The effect of socioeconomic deprivation on corneal graft survival in the United Kingdom

Objective: To investigate the effect of socioeconomic deprivation on cornea graft survival in the United Kingdom.

Design: Retrospective cohort study.

Participants: All the recipients (n = 13?644) undergoing their first penetrating keratoplasty (PK) registered on the United Kingdom Transplant Registry between April 1999 and March 2011 were included.

Methods: Data of patients' demographic details, indications, graft size, corneal vascularization, surgical complication, rejection episodes, and postoperative medication were collected at the time of surgery and 1, 2, and 5 years postoperatively. Patients with endophthalmitis were excluded from the study. Patients' home postcodes were used to determine the socioeconomic status using a well-validated deprivation index in the United Kingdom: A Classification of Residential Neighborhoods (ACORN). Kaplan–Meier survival and Cox proportional hazards regression were used to evaluate the influence of ACORN categories on 5-year graft survival, and the Bonferroni method was used to adjust for multiple comparisons.

Main Outcome Measures: Patients' socioeconomic deprivation status and corneal graft failure.

Results: A total of 13?644 patients received their first PK during the study periods. A total of 1685 patients (13.36%) were lost to follow-up, leaving 11?821 patients (86.64%) for analysis. A total of 138 of the 11?821 patients (1.17%) developed endophthalmitis. The risk of graft failure within 5 years for the patients classified as hard-pressed was 1.3 times that of the least deprived (hazard ratio, 1.3; 95% confidence interval, 1.1–1.5; P = 0.003) after adjusting for confounding factors and indications. There were no statistically significant differences between the causes of graft failure and the level of deprivation (P = 0.14).

Conclusions: Patients classified as hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Impact of counselling on quality of life and sleep in cancer patients

It has been acknowledged that poor quality of sleep significantly correlates with poor quality of life; evidence suggests that counselling has a positive impact not only on the cancer patient's quality of life, but also on family members and friends. The aim of this service evaluation was to determine if there was an improvement in clients’ quality of life and sleep patterns following counselling as offered by a local cancer charity. A total of 60 matched pre- and post-counselling questionnaires were completed and subjected to statistical analysis. When considering quality of life, in the domains of Role Emotional, Mental Health and Mental Component Summary Score, it can be concluded that counselling has a positive effect on emotional health and mental wellbeing. The mean total number of hours sleep per night significantly increased from 6 hours sleep per night at baseline to 6.8 hours sleep per night at the completion of counselling (p=0.005) showing clients gained an extra 48 minutes sleep per night. The improved emotional and mental wellbeing alongside the extra 48 minutes sleep per night provides evidence that there is a positive outcome for those patients and families who use counselling services. Nurses and other members of the multidisciplinary team should be encouraged to discuss supportive therapies with patients and those affected by cancer at all stages of the cancer trajectory, regardless of social status, gender or cancer type.

Ferroelectric Domain Wall Injection

Ferroelectric domain wall injection has been demonstrated by engineering of the
local electric field, using focused ion beam milled defects in thin single crystal lamellae of KTiOPO4 (KTP). The electric field distribution (top) displays localized field hot-spots, which correlate with nucleation events (bottom). Designed local field variations can also dictate subsequent domain wall mobility, demonstrating a new paradigm in ferroelectric domain wall control.

Using evidence in policy: The importance of mediating beliefs and practices

This article argues that to understand the use of evidence in policy, we need to examine how meanings and practices in the civil service shape what is accepted as knowledge, and how differences between the beliefs and values of the academy and the polity can impede the flow and transfer of knowledge. It considers the importance of social context and shared meanings in legitimating knowledge. Who counts as legitimate knowledge providers has expanded and here the role of stakeholder groups and experiential knowledge is of particular interest. How hierarchy, anonymity, and generalist knowledge within the civil service mediate the use of evidence in policy is examined. The difference in values and ideology of the civil service and the academy has implications for how academic research is interpreted and used to formulate policy and for its position in knowledge power struggles. There are particular issues about the social science nature of evidence to inform rural policy being mediated in a government department more used to dealing with natural science knowledge. This article is based on participant observation carried out in a UK Department of Agriculture and Rural Development. © 2013 The Author. Sociologia Ruralis © 2013 European Society for Rural Sociology.

A Lead-Free and High-Energy Density Ceramic for Energy Storage Applications

In this work, we demonstrate a very high-energy density and high-temperature stability capacitor based on SrTiO3-substituted BiFeO3 thin films. An energy density of 18.6 J/cm3 at 972 kV/cm is reported. The temperature coefficient of capacitance (TCC) was below 11% from room temperature up to 200°C. These results are of practical importance, because it puts forward a promising novel and environmentally friendly, lead-free material, for high-temperature applications in power electronics up to 200°C. Applications include capacitors for low carbon vehicles, renewable energy technologies, integrated circuits, and for the high-temperature aerospace sector. © 2013 Crown copyright

Synthesis of Walking Sounds for Alleviating Gait Disturbances in Parkinson’s Disease

Managing gait disturbances in people with Parkinson’s disease is a pressing challenge, as symptoms can contribute to injury and morbidity through an increased risk of falls. While drug-based interventions have limited efficacy in alleviating gait impairments, certain non-pharmacological methods, such as cueing, can also induce transient improvements to gait. The approach adopted here is to use computationally-generated sounds to help guide and improve walking actions. The first method described uses recordings of force data taken from the steps of a healthy adult which in turn were used to synthesize realistic gravel-footstep sounds that represented different spatio-temporal parameters of gait, such as step duration and step length. The second method described involves a novel method of sonifying, in real time, the swing phase of gait using real-time motion-capture data to control a sound synthesis engine. Both approaches explore how simple but rich auditory representations of action based events can be used by people with Parkinson’s to guide and improve the quality of their walking, reducing the risk of falls and injury. Studies with Parkinson’s disease patients are reported which show positive results for both techniques in reducing step length variability. Potential future directions for how these sound approaches can be used to manage gait disturbances in Parkinson’s are also discussed.

Chlorophyll-a concentrations and macroinvertebrate declines coincide with the collapse of overwintering diving duck populations in a large eutrophic lake

1. Lough Neagh is one of the most important non-estuarine sites in the British Isles for overwinteringwildfowl. A change in the waterbird assemblage following the winter of 2000/2001 was drivenmainly by a rapid decline in the population of overwintering diving ducks. Sudden and discretechanges in resident as well as migratory waterbirds may suggest an intrinsic cause.
2. We compared the density and biomass of benthic macroinvertebrates, the food of overwinteringdiving ducks, in 2010 (following the diving duck population decline) with values from a baselinesurvey conducted in 1997/1998 (before the decline in diving ducks).
3. The mean total density of macroinvertebrates declined significantly by c. 65% from 15 300 m2in1997/1998 to 5136 m2in 2010. There was a concomitant c. 70% decline in mean macroinvertebratebiomass from 15 667 mg m2to 5112 mg m2. In terms of taxonomic composition, the relativecontribution of Tanypodinae, Glyptotendipes spp . and Tanytarsini declined, while the relativecontribution of Chironomus spp. increased.
4. We describe a shift in chlorophyll-a concentration, a proxy of phytoplankton biomass, in thelargest freshwater lake in the British Isles coincident with a significant reduction in macroinverte-brate density and biomass, with potential implications for ecosystem processes and ecologically andeconomically important consumer populations, including waterbirds and fishes

Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health

The empirical association between income inequality, population health and other social problems is now well established and the research literature suggests that the relationship is not artefactual. Debate is still ongoing as to the cause of this association. Wilkinson, Marmot and colleagues have argued for some time that the relationship stems from the psycho-social effects of status comparisons. Here, income inequality is a marker of a wider status hierarchy that provokes an emotional stress response in individuals that is harmful to health and well-being. We label this the ‘status anxiety hypothesis’. If true, this would imply a structured relationship between income inequality at the societal level, individual income rank and anxiety relating to social status. This paper sets out strong and weak forms of the hypothesis and then presents three predictions concerning the structuring of ‘status anxiety’ at the individual level given different levels of national income inequality and varying individual income. We then test these predictions using data from a cross-national survey of over 34,000 individuals carried out in 2007 in 31 European countries. Respondents from low inequality countries reported less status anxiety than those in higher inequality countries at all points on the income rank curve. This is an important precondition of support for the status anxiety hypothesis and may be seen as providing support for the weaker version of the hypothesis. However, we do not find evidence to support the stronger version of the hypothesis which requires the negative effect of income rank on status anxiety to be exacerbated by increasing income inequality.

An Innovative teaching tool for students is it Appropriate?

Background: Clinical supervision takes place once the newly qualified nurse is employed in clinical practice. However, often the variety and diversity of nursing jobs can result in a hit and miss delivery of supervision training. By introducing training uniformly at undergraduate stage a more seamless transition may occur (McColgan K, Rice C. 2012).

There is an increased interest in higher education in the use of online learning resources for students. As part completion of a DNP an App. for training students in clinical supervision was developed.

Aim: The creation of a clinical supervision training App. for use in undergraduate nursing.

Objectives:
•To develop a teaching tool that is up to date, current and easily accessible to students.
•To introduce supervision training for undergraduate nursing students
•To motivate the undergraduate nursing student to identify examples from their clinical experience to encourage change and promote professional development.

Approach:
Stage 1
In 2010/11 informal inquiries with senior nurses regarding the introduction of supervision training in undergraduate nursing
Stage 2
A review of UK supervision training.
Stage 3
Template production of teaching tool.
Stage 4
Collaboration with a computer technician to transfer multimedia outputs onto an App.
Stage 5
App. piloted with lecturers (n=4) and post registration students (n=20).
Stage 6
Minor alterations made to App. design template
Stage 7
App. included in an experimental study looking at online learning versus blended learning June 2013 (n=61, n=63)

Conclusion: A collaborative approach to the development of any educational programme is essential to ensure the success of the final teaching product (McCutcheon 2013). The end result is that this App. could be:
•Made available to nurses in the UK.
•Adapted to suit other healthcare professionals and students.
•Used as a prototype for other healthcare related subjects.

McColgan K., Rice C. (2012) An online training resource for clinical supervision. Nursing Standard, 26(24) 35-39.
McCutcheon K. (2013) Development of a multi-media book for clinical supervision training in an undergraduate nursing programme. Journal of Nursing Education and Practice, 3(5) 31-38.

On Not Reading Fifty Shades:Feminism and the Fantasy of Romantic Immunity

This paper explores the politics of feminist criticism of the Fifty Shades novels as seen in both traditional media commentary and popular online news and cultural websites and blogs. I argue that much media commentary, in broadsheet and other ‘respectable’ outlets particularly, has featured avowedly feminist writers dismissing the books as ‘bad’, not only containing bad writing and bad sex but, ultimately, as being bad for their women readers. Situating these responses within a history of feminist discomfort with popular erotic and romantic fiction marketed to women I read these responses as a form of ‘anti-romantic’ fantasy in which the reader/critic is able to assert both her immunity from the romantic fantasy offered in the text and her cultural distance from those women who are subject to it. Further, this act of disavowal is often linked to a professed concern for the women who read the novel who the critic argues will, inevitably, replicate the abusive and harmful relationship dynamics that the novel represent. Such a move then positions the feminist critic as not only more culturally intelligent than women readers of the novel but enacts a fantasy of respectable, middle-class feminist cultural custodianship. Such a fantasy, I argue, is connected to the post-feminist era in which we live, which has produced a class of self-appointed ‘feminist’ cultural critics who seek to contest their own cultural marginalisation through enacting a governmental authority to worry about other women. This paper, therefore, is a critical investigation of the pleasures and politics of very publicly not reading Fifty Shades and its significance for analysing the contemporary politics of popular culture and feminism.

Lost in translation: Public policies, evidence-based practice, and Autism Spectrum Disorder

Prevalence rates of autism spectrum disorder have risen dramatically over the past few decades (now estimated at 1:50 children). The estimated total annual cost to the public purse in the United States is US$137 billion, with an individual lifetime cost in the United Kingdom estimated at between £0.8 million and £1.23 million depending on the level of functioning. The United Nations Convention for the Rights of Persons with Disabilities has enshrined full and equal human rights—for example, for inclusion, education and employment—and there is ample evidence that much can be achieved through adequate support and early intensive behavioural interventions. Not surprisingly, most governments worldwide have devised laws, policies, and strategies to improve services related to autism spectrum disorder, yet intriguingly the approaches differ considerably across the globe. Using Northern Ireland as a case in point, we look at relevant governmental documents and offer international comparisons that illustrate inconsistencies akin to a “postcode lottery” of services.

Qualitative data analysis:A practical example

The aim of this paper is to equip readers with an understanding of the principles of qualitative data analysis and offer a practical example of how analysis might be undertaken in an interview-based study.

Detection of an artificial target with low radar cross-section in presence of backscatter

This paper presents an approach to improve the detection of an artificial target with low radar cross-section in presence of clutter. The target proposed in the paper modulates the phase response of the circularly polarized incident signal by means of rotation. The same physical phenomenon can be used to steer the modulated response in a non-specular direction. The bi-static measurements of the response of the target have demonstrated good agreement with theoretical prediction as well as with full-wave simulation.