanthropists. In addition, it included people who were transported from Ireland by means of the criminal justice system a practice that had originated in the seventeenth century. What is less well known is that after the end of transportation from Ireland to eastern Australia in 1853, to Bermuda in 1863 and to Western Australia in 1868, Irish convicts continued to be channelled towards emigration by being offered early release if they agreed to leave Ireland. These people, and especially the women among them, are the subject of this article.