Lifelong learning:Reflections of a junior doctor

Purpose - The aim of this paper is investigate the importance of lifelong learning in the area of medicine. Design/methodology/approach - The paper examines changes in methods of learning and challenges to educators today. Findings - The paper finds that today there is a pressure for the formalized accounting of education with a few high profile cases of negligent medical care which have perhaps created the belief that recording learning for all may catch errant doctors in the future. It is suggested that learning risks becoming an exercise in meeting demands, but inspiring the desire to learn is also crucial. Originality/value - The paper provides a useful opinion on lifelong learning for the medical profession. © Emerald Group Publishing Limited.

Uniformity and diversity in religious education in Northern Ireland

This paper considers the tension that can exist in the aims of religious education between the desire to encourage open-minded, critical thinking through exposure to diverse traditions, ideas and cultures and the encouragement, overt or otherwise, into uniformity whereby learners take on the values of a particular tradition, culture or ideology (say of a religion, family or school). The particular situation of teaching religious education to post-primary school pupils in Northern Ireland is considered, and evidence cited to suggest that the Northern Ireland Core Syllabus in Religious Education has tried to impose a particular non-denominational Christian uniformity on pupils and teachers through its use of religious language. This has contributed to a culture of 'avoidance' in relation to the teaching of broad Christian diversity. The article concludes that there is a need for an ongoing and meaningful dialogue to discover what kind of balance between uniformity and diversity is best in teaching religious education in Northern Ireland, and notes that this also requires the reassessment of fundamental issues such as the aims of education and the relationship between secular and religious values in publicly funded schools. © 2004 Christian Education.

Clarifying the acquis humanitaire: a transnational legal perspective on the internalization of humanitarian norms

Although the international obligations and institutional frameworks for disaster response are not yet settled, as evidenced by the International Law Commission’s work on the protection of persons in the event of disasters and the on-going promotion of disaster laws by the Red Cross Movement; the diverse source and nature of such initiatives suggests that the international community is engaged in a process of norm creation, elaboration and interpretation reflecting a desire for legal clarity in humanitarian operations. Situated within the framework of transnational law, this paper argues that an acquis humanitaire, based on the principle of humanity, encapsulates the evolving body of law and practice specifically relating to the protection of persons in times of humanitarian crisis in both armed conflicts and natural or human-made disasters. Reflecting the non-traditional, non-statist, dynamic and normative basis of transnational legal process, as elaborated by Harold Koh, the constant flow of ideas and principles between the national, regional and international spheres provides an analytical framework for the on-going transnational dialogues on the social, political and legal internalization of humanitarian norms. Drawing on the internalization of humanitarian norms within the United Kingdom, this paper concludes that as the international community examines the codification of a universal legal framework for the protection of persons in the event of disasters it is necessary to understand the transnational process of interpretation and internalization of humanitarian norms, and how this may vary across different regions and countries.

Shared decision making in patients at risk of cancer: The role of domain and numeracy

Background
Shared decision making has become an integral part of medical consultation. Research has, however, reported wide differences in individuals' desires to be involved in the decision-making process, and these differences in preferences are likely to be the result of a number of factors including age, education and numeracy.

Objective
To investigate whether patients at genetic risk for cancer had preferences for shared decision making that differed depending on medical domain (general health vs. cancer) and whether decision preferences are linked to numeracy abilities.

Methods
Four hundred and seventy-six women who consented to participate in response to an email sent by a local branch of the U.S.-based Cancer Genetics Network (CGN) to its members. Participants completed the Control Preference Scale, as well as an objective and subjective numeracy scales.

Results
Decision domain (cancer vs. general health) was not associated with women's preferences for involvement in decision making. Objective and subjective numeracy predicted a preference for decision involvement in general, and only objective numeracy was predictive with regard to cancer.

Conclusion
Participants were equally likely to state they wanted to play an active, collaborative or passive role in both medical domains (general and cancer). High-numeracy participants were more likely to express a desire for an active role in general and in case they were diagnosed with cancer.

Practice implications
Health authorities' recommendations to clinicians to include patients in their medical decisions are supported by patients' desires, and clinicians should be cognizant of their patients' preferences as well as their numeracy skills.

Silk-inspired polymers and proteins

The biocompatibility and biodegradability of natural silk fibres and the benign conditions under which they (with impressive mechanical properties) are produced represent a biomimetic ideal. This ideal has inspired people in both academia and industry to prepare silk-mimetic polymers and proteins by chemical and/or biotechnological means. in the present paper, we aim to give an overview of the design principles of such silk-inspired polymers/proteins, their processing into various materials morphologies, their mechanical and biological properties, and, finally, their technical and biomedical applications.

Changing the intellectual climate

Calls for more broad-based, integrated, useful knowledge now abound in the world of global environmental change science. They evidence many scientists' desire to help humanity confront the momentous biophysical implications of its own actions. But they also reveal a limited conception of social science and virtually ignore the humanities. They thereby endorse a stunted conception of 'human dimensions' at a time when the challenges posed by global environmental change are increasing in magnitude, scale and scope. Here, we make the case for a richer conception predicated on broader intellectual engagement and identify some preconditions for its practical fulfilment. Interdisciplinary dialogue, we suggest, should engender plural representations of Earth's present and future that are reflective of divergent human values and aspirations. In turn, this might insure publics and decision-makers against overly narrow conceptions of what is possible and desirable as they consider the profound questions raised by global environmental change.

AgentSpeak+: AgentSpeak with Probabilistic Planning

AgentSpeak is a logic-based programming language, based on the Belief-Desire-Intention (BDI) paradigm, suitable for building complex agent-based systems. To limit the computational complexity, agents in AgentSpeak rely on a plan library to reduce the planning problem to the much simpler problem of plan selection. However, such a plan library is often inadequate when an agent is situated in an uncertain environment. In this paper, we propose the AgentSpeak+ framework, which extends AgentSpeak with a mechanism for probabilistic planning. The beliefs of an AgentSpeak+ agent are represented using epistemic states to allow an agent to reason about its uncertain observations and the uncertain effects of its actions. Each epistemic state consists of a POMDP, used to encode the agent’s knowledge of the environment, and its associated probability distribution (or belief state). In addition, the POMDP is used to select the optimal actions for achieving a given goal, even when facing uncertainty.

At Home in Care: Children living with birth parents on a Care Order

This study explored the processes, background information, and perceived reasons why children and young people returned home while remaining in care, in the five HSC Trusts in Northern Ireland. The research also focused on understanding the functions the Care Order had for social services, the birth parents, and young people involved.
It was found that on 31st March 2009, there were 193 children/young people living with their birth parents on a Care Order in Northern Ireland. This is eight per cent of the total population of Looked After children, and is lower than had been anticipated from governmental statistics. In total, the case files of 47 of these young people (24% of them) were reviewed, and interviews were conducted with ten of them and their birth parent/s.
The analysis revealed that the majority of them had in common a parental background history of alcohol abuse and domestic violence, and most return breakdowns in the study were related to continuing parental alcohol and/or drugs misuse. While some children had a planned return home after parents had engaged in supports and completed assessments, many young people had returns that were not planned, as they initiated the move themselves, or previous foster placements had broken down and there were no alternative placements identified for them. Many of these young people essentially ‘voted with their feet’, and social services were required to ensure that they remained safe in often less than optimal circumstances.
After returning home, for many, Care Orders remained for initially unintended lengthy periods because of the risks posed by parents’ intermittent alcohol abuse and their lifestyle, contact issues, and parents’ desire to ensure that their children were able to access the supports that they needed. Thus, Care Orders at home tended to serve two main functions: to either monitor and/or support the placement.

Nanoencapsulation of ABT-737 and camptothecin enhances their clinical potential through synergistic antitumor effects and reduction of systemic toxicity

The simultaneous delivery of multiple cancer drugs in combination therapies to achieve optimal therapeutic effects in patients can be challenging. This study investigated whether co-encapsulation of the BH3-mimetic ABT-737 and the topoisomerase I inhibitor camptothecin (CPT) in PEGylated polymeric nanoparticles (NPs) was a viable strategy for overcoming their clinical limitations and to deliver both compounds at optimal ratios. We found that thrombocytopenia induced by exposure to ABT-737 was diminished through its encapsulation in NPs. Similarly, CPT-associated leukopenia and gastrointestinal toxicity were reduced compared with the administration of free CPT. In addition to the reduction of dose-limiting side effects, the co-encapsulation of both anticancer compounds in a single NP produced synergistic induction of apoptosis in both in vitro and in vivo colorectal cancer models. This strategy may widen the therapeutic window of these and other drugs and may enhance the clinical efficacy of synergistic drug combinations.

Integrating elements of undergraduate curriculum learning

Integrating elements of undergraduate curriculum learning Rapidly advancing practice and recognition of nursing, midwifery and medicine as a vital interrelated workforce, implies a need for a variety of curricula opportunities. This project addresses the challenge for healthcare educators to widen student engagement and participation through inter-professional education by creating learning environments whereby student interactions foster the desire to develop situational awareness, independent learning and contribution to patient advocacy. Overall aim of this ‘Feeding and Nutrition in Infants and Children’ project is to provide opportunities for integrated learning to enable students to advance their knowledge and understanding of current best practice. This Inter-professional (IPE) student-lead workshop was initially implemented in 2006-07 in collaboration with the Centre for Excellence in IPE, within the curricula of medical and nursing programmes¹. Supported by the development of a student resource pack, this project is now being offered to Learning Disability nursing and Midwifery students since September 2014. Methods: Fourth year medical students, undertaking a ‘Child Healthcare module’, alongside nursing and /or midwifery students are divided into groups with three or four students from each profession. Each group focuses on a specific feeding problem that is scenario-based on a common real-life issue prior to the workshop and then present their findings / possible solutions to feeding problem. They are observed by both facilitators and peers, who provide constructive feedback on aspects of performance including patient safety, cultural awareness, communication, decision making skills, teamwork and an appreciation of the role of various professionals in managing feeding problems in infants and children. Results: Participants complete a Likert-scale questionnaire to ascertain their reactions to this integrated learning experience. Ongoing findings suggest that students evaluate this learning activity very positively and have stated that they value the opportunity to exercise their clinical judgement and decision making skills. Most recent comments: ‘appreciate working alongside other student’s / multidisciplinary team approach’ As a group students engage in this team problem-solving exercise, drawing upon their strengths and abilities to learn from each other. This project provides a crucial opportunity for learning and knowledge exchange for all those medical, midwifery and nursing students involved. Reference: 1. Purdy, J. & Stewart, M (2009) ‘Feeding and Nutrition in Infants and Children: An Interprofessional Approach’. The Clinical Teacher, vol 6, no.3. Authors: Dr. Angela Bell, Centre for Medical Education, Queen’s University Belfast. Doris Corkin, Senior Lecturer (education), Children’s Nursing, School of Nursing & Midwifery, Queen’s University Belfast. Carolyn Moorhead, Midwifery Lecturer, School of Nursing & Midwifery, Queen’s University Belfast. Ann Devlin, Lecturer (education), Learning Disability Nursing, School of Nursing & Midwifery, Queen’s University Belfast.

Imaging intracellular and systemic in vivo gold nanoparticles to enhance radiotherapy

Nanoparticles offer alternative options in cancer therapy both as drug delivery carriers and as direct therapeutic agents for cancer cell inactivation. More recently, gold nanoparticles (AuNPs) have emerged as promising radiosensitizers achieving significantly elevated radiation dose enhancement factors when irradiated with both kilo-electron-volt and mega-electronvolt X-rays. Use of AuNPs in radiobiology is now being intensely driven by the desire to achieve precise energy deposition in tumours. As a consequence, there is a growing demand for efficient and simple techniques for detection, imaging and characterization of AuNPs in both biological and tumour samples. Spatially accurate imaging on the nanoscale poses a serious challenge requiring high- or super-resolution imaging techniques. In this mini review, we discuss the challenges in using AuNPs as radiosensitizers as well as various current and novel imaging techniques designed to validate the uptake, distribution and localization in mammalian cells. In our own work, we have used multiphoton excited plasmon resonance imaging to map the AuNP intracellular distribution. The benefits and limitations of this approach will also be discussed in some detail. In some cases, the same "excitation" mechanism as is used in an imaging modality can be harnessed tomake it also a part of therapymodality (e.g. phototherapy)-such examples are discussed in passing as extensions to the imaging modality concerned.

Infra-Éireann: Making Ireland Modern - Irish Pavilion for the 14th Architectural biennale, Venice 2014.

After an open competition, we were selected to commission, curate and design the Irish pavilion for the Venice biennale 2014. Our proposal engage with the role of infrastructure and architecture in the cultural development of the new Irish state 1914-2014. This curatorial programme was realised in a demountable, open matrix pavilion measuring 12 x 5 x 6 metres.

How modernity is absorbed into national cultures usually presupposes an attachment to previous conditions and a desire to reconcile the two. In an Irish context, due to the processes of de-colonisation and political independence, this relationship is more complicated.

In 1914, Ireland was largely agricultural and lacked any significant industrial complex. The construction of new infrastructures after independence in 1921 became central to the cultural imagining of the new nation. The adoption of modernist architecture was perceived as a way to escape the colonial past. As the desire to reconcile cultural and technological aims developed, these infrastructures became both the physical manifestation and concrete identity of the new nation with architecture an essential element in this construct.

Technology and infrastructure are inherently cosmopolitan. Beginning with the Shannon hydro-electric facility at Ardnacrusha (1929) involving the German firm of Siemens-Schuckert, Ireland became a point of various intersections between imported international expertise and local need. By the turn of the last century, it had become one of the most globalised countries in the world, site of the European headquarters of multinationals such as Google and Microsoft. Climatically and economically expedient to the storing and harvesting of data, Ireland has subsequently become an important repository of digital information farmed in large, single-storey sheds absorbed into dispersed suburbs. In 2013, it became the preferred site for Intel to design and develop its new microprocessor board, the Galileo, a building block for the internet of things.

The story of the decades in between, of shifts made manifest in architecture and infrastructure, from the policies of economic protectionism to the embracing of the EU is one of the influx of technologies and cultural references into a small country on the edges of Europe: Ireland as both a launch-pad and testing ground for a series of aspects of designed modernity.

Exendin-4 protects against post-myocardial infarction remodelling via specific actions on inflammation and the extracellular matrix

Glucagon-like peptide-1 (GLP-1) is an insulin-releasing hormone clinically exploited for glycaemic control in diabetes, which also confers acute cardioprotection and benefits in experimental/clinical heart failure. We specifically investigated the role of the GLP-1 mimetic, exendin-4, in post-myocardial infarction (MI) remodelling, which is a key contributor to heart failure. Adult female normoglycaemic mice underwent coronary artery ligation/sham surgery prior to infusion with exendin-4/vehicle for 4 weeks. Metabolic parameters and infarct sizes were comparable between groups. Exendin-4 protected against cardiac dysfunction and chamber dilatation post-MI and improved survival. Furthermore, exendin-4 modestly decreased cardiomyocyte hypertrophy/apoptosis but markedly attenuated interstitial fibrosis and myocardial inflammation post-MI. This was associated with altered extracellular matrix (procollagen IαI/IIIαI, connective tissue growth factor, fibronectin, TGF-β3) and inflammatory (IL-10, IL-1β, IL-6) gene expression in exendin-4-treated mice, together with modulation of both Akt/GSK-3β and Smad2/3 signalling. Exendin-4 also altered macrophage response gene expression in the absence of direct actions on cardiac fibroblast differentiation, suggesting cardioprotective effects occurring secondary to modulation of inflammation. Our findings indicate that exendin-4 protects against post-MI remodelling via preferential actions on inflammation and the extracellular matrix independently of its established actions on glycaemic control, thereby suggesting that selective targeting of GLP-1 signalling may be required to realise its clear therapeutic potential for post-MI heart failure.

Incorporating PGMs into a BDI Architecture

In this paper, we present a hybrid BDI-PGM framework, in which PGMs (Probabilistic Graphical Models) are incorporated into a BDI (belief-desire-intention) architecture. This work is motivated by the need to address the scalability and noisy sensing issues in SCADA (Supervisory Control And Data Acquisition) systems. Our approach uses the incorporated PGMs to model the uncertainty reasoning and decision making processes of agents situated in a stochastic environment. In particular, we use Bayesian networks to reason about an agent’s beliefs about the environment based on its sensory observations, and select optimal plans according to the utilities of actions defined in influence diagrams. This approach takes the advantage of the scalability of the BDI architecture and the uncertainty reasoning capability of PGMs. We present a prototype of the proposed approach using a transit scenario to validate its effectiveness.

Chase over the Nile: The Social Evolution of Riverine Landscape in Urban Egypt

Throughout its history, Cairo evolved as a regional metropolis that sprawls along the banks of the Nile accumulating narratives of evolving social landscape. Overlooking the Nile reflected a privileged social position and place for the urban elite. In spatial terms, the urban bourgeoisie tend to develop living havens in enclaves that are distant from the populace’s everyday life. Ironically, exclusive settlements only attract urban growth further in their direction. This chapter offers an analytical reading of the socio-spatial structure of Cairo following the emergence and decline of a series bourgeoisie quarters along the shores of the Nile. It reports urban narratives based on archival records, documents and investigation of historical texts and travelers’ accounts. This essay argues that cities are essentially social constructs in which hierarchy and connectivity are fundamental aspects of its economic and spatial logic. Through social ambition and desire for upgrade, middle class infiltrate into bourgeoisie havens and sometimes encircle it, seeking better living condition inscribed by social mobility and connectivity to centres of wealth and power. Being both natural barrier and cohesive spine, the Nile helped Cairo to develop successive nucleuses of highly crafted urban experiences that have left their imprints on the contemporary urban scene.