A systematic review of population based epidemiological studies in Myasthenia Gravis

Background: The aim was to collate all myasthenia gravis (MG) epidemiological studies including AChR MG and MuSK MG specific studies. To synthesize data on incidence rate (IR), prevalence rate (PR) and mortality rate (MR) of the condition and investigate the influence of environmental and technical factors on any trends or variation observed.

Methods: Studies were identified using multiple sources and meta-analysis performed to calculate pooled estimates for IR, PR and MR.

Results: 55 studies performed between 1950 and 2007 were included, representing 1.7 billion population-years. For All MG estimated pooled IR (eIR): 5.3 per million person-years (C.I.: 4.4, 6.1), range: 1.7 to 21.3; estimated pooled PR: 77.7 per illion persons (C.I.: 64.0, 94.3), range 15 to 179; MR range 0.1 to 0.9 per millions person-years. AChR MG eIR: 7.3 (C.I.: 5.5, 7.8), range: 4.3 to 18.0; MuSK MG IR range: 0.1 to 0.32. However marked variation persisted between populations studied with similar methodology and in similar areas.

Conclusions: We report marked variation in observed frequencies of MG. We show evidence of increasing frequency of MG with year of study and improved study quality. This probably reflects improved case ascertainment. But other factors must also influence disease onset resulting in the observed variation in IR across geographically and genetically similar populations.

Atmospheric Pressure DC Plasma Processing of TIO2/PEDOT:PSS Nanocomposites

In this work we demonstrate the synthesis of a TiO2/PEDOT:PSS nanocomposite material in aqueous solution through atmospheric pressure direct current (DC) plasma processing at room temperature. The dispersion of the TiO2 nanoparticles is enhanced after microplasma processing, and TiO2/polymer hybrid nanoparticles with a distinct core shell structure have been obtained. We have observed increased TiO2/PEDOT:PSS nanocomposite electrical conductivity due to microplasma processing. The improvement in nanocomposite properties is due to the enhanced dispersion and stability in liquid polymer of microplasma treated TiO2 nanoparticles. Both plasma induced surface charge and nanoparticle surface termination with specific plasma chemical species are thought to provide an enhanced barrier to nanoparticle agglomeration and promote nanoparticle-polymer bonding, which is expected to have a significant benefit in materials processing with inorganic nanoparticles for wide range of applications.

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

OBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

DESIGN: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

RESULTS: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

CONCLUSIONS: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

Investigating Intra-individual Dietary Changes and Radiocarbon Ages Using High Resolution δ13C, δ15N Isotope Ratios and 14C Ages Obtained From Dentine Increments

Ten medieval permanent teeth were subjected to incremental dentine sectioning and stable isotope analysis to investigate dietary changes in high resolution. In addition to this, eight increments were also selected for 14C measurements to examine possible intra-individual age differences. Results reveal the cessation of weaning, various dietary profiles and in some cases significantly different 14C ages obtained from a single tooth. This case study illustrates how 14C measurements can function as a proxy alongside the commonly used carbon and nitrogen stable isotope values to interpret the diet of past individuals

People with intellectual disabilities: promoting quality end of life care

Background: Internationally concerns have been highlighted about the quality of palliative care that people with intellectual disability receive. It has also been evidenced that people with intellectual disabilities are seldom referred to hospice and palliative care services. 

Aims: This study aimed to explore the experience of health and social care professionals in providing palliative care to people with intellectual disabilities. 

Methods An exploratory, qualitative design was used. A purposive sample of thirty health and social care professionals, working in intellectual disability and palliative care services, who had provided end-of-life care to adults with intellectual disabilities, were recruited to the study following informed consent. They were asked to reflect on a case scenario of a person with intellectual disability to whom they had provided end of life care. A semi-structured interview technique, with open questions and prompts, was used to explore their experiences and insights. The narrative from the case scenarios were content analysed using a recognised framework. 

Results: Three themes emerged from the data within the case scenarios: Identifying end of life care needs, meeting support needs and empowerment in partnership. Examples of good practice and issues in practice were apparent. 

Conclusion/ Discussion: This study contributes to the developing international evidence base to enhance end of life care for people with intellectual disabilities and provides further insights into this area of practice. Funder: HSC Research and Development Doctoral Fellowship Scheme

2P/Encke, the Taurid complex NEOs and the Maribo and Sutter's Mill meteorites

Aims. 2P/Encke is a short period comet that was discovered in 1786 and has been extensively observed and studied for more than 200years. The Taurid meteoroid stream has long been linked with 2P/Encke owing to a good match of their orbital elements, even thoughthe comet’s activity is not strong enough to explain the number of observed meteors. Various small near-Earth objects (NEOs) havebeen discovered with orbits that can be linked to 2P/Encke and the Taurid meteoroid stream. Maribo and Sutter’s Mill are CM typecarbonaceous chondrite that fell in Denmark on January 17, 2009 and April 22, 2012, respectively. Their pre-atmospheric orbits placethem in the middle of the Taurid meteoroid stream, which raises the intriguing possibility that comet 2P/Encke could be the parentbody of CM chondrites.
Methods. To investigate whether a relationship between comet 2P/Encke, the Taurid complex associated NEOs, and CM chondritesexists, we performed photometric and spectroscopic studies of these objects in the visible wavelength range. We observed 2P/Enckeand 10 NEOs on August 2, 2011 with the FORS instrument at the 8.2 m Very Large Telescope on Cerro Paranal (Chile).
Results. Images in the R filter, used to investigate the possible presence of cometary activity around the nucleus of 2P/Encke andthe NEOs, show that no resolved coma is present. None of the FORS spectra show the 700 nm absorption feature due to hydratedminerals that is seen in the CM chondrite meteorites. All objects show featureless spectra with moderate reddening slopes at λ < 800nm. Apart for 2003 QC10 and 1999 VT25, which show a flatter spectrum, the spectral slope of the observed NEOs is compatible withthat of 2P/Encke. However, most of the NEOs show evidence of a silicate absorption in lower S/N data at λ > 800 nm, which is notseen in 2P/Encke, which suggests that they are not related.
Conclusions. Despite similar orbits, we find no spectroscopic evidence for a link between 2P/Encke, the Taurid complex NEOs andthe Maribo and Sutter’s Mill meteorites. However, we cannot rule out a connection to the meteorites either, as the spectral differencesmay be caused by secondary alteration of the surfaces of the NEOs. 

Factors predicting the portion size and perceived fillingness of evening meals in Danish and Iris households

Purpose:
This study explored how meal-related variables, socio-demographics and psychological predispositions affect the portion
size and perceived fillingness of an evening meal in Danish and Irish households.
Methods:
Using survey data collected in 2115 respondents from Denmark (DK) and the Island of Ireland (IOI), we compared four
sets of predictors of the portion size chosen for four evening meals (i.e. pizza/soup/chicken salad/pork meal): Biological
variables (hunger, thirst), socio-demographic variables (gender, age, BMI); psychological predispositions (cognitive
restraint, uncontrolled eating, emotional eating, general health interest) and meal-related variables (expected fillingness,
perceived healthiness, liking, frequency of consumption). We also compared five sets of predictors (the previous
four plus portion size) of perceived portion fillingness.
Results:
Portion size selections were associated mainly with demographic variables (gender, BMI) and psychological predispositions
(cognitive restraint, uncontrolled eating). In addition, only liking and sometimes expected healthiness (mealrelated
variables) appeared as drivers. Conversely, perceived portion fillingness was mostly influenced by the selected
portion size as well as expected fillingness and liking. There were some differences between meals; e.g. GHI not a
predictor for Pizza but a predictor for Chicken salad. Also some country differences were observed; emotional eating
predicted portion selection in the IOI but not DK.
Conclusions:
When making portion size selections at home, psychological predispositions, restrained and uncontrolled eating as well
as meal-related variables, liking and healthiness explained the decisions. However, surprisingly, individuals’ expected
fillingness of a food did not influence their portion size selection but was a driver of fillingness of the selected portion.

Christianity as a Vocation: The Rostrevor Benedictines and the Renewal of Faith in Ireland

This chapter explores how the Benedictine monks at Holy Cross Monastery in Rostrevor, Northern Ireland, have re-introduced the idea of vocation into the minds of a range of Christians on the island of Ireland. A picture of this new vision of the church in Ireland is painted through sections devoted to 'living ecumenism' and 'creating safe spaces'. The work of the Rostrevor Benedictines may seem limited because of the small scale of the changes among individuals. But Holy Cross is just one of multiple 'extra-institutional' spaces in Ireland's changing religious landscape. From their strategic positions on the margins, extra-institutional expressions of religion may prompt more significant changes in religious practice than initially seem possible.