The molecular basis of galactosemia - Past, present and future

Galactosemia, an inborn error of galactose metabolism, was first described in the 1900s by von Ruess. The subsequent 100years has seen considerable progress in understanding the underlying genetics and biochemistry of this condition. Initial studies concentrated on increasing the understanding of the clinical manifestations of the disease. However, Leloir's discovery of the pathway of galactose catabolism in the 1940s and 1950s enabled other scientists, notably Kalckar, to link the disease to a specific enzymatic step in the pathway. Kalckar's work established that defects in galactose 1-phosphate uridylyltransferase (GALT) were responsible for the majority of cases of galactosemia. However, over the next three decades it became clear that there were two other forms of galactosemia: type II resulting from deficiencies in galactokinase (GALK1) and type III where the affected enzyme is UDP-galactose 4'-epimerase (GALE). From the 1970s, molecular biology approaches were applied to galactosemia. The chromosomal locations and DNA sequences of the three genes were determined. These studies enabled modern biochemical studies. Structures of the proteins have been determined and biochemical studies have shown that enzymatic impairment often results from misfolding and consequent protein instability. Cellular and model organism studies have demonstrated that reduced GALT or GALE activity results in increased oxidative stress. Thus, after a century of progress, it is possible to conceive of improved therapies including drugs to manipulate the pathway to reduce potentially toxic intermediates, antioxidants to reduce the oxidative stress of cells or use of "pharmacological chaperones" to stabilise the affected proteins.

Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis

BACKGROUND: Seasonal/perennial allergic conjunctivitis is the most common allergic conjunctivitis, usually with acute manifestations when a person is exposed to allergens and with typical signs and symptoms including itching, redness, and tearing. The clinical signs and symptoms of allergic conjunctivitis are mediated by the release of histamine by mast cells. Histamine antagonists (also called antihistamines) inhibit the action of histamine by blocking histamine H1 receptors, antagonising the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine. Mast cell stabilisers inhibit degranulation and consequently the release of histamine by interrupting the normal chain of intracellular signals. Topical treatments include eye drops with antihistamines, mast cell stabilisers, non-steroidal anti-inflammatory drugs, combinations of the previous treatments, and corticosteroids. Standard treatment is based on topical antihistamines alone or topical mast cell stabilisers alone or a combination of treatments. There is clinical uncertainty about the relative efficacy and safety of topical treatment.

OBJECTIVES: The objective of this review was to assess the effects of topical antihistamines and mast cell stabilisers, alone or in combination, for use in treating seasonal and perennial allergic conjunctivitis.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2014, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 July 2014. We also searched the reference lists of review articles and relevant trial reports for details of further relevant publications.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing topical antihistamine and mast cell stabilisers, alone or in combination, with placebo, no treatment or to any other antihistamine or mast cell stabiliser, or both, that examined people with seasonal or perennial allergic conjunctivitis, or both. The primary outcome was any participant-reported evaluation (by questionnaire) of severity of four main ocular symptoms: itching, irritation, watering eye (tearing), and photophobia (dislike of light), both separately and, if possible, by an overall symptom score. We considered any follow-up time between one week and one year.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Disagreements were resolved by discussion among review authors and the involvement of a third review author. We followed standard methodological approaches used by Cochrane.

MAIN RESULTS: We identified 30 trials with a total of 4344 participants randomised, with 17 different drugs or treatment comparisons. The following antihistamines and mast cell stabilisers were evaluated in at least one RCT: nedocromil sodium or sodium cromoglycate, olopatadine, ketotifen, azelastine, emedastine, levocabastine (or levocabastine), mequitazine, bepotastine besilate, combination of antazoline and tetryzoline, combination of levocabastine and pemirolast potassium. The most common comparison was azelastine versus placebo (nine studies).We observed a large variability in reporting outcomes. The quality of the studies and reporting was variable, but overall the risk of bias was low. Trials evaluated only short-term effects, with a range of treatment of one to eight weeks. Meta-analysis was only possible in one comparison (olopatadine versus ketotifen). There was some evidence to support that topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo. There were no reported serious adverse events related to the use of topical antihistamine and mast cell stabilisers treatment.

AUTHORS' CONCLUSIONS: It seems that all reported topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo in the short term. However, there is no long-term data on their efficacy. Direct comparisons of different antihistamines and mast cell stabilisers need to be interpreted with caution. Overall, topical antihistamines and mast cell stabilisers appear to be safe and well tolerated. We observed a large variability in outcomes reported. Poor quality of reporting challenged the synthesis of evidence.

Mental illness or mental distress; stigma and concealment in University students - a discussion paper

This discussion paper addresses the issue of mental distress, sometimes mis- perceived or misinterpreted as mental illness. The
focus is on positive psychology. Reflecting in part on a UK-based study with younger University students studying to health
related degrees, nursing, midwifery and medicine (N = 12), many of the students were apparently suffering dis-stress with
disordered eating at least in part being used as a coping mechanism. However notwithstanding that they were at the end of
their first year studies in health, a significant number of the students interpreted their approach to eating as a mental illness.
Consequently, many within the study felt stigmatised and were reluctant to acknowledge certainly to the University health care
authorities that there was an issue; perceiving both academic and career/professional consequences of mental health labelling. The
paper approaches the issue of mental health from a health promoting perspective, reflecting against the theory of salutogenesis
and its focus within the three dimensions of comprehensibility, manageability and meaningfulness as an approach to building
resilience and managing stressors to better facilitate a sense of coherence. Complex manifestations of distress and poor coping
mechanisms can in some cases be misinterpreted or miss perceived as mental illness. Promoting mental health and reducing the
stigma of mental illness or the misperception of mental distress as mental illness, would need to be addressed in order to more
effectively outreach certainly to younger University students who might be at risk. The focus should be on how better to promote
their sense of coherence.

Parasite neuropeptide biology:Seeding rational drug target selection?

The rationale for identifying drug targets within helminth neuromuscular signalling systems is based on the premise that adequate nerve and muscle function is essential for many of the key behavioural determinants of helminth parasitism, including sensory perception/host location, invasion, locomotion/orientation, attachment, feeding and reproduction. This premise is validated by the tendency of current anthelmintics to act on classical neurotransmitter-gated ion channels present on helminth nerve and/or muscle, yielding therapeutic endpoints associated with paralysis and/or death. Supplementary to classical neurotransmitters, helminth nervous systems are peptide-rich and encompass associated biosynthetic and signal transduction components - putative drug targets that remain to be exploited by anthelmintic chemotherapy. At this time, no neuropeptide system-targeting lead compounds have been reported, and given that our basic knowledge of neuropeptide biology in parasitic helminths remains inadequate, the short-term prospects for such drugs remain poor. Here, we review current knowledge of neuropeptide signalling in Nematoda and Platyhelminthes, and highlight a suite of 19 protein families that yield deleterious phenotypes in helminth reverse genetics screens. We suggest that orthologues of some of these peptidergic signalling components represent appealing therapeutic targets in parasitic helminths.

Bearing Witness to the 'Pain of Others': Researching Power, Violence and Resistance in a Women's Prison

Addressing the dynamics of interpersonal violence, institutionalised abuses and prisoner isolation, this article consolidates critical analyses as challenges to the essentially liberal constructions and interpretations of prisoner agency and penal reformism. Grounded in long-term research with women in prison in the North of Ireland, it connects embedded, punitive responses that undermine women prisoners’ self-esteem and mental health to the brutalising manifestations of formal and informal punishments, including lockdowns and isolation. It argues that critical social research into penal policy and prison regimes has a moral duty, an ethical obligation and a political responsibility to investigate abuses of power, seek out the ‘view from below’. Challenging the revisionism implicit within the ‘healthy prison’ discourse, it argues for alternatives to prison as the foundation of decarceration and abolition.

Solar coronal magnetic fields derived using seismology techniques applied to omnipresent sunspot waves

Sunspots on the surface of the Sun are the observational signatures of intense manifestations of tightly packed magnetic field lines, with near-vertical field strengths exceeding 6,000 G in extreme cases1. It is well accepted that both the plasma density and the magnitude of the magnetic field strength decrease rapidly away from the solar surface, making high-cadence coronal measurements through traditional Zeeman and Hanle effects difficult as the observational signatures are fraught with low-amplitude signals that can become swamped with instrumental noise2, 3. Magneto-hydrodynamic (MHD) techniques have previously been applied to coronal structures, with single and spatially isolated magnetic field strengths estimated as 9–55 G (refs 4,5,6,7). A drawback with previous MHD approaches is that they rely on particular wave modes alongside the detectability of harmonic overtones. Here we show, for the first time, how omnipresent magneto-acoustic waves, originating from within the underlying sunspot and propagating radially outwards, allow the spatial variation of the local coronal magnetic field to be mapped with high precision. We find coronal magnetic field strengths of 32 ± 5 G above the sunspot, which decrease rapidly to values of approximately 1 G over a lateral distance of 7,000 km, consistent with previous isolated and unresolved estimations. Our results demonstrate a new, powerful technique that harnesses the omnipresent nature of sunspot oscillations to provide magnetic field mapping capabilities close to a magnetic source in the solar corona.

Of no fixed form: The Irish Pavilion at Venice 2014 and beyond

This paper explores the theme of exhibiting architectural research through a particular example, the development of the Irish pavilion for the 14th architectural biennale, Venice 2014. Responding to Rem Koolhaas’s call to investigate the international absorption of modernity, the Irish pavilion became a research project that engaged with the development of the architectures of infrastructure in Ireland in the twentieth and twenty-first centuries. Central to this proposition was that infrastructure is simultaneously a technological and cultural construct, one that for Ireland occupied a critical position in the building of a new, independent post-colonial nation state, after 1921.

Presupposing infrastructure as consisting of both visible and invisible networks, the idea of a matrix become a central conceptual and visual tool in the curatorial and design process for the exhibition and pavilion. To begin with this was a two-dimensional grid used to identify and order what became described as a series of ten ‘infrastructural episodes’. These were determined chronologically across the decades between 1914 and 2014 and their spatial manifestations articulated in terms of scale: micro, meso and macro. At this point ten academics were approached as researchers. Their purpose was twofold, to establish the broader narratives around which the infrastructures developed and to scrutinise relevant archives for compelling visual material. Defining the meso scale as that of the building, the media unearthed was further filtered and edited according to a range of categories – filmic/image, territory, building detail, and model – which sought to communicate the relationship between the pieces of architecture and the larger systems to which they connect. New drawings realised by the design team further iterated these relationships, filling in gaps in the narrative by providing composite, strategic or detailed drawings.

Conceived as an open-ended and extendable matrix, the pavilion was influenced by a series of academic writings, curatorial practices, artworks and other installations including: Frederick Kiesler’s City of Space (1925), Eduardo Persico and Marcello Nizzoli’s Medaglio d’Oro room (1934), Sol Le Witt’s Incomplete Open Cubes (1974) and Rosalind Krauss’s seminal text ‘Grids’ (1979). A modular frame whose structural bays would each hold and present an ‘episode’, the pavilion became both a visual analogue of the unseen networks embodying infrastructural systems and a reflection on the predominance of framed structures within the buildings exhibited. Sharing the aspiration of adaptability of many of these schemes, its white-painted timber components are connected by easily-dismantled steel fixings. These and its modularity allow the structure to be both taken down and re-erected subsequently in different iterations. The pavilion itself is, therefore, imagined as essentially provisional and – as with infrastructure – as having no fixed form. Presenting archives and other material over time, the transparent nature of the space allowed these to overlap visually conveying the nested nature of infrastructural production. Pursuing a means to evoke the qualities of infrastructural space while conveying a historical narrative, the exhibition’s termination in the present is designed to provoke in the visitor, a perceptual extension of the matrix to engage with the future.

Antifungal Activity of Peptides From the African Volcano Frog

Background: Candidal species, particularly Candida albicans are common pathogens in the oral cavity and perioral region. Many of the manifestations of candidiasis are associated with the formation of Candida biofilms on host surfaces and/or implanted biomaterials. Biofilms are clinically important due to their increased resistance to therapeutic intervention and the ability of cells within the biofilm to withstand host immune defences.
Objectives: The present study was designed to investigate the antifungal activity of two peptides found in skin secretions of the African volcano frog (Xenopus amieti) against the type strain of C. albicans NCTC 3179.
Methods: The antifungal activity of magainin-AM1 and peptide glycine-leucine-amide (PGLa-AM1) against C. albicans NCTC 3179 was studied in both planktonic and biofilm forms. Radial diffusion assays were used to obtain the minimum inhibitory concentration (MIC) of magainin-AM1 and PGLa-AM1 against planktonic C. albicans. Time kill assays were used to determine the time dependent fungicidal action of the peptides at both 4oC and 37oC. A 96 well microtitre plate model for candidal biofilm formation was employed to study the ability of the peptides to disrupt the early biofilm development (up to 24 hours) compared with the antifungal drug fluconazole. Biofilm formation was determined quantitatively using the crystal violet assay.
Results: Both magainin-AM1 and PGLa-AM1 demonstrated inhibitory activity against Candida albicans, with MIC values of 24.3 uM and 7.5uM respectively. Time-kill assays revealed bactericidal activity of both peptides at 37oC and 4oC. Magainin-AM1 and PGLa-AM1 inhibited biofilm formation in microtitre plate assays. The peptides were particularly effective during early biofilm establishment when compared with fluconazole treatment.
Conclusions: Magainin-AM1 and PGLa-AM1 are active against C albicans in both planktonic and biofilm forms. Further testing of this peptide family against candidal biofilms is recommended.

Residential segregation, dividing walls and mental health: A population-based record linkage study

Background
Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. Whilst most previous research has relied on conceptualized measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or “peacelines”) which can be used to accurately identify residential segregation.
Methods
We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health.
Results
Using multi-level logistic regression models we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a “peaceline” increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI: 1.14, 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI: 1.32, 1.48), even after adjustment for gender, age, conurbation, deprivation and crime.
Conclusions
Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures Acute respiratory distress syndrome.

Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided. Mortality remains at approximately 30%.

The Promise of Peace:Revisiting the Northern Irish Model

The Northern Ireland peace process is often eulogized as a successful model of conflict transformation. Although the process exhibited many of the problems that beset other societies seeking to move from conflict to a negotiated peace (including disagreements over the functioning of institutions and the meanings of cultural symbols, unresolved issues relating to the effects of political violence on victims and survivors and society at large; and the residual presence of violent and political ‘spoiler’ groups), the resilience of political dialogue has proven remarkable.
This collection revisits the promise of ‘a truly historic opportunity for a new beginning’ a decade and a half on from the signing of the Belfast/Good Friday Agreement in 1998. The book will bring together academics from across a number of disciplines, including management and organizational behaviour, law, politics, sociology, archaeology and literature.

The different contributions aim to assess what impact it has made in the legal, policy, and institutional areas it specifically targeted: political reform, human rights and equality provision, working through legacies of the past (including police reform, prisoner release and victims' rights) and the building of new relationships within the island of Ireland and between Ireland and Britain. With the emergence of first-time voters who had no direct experience of the violence the book explores what the Agreement offers for future generations.

The book is the culmination of a 12-month research project sponsored by the British Academy and Leverhulme that addressed the following aspects of the peace process:
Peace walls: The euphemistically named peace walls remain one of the most visible reminders of Northern Ireland’s divisions and they are famously the only material manifestations of the conflict that have grown in number and extent since the 1998 Agreement. They were originally placed between antagonistic neighbouring communities – often at their request – at times of heightened tensions. Research under this theme explored the lack of ongoing engagement with their continuing presences, evolving meanings and impact on the communities that reside beside them needs to be overtly addressed.
Cultural division: Cultural differences have often been seen as lying at the heart of the ‘Irish problem’. Despite this, art and artists have increasingly been seen as having the potential to develop new discourses. Research explored the following questions: What role can the arts play in re-imagining the spaces opened up by the promises of the 1998 Agreement? What implication does the confrontation with the legacies of conflict have for artistic practices? What impact do the arts have on constructions of identity, on narratives of history, and on electoral politics?
Institutional transformation: This strand of research explored the significance of the process of organizational change which followed the establishment of the 1998 on political and other public policy institutions such as the police and prison services. It suggested that the experience and lessons learned from such periods of transition have much to contribute to how Northern Ireland begins to address political polarization in other areas of public service infrastructure, chiefly around the sectarian monoliths of education and housing.
Working through the past: ‘Legacy’ issues have gained increasing prominence since 1998: issues to do with public symbolism (particularly relating to the flying of flags and parading), defining victimhood, securing victims’ rights, recovery of the ‘disappeared’, reintegrating ex- prisoners back into society, and the possibilities for truth recovery and reconciliation have all acquired salient and emotive force. Although the 1998 Agreement promised to ‘honour the dead’ through a ‘new beginning’, it is increasingly unclear as to whether an agreed narrative about the past is possible – or even worthwhile pursuing. Research under this theme looked at the complex relationship between memory, commemoration and violence; how commemorative events are performed, organized, policed and represented. It also addressed the fraught issue of how to come to terms with Northern Ireland’s divided and bloodied past.

The editors are in the process of guiding contributors to adapt their papers, which were presented to a series of workshops on the above themes, to the purposes of the book. In particular, the contributors will be guided to focus on the related aims of assessing the extent of change that has occurred and providing an assessment of what remains to be done. To that end, contributors are asked to engage directly with the questions that close the ‘Introduction’, namely: To what extent has the ‘promise’ of the 1998 Agreement been fulfilled? To what extent has the 1998 Agreement given rise to forms of exclusion? To what extent has the 1998 Agreement shaped new forms of debate, dispute and engagement? In the absence of that guidance having been sent out yet, the outlines below are, for the time being, the abstracts of their original papers.