A school based study of psychological disturbance in children following the Omagh bomb

Objective
To assess the extent and nature of psychiatric morbidity among children (aged 8 to 13 years) 15 months after a car bomb explosion in the town of Omagh, Northern Ireland.

Method
A survey was conducted of 1945 school children attending 13 schools in the Omagh district. Questionnaires included demographic details, measures of exposure, the Horowitz Impact of Events Scale, the Birleson Self-Rating Depression Scale, and the Spence Children’s Anxiety Scale.

Results
Children directly exposed to the bomb reported higher levels of probable PTSD (70%), and psychological distress than those not exposed. Direct exposure was more closely associated with an increase in PTSD symptoms than in general psychiatric distress. Significant predictors of increased IES scores included being male, witnessing people injured and reporting a perceived life threat but when co-morbid anxiety and depression are included as potential predictors anxiety remains the only significant predictor of PTSD scores.

Conclusions
School-based studies are a potentially valuable means of screening and assessing for PTSD in children after large-scale tragedies. Assessment should consider type of exposure, perceived life threat and other co-morbid anxiety as risk factors for PTSD.

Physical activity and the rejuvenation of Connswater (PARC study): protocol for a natural experiment investigating the impact of urban regeneration on public health

Background: There is a dearth of evidence regarding the impact of urban regeneration projects on public health, particularly the nature and degree to which urban regeneration impacts upon health-related behaviour change. Natural experiment methodology enables comprehensive large-scale evaluations of such interventions. The Connswater Community Greenway in Belfast is a major urban regeneration project involving the development of a 9 km linear park, including the provision of new cycle paths and walkways. In addition to the environmental improvements, this complex intervention involves a number of programmes to promote physical activity in the regenerated area. The project affords a unique opportunity to investigate the public health impact of urban regeneration.

Methods/Design: The evaluation framework was informed by the socio-ecological model and guided by the RE-AIM Framework. Key components include: (1) a quasi-experimental before-and-after survey of the Greenway population (repeated cross-sectional design), in tandem with data from a parallel Northern Ireland-wide survey for comparison; (2) an assessment of changes in the local built environment and of walkability using geographic information systems; (3) semi-structured interviews with a purposive sample of survey respondents, and a range of community stakeholders, before and after the regeneration project; and (4) a cost-effectiveness analysis. The primary outcome is change in proportion of individuals identified as being regularly physically active, according to the current UK recommendations. The RE-AIM Framework will be used to make an overall assessment of the impact of the Greenway on the physical activity behaviour of local residents.

Discussion: The Connswater Community Greenway provides a significant opportunity to achieve long-term, population level behaviour change. We argue that urban regeneration may be conceptualised meaningfully as a complex intervention comprising multiple components with the potential, individually and interactively, to affect the behaviour of a diverse population. The development and implementation of our comprehensive evaluation framework reflects this complexity and illuminates an approach to the empirical, rigorous evaluation of urban regeneration. More specifically, this study will add to the much needed evidence-base about the impact of urban regeneration on public health as well as having important implications for the development of natural experiment methodology.

An ultrastructural study of carcinoid tumor of the iris

An iris tumor developed in a 37-year-old woman who had had a bronchial carcinoid tumor resected nine years previously. The iris tumor was locally excised with a modified trabeculectomy approach. Histologic studies showed it to be a metastatic carcinoid tumor. Electron microscopy demonstrated typical dark and pale carcinoid cells with neurosecretory granules, basal bodies, and apical microvilli. The cisternae of the granular endoplasmic reticulum were disposed in a series of concentric rings encapsulating a central core of mitochondria. This unusual type of subcellular organization and specialization is probably a reflection of the slow-growing and highly differentiated nature of the iris tumor.

Staffing, status and subject knowledge: what does the construction of citizenship as a new curriculum subject in England tell us about the nature of school subjects?

Almost a decade ago, the new subject of citizenship was created in the English National Curriculum and several universities were funded to train teachers in this new subject. This presented a rare challenge, namely how to train people to teach a subject that did not exist in schools, and in which they were unlikely to have a specialist degree. In this article we have taken the opportunity afforded by the
tenth birthday of the report in which Crick recommended this curriculum reform to reflect on that experience from the perspective of teacher educators. Through reflecting on the case study of citizenship education in England we highlight several themes that are of more general interest to teacher educators. The key issues that have emerged in this case study relate to the general problems of translating central policy into classroom practice; the nature and aims of subjects in the curriculum; and the identities of teachers in secondary schools. The article illustrates how teacher educators responded to the formidable challenge of creating (or at least contributing to) a new subject and a subject community.

Comparative study on transport properties for LiFAP and LiPF6 in alkyl-carbonates as electrolytes through conductivity, viscosity and NMR self-diffusion measurements

We present in this work a comparative study on density and transport properties, such as the conductivity (sigma), viscosity (eta) and self-diffusion coefficients (D), for electrolytes based on the lithium hexafluorophosphate, LiPF6; or on the lithium tris(pentafluoroethane)-trifluorophosphate, LiFAP dissolved in a binary mixture of ethylene carbonate (EC) and dimethylcarbonate (DMC) (50:50 wt%). For each electrolyte, the temperature dependence on transport properties over a temperature range from 10 to 80 degrees C and 20 to 70 degrees C for viscosity and conductivity, respectively, exhibits a non-Arrhenius behavior. However, this dependence is correctly correlated by using the Vogel-Tamman-Fulcher (VTF) type fitting equation. In each case, the best-fit parameters, such as the pseudo activation energy and ideal glass transition temperature were then extracted. The self-diffusion coefficients (D) of the Li+ cation and PF6- or FAP(-) anions species, in each studied electrolyte, were then independently determined by observing Li-3, F-19 and P-31 nuclei with the pulsed-gradient spin-echo (PGSE) NMR technique over the same temperature range from 20 to 80 degrees C. Results show that even if the diffusion of the lithium cation is quite similar in both electrolytes, the anions diffusion differs notably. In the case of the LiPF6-based electrolyte, for example at T approximate to 75 degrees C (high temperature), the self-diffusion coefficients of Li+ cations in solution (D (Li+)approximate to 5 x 10(-19) m(2) s(-1)) is 1.6 times smaller than that of PF6- anions (D (PF6-) = 8.5 x 10(-19) m(2) s(-1)), whereas in the case of the LiFAP-based electrolyte, FAP(-) anions diffuse at same rate as the Li+ cations (D (FAP(-)) = 5 x 10(-1) m(2) s(-1)). Based on these experimental results, the transport mobility of ions were then investigated through Stokes-Einstein and Nernst-Einstein equations to determine the transport number of lithium t(Li)(+), effective radius of solvated Li+ and of PF6- and FAP(-) anions, and the degree of dissociation of these lithium salts in the selected EC/DMC (50:50 wt%) mixture over a the temperature range from 20 to 80 degrees C. This study demonstrates the conflicting nature of the requirements and the advantage of the well-balanced properties as ionic mobility and dissociation constant of the selected electrolytes. (C) 2013 Elsevier Ltd. All rights reserved.

Further refinement of the nature of the communication impairment in Cornelia de Lange syndrome

Purpose – Research into the communication skills of individuals with Cornelia de Lange syndrome (CdLS) is extremely limited. This paper aims to evaluate the nature of these skills and impairments in CdLS using a detailed informant assessment of pre-verbal communication skills.
Design/methodology/approach – The study used the Pre-verbal Communication Schedule to evaluate communication skills in individuals with CdLS (n ¼ 14), aged five to14 years. The group was compared with a contrast group of individuals with Cri du Chat syndrome (CdCS; n ¼ 14) who were matched for age and intellectual ability.
Findings – A significant difference was identified in understanding non-vocal communication (p , 0.005), with the CdLS group showing a greater deficit. These findings indicate the presence of a syndrome-specific deficit in understanding non-verbal communication in individuals with CdLS and suggest that there may be a dissociation between the processing of verbal and non-verbal communication.
Originality/value – The findings indicate that, in many ways, these two syndrome groups are not dissimilar in terms of their communication skills. However, individuals with CdLS show a syndrome-specific deficit in understanding non-vocal communication relative to the CdCS group.

A genome-wide association study identifies new susceptibility loci for esophageal adenocarcinoma and Barrett's esophagus

Esophageal adenocarcinoma is a cancer with rising incidence and poor survival. Most such cancers arise in a specialized intestinal metaplastic epithelium, which is diagnostic of Barrett's esophagus. In a genome-wide association study, we compared esophageal adenocarcinoma cases (n = 2,390) and individuals with precancerous Barrett's esophagus (n = 3,175) with 10,120 controls in 2 phases. For the combined case group, we identified three new associations. The first is at 19p13 (rs10419226: P = 3.6 × 10(-10)) in CRTC1 (encoding CREB-regulated transcription coactivator), whose aberrant activation has been associated with oncogenic activity. A second is at 9q22 (rs11789015: P = 1.0 × 10(-9)) in BARX1, which encodes a transcription factor important in esophageal specification. A third is at 3p14 (rs2687201: P = 5.5 × 10(-9)) near the transcription factor FOXP1, which regulates esophageal development. We also refine a previously reported association with Barrett's esophagus near the putative tumor suppressor gene FOXF1 at 16q24 and extend our findings to now include esophageal adenocarcinoma.

Assessing the distribution of social-ecological resilience and risk: Ireland as a case study of the uneven impact of famine

Explanations for the causes of famine and food insecurity often reside at a high level of aggregation or abstraction. Popular models within famine studies have often emphasised the role of prime movers such as population stress, or the political-economic structure of access channels, as key determinants of food security. Explanation typically resides at the macro level, obscuring the presence of substantial within-country differences in the manner in which such stressors operate. This study offers an alternative approach to analyse the uneven nature of food security, drawing on the Great Irish famine of 1845–1852. Ireland is often viewed as a classical case of Malthusian stress, whereby population outstripped food supply under a pre-famine demographic regime of expanded fertility. Many have also pointed to Ireland's integration with capitalist markets through its colonial relationship with the British state, and country-wide system of landlordism, as key determinants of local agricultural activity. Such models are misguided, ignoring both substantial complexities in regional demography, and the continuity of non-capitalistic, communal modes of land management long into the nineteenth century. Drawing on resilience ecology and complexity theory, this paper subjects a set of aggregate data on pre-famine Ireland to an optimisation clustering procedure, in order to discern the potential presence of distinctive social–ecological regimes. Based on measures of demography, social structure, geography, and land tenure, this typology reveals substantial internal variation in regional social–ecological structure, and vastly differing levels of distress during the peak famine months. This exercise calls into question the validity of accounts which emphasise uniformity of structure, by revealing a variety of regional regimes, which profoundly mediated local conditions of food security. Future research should therefore consider the potential presence of internal variations in resilience and risk exposure, rather than seeking to characterise cases based on singular macro-dynamics and stressors alone.

Suspected giant cell arteritis:A study of referrals for temporal artery biopsy

Background: The purpose of this study is to describe the nature of cases undergoing temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA). Methods: A retrospective review of case notes was undertaken for all patients on whom ophthalmologists had performed TAB in 2 teaching hospitals between 1995 and 2001. Presenting symptoms, referring specialty, TAB result, treatment, and discharge diagnosis were recorded. Results: Ophthalmologists performed TAB on 110 patients for suspected GCA. A variety of specialties referred patients to ophthalmology for TAB; presenting symptoms varied with referral source. Of the 110 TABs, 21 (19%) were reported as positive for GCA, 84 (76%) were negative, and 5 (4.5%) were reported as inadequate. The symptoms most commonly associated with a positive TAB were visual disturbance (15/21) and headache (15/21).The odds ratios for having a positive TAB result rather than a negative result were 1.0 for the presence of headache, 4.1 for visual disturbance, and 6.7 for jaw claudication. Interpretation: Physicians were faced with a different population of GCA suspects than ophthalmologists. While physicians should be alert to the significance of visual symptoms or jaw claudication, ophthalmologists should be ready to facilitate prompt TABs when appropriate. TAB should be performed promptly and an adequate length of artery taken for biopsy. An argument can be made that TAB is not needed in cases of suspected GCA. However, a positive result provides firm justification for the use of steroids. We feel that TAB has a useful role and we make reference to methods to maximize its usefulness.

Victimhood and Attitudes towards Dealing with the Legacy of the Past: Northern Ireland as a Case Study

Research Highlights and Abstract: Using Northern Ireland as a case study, this article provides the first nationally representative and systematic study of victims' views on how to deal with the past; Focusing specifically on Northern Ireland, it both investigates and provides a comprehensive account of the marked divisions between the various religious groupings-Protestants, Catholics and the non-affiliated-in terms of a range of truth recovery mechanisms to deal with legacy of its violent past; It empirically investigates and validates two key predictors-perceptions of victimhood and general attitudes towards the past-in determining the source of these divisions It outlines the implications of our findings for other societies emerging from conflict. Truth recovery mechanisms have become a cornerstone of peacebuilding efforts in societies emerging from conflict. Yet, to date, the view of victims in post-conflict societies concerning such arrangements remains highly anecdotal and often second-hand in nature. Mindful of this omission and using Northern Ireland as a case study, this article investigates the views of victims towards a range of mechanisms to deal with the legacy of Northern Ireland's violent past. Based on the 2011 Northern Ireland Social and Political Attitudes Survey, the results suggest some marked divisions in relation to this issue, with victims within the Catholic community being significantly more supportive of such initiatives than either Protestants or those with no religion. Moreover, while perceptions of victimhood emerge as the key predictor of attitudes among Protestants and the non-affiliated, general opinions on how to deal with the past are the key determinant of views among members of the Catholic community

Delivering Social Work Education on Case Reviews and Inquiry Reports: An Exploratory Study of Students' Perspectives in Northern Ireland

It is self-evident that we live in the age of inquiry where the negative impact of risk has been examined through numerous formal processes. In the wake of such scrutiny, there have been repeated recommendations for better training of the professionals charged with safeguarding the welfare of vulnerable individuals. Yet there has been very little examination of how student social workers, in particular, evaluate this training. This exploratory study responded to this gap through a mixed-methods design centring on the views of qualifying and post-qualifying social work students attending courses within two regional universities in Northern Ireland. The study found that, in the main, the cohorts responded favourably to certain aspects of the curriculum and how they were delivered. That said, the emotive nature of the case review and inquiry reports was inadequately addressed in the classroom and was not processed afterwards through a psycho-social framework. In effect, students were often left with residual anxieties that potentially hampered learning. On the basis of the findings, the study calls for further research into this highly significant area of professional competence.

Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast

It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs.

Mother's Narratives of Trauma: An exploratory study of how mothers' narrate the impact of trauma on their families

This study explored the narratives of 10 mothers whose families had been impacted by potentially traumatising events. The study was set in the context of Post-Traumatic Stress Disorder (PTSD), a relatively narrow psychiatric construct, which currently dominates much professional discourse and practice in traumatology, but references literature that provides a theoretical rationale for a broader approach. Narrative Interviewing methodology was employed and mothers of families referred to a specialist clinical service were interviewed prior to professional therapeutic intervention. The 10 mothers' narratives were analysed thematically via a rigorous process involving two independent analysts and the data organised into an evolving theoretical framework of themes and supra-themes. As hypothesised, PTSD symptomatology constituted a small proportion of the mothers' narratives (6.2%). The major components of the narratives included family and relational distress (35.7%), non-pathological individual distress (24.4%), resilience (16.7%) and a prior history of adversity (16.6%). Although exploratory in nature, the results of this study are sufficiently strong to warrant further investigation and raise tentative questions regarding the appropriateness of many existing therapeutic services for people impacted by trauma.

Gender, gender roles and completion of nursing education:a longitudinal study

The current worldwide nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. The aim of this paper was to investigate how key psychological attributes and constructions differentiate between completers and non-completers of nursing education. A questionnaire including measures of gender role identity and perceived gender appropriateness of careers was administered to 384 students early in the first year of the course. At the end of the programme attrition rates were obtained. The findings indicate that males were more likely to leave the course than females. Furthermore, those who completed the course tended to view nursing as more appropriate for women, in contrast to the non-completers who had less gender typed views. The female-dominated nature of nursing, prevalent stereotypes and gender bias inherent in nursing education seem to make this an uncomfortable place for males and those with less gendered typed views. Whilst it is acknowledged that attrition is undoubtedly a complex issue with many contributing factors, the nursing profession need to take steps to address this bias to ensure their profession is open equally to both female and male recruits.

The Nature of Religious Diversity: A Cultural Ecosystem Approach

Studies of religious and other cultural groups tend to be particularistic or focus on one or more axes of variation. In this article we develop a more comprehensive approach to studying cultural diversity that emulates the study of biological diversity. We compare our cultural ecosystem approach with the axis approach, using the distinction between “tight” and “loose” cultures as an example. We show that while the axis approach is useful, the cultural ecosystem approach adds considerable value to the axis approach. We end by advocating the establishment of field sites for the study of religious and cultural diversity, comparable to biological field sites.