Making Risk Visible. The role of images in the assessment of (cancer) genetic risk

Whilst analysis of 'risk' (in its many conceptual shapes) has loomed large in both medicine and social sciences over the past 25 years, detailed investigations as to how risk assessments are actually put together (in either lay or professional contexts) are few in number. The studies that are available usually focus on the use of words or everyday conversation in assembling risk. Talking about risk is, of course, important, but what tends to be ignored is the fact that risk can be and is often made visible. For example, it can be made visible through the use of tables, charts, diagrams and various kinds of sophisticated laboratory images. This paper concentrates on the role of such images in the context of a cancer genetics clinic and its associated laboratory. Precisely how these images are tied into the production of risk estimates, how professionals discuss and use such images in clinical work, and how professionals reference them to display facts about risk is the focus of the paper. The paper concludes by highlighting the significance of different kinds of visibility for an understanding of genetic abnormalities and how such differences might impact on the attempts of lay people to get to grips with risk.

The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

One thing leads to another: science in the news as a basis for curriculum and professional development

Science based news is widely reported in the media. The ability to interact critically with such news reports is increasingly seen as a legitimate part of the science education agenda. This paper reports the findings of two studies looking at the early response and subsequent usage of a resource promoting the integration of science-based news in secondary science curriculum in Northern Ireland. This paper charts the introduction of the resource into schools. The subsequent impact on the science curriculum and the implications for teacher professional development are considered. Many science teachers demonstrate willingness and aptitude to use primary media sources within their teaching. Some who adopted the resource demonstrate the capacity to sustain the development using the resource as a catalyst in ongoing curricular change. Insights gained in this study are relevant to policy makers and curriculum developers as well as teachers seeking to promote this aspect of science education

Improved Principal Component Monitoring of Large-Scale Processes

This is the first paper that shows and theoretically analyses that the presence of auto-correlation can produce considerable alterations in the Type I and Type II errors in univariate and multivariate statistical control charts. To remove this undesired effect, linear inverse ARMA filter are employed and the application studies in this paper show that false alarms (increased Type I errors) and an insensitive monitoring statistics (increased Type II errors) were eliminated.

Improved Process Monitoring Using Nonlinear Principal Component Models

This paper presents two new approaches for use in complete process monitoring. The firstconcerns the identification of nonlinear principal component models. This involves the application of linear
principal component analysis (PCA), prior to the identification of a modified autoassociative neural network (AAN) as the required nonlinear PCA (NLPCA) model. The benefits are that (i) the number of the reduced set of linear principal components (PCs) is smaller than the number of recorded process variables, and (ii) the set of PCs is better conditioned as redundant information is removed. The result is a new set of input data for a modified neural representation, referred to as a T2T network. The T2T NLPCA model is then used for complete process monitoring, involving fault detection, identification and isolation. The second approach introduces a new variable reconstruction algorithm, developed from the T2T NLPCA model. Variable reconstruction can enhance the findings of the contribution charts still widely used in industry by reconstructing the outputs from faulty sensors to produce more accurate fault isolation. These ideas are illustrated using recorded industrial data relating to developing cracks in an industrial glass melter process. A comparison of linear and nonlinear models, together with the combined use of contribution charts and variable reconstruction, is presented.

Fault reconstruction in linear dynamic systems using multivariate statistics

Treasure et al. (2004) recently proposed a new sub space-monitoring technique, based on the N4SID algorithm, within the multivariate statistical process control framework. This dynamic-monitoring method requires considerably fewer variables to be analysed when compared with dynamic principal component analysis (PCA). The contribution charts and variable reconstruction, traditionally employed for static PCA, are analysed in a dynamic context. The contribution charts and variable reconstruction may be affected by the ratio of the number of retained components to the total number of analysed variables. Particular problems arise if this ratio is large and a new reconstruction chart is introduced to overcome these. The utility of such a dynamic contribution chart and variable reconstruction is shown in a simulation and by application to industrial data from a distillation unit.

Improved reliability in diagnosing faults using multivariate statistics

This paper analyses multivariate statistical techniques for identifying and isolating abnormal process behaviour. These techniques include contribution charts and variable reconstructions that relate to the application of principal component analysis (PCA). The analysis reveals firstly that contribution charts produce variable contributions which are linearly dependent and may lead to an incorrect diagnosis, if the number of principal components retained is close to the number of recorded process variables. The analysis secondly yields that variable reconstruction affects the geometry of the PCA decomposition. The paper further introduces an improved variable reconstruction method for identifying multiple sensor and process faults and for isolating their influence upon the recorded process variables. It is shown that this can accommodate the effect of reconstruction, i.e. changes in the covariance matrix of the sensor readings and correctly re-defining the PCA-based monitoring statistics and their confidence limits. (c) 2006 Elsevier Ltd. All rights reserved.

Credit and community: working class debt in the UK since 1880

This book examines credit in working class communities since 1880, focusing on forms of borrowing that were dependent on personal relationships and social networks. It provides an extended historical discussion of credit unions, legal and illegal moneylenders (loan sharks), and looks at the concept of ‘financial exclusion’. Initially, the book focuses on the history of tallymen, check traders, and their eventual movement into moneylending following the loss of their more affluent customers, due to increased spending power and an increasingly liberalized credit market. They also faced growing competition from mail order companies operating through networks of female agents, whose success owed much to the reciprocal cultural and economic conventions that lay at the heart of traditional working class credit relationships. Discussion of these forms of credit is related to theoretical debates about cultural aspects of credit exchange that ensured the continuing success of such forms of lending, despite persistent controversies about their use. The book contrasts commercial forms of credit with formal and informal co-operative alternatives, such as the mutuality clubs operated by co-operative retailers and credit unions. It charts the impact of post-war immigration upon credit patterns, particularly in relation to the migrant (Irish and Caribbean) origins of many credit unions and explains the relative lack of success of the credit union movement. The book contributes to anti-debt debates by exploring the historical difficulties of developing legislation in relation to the millions of borrowers who have patronized what has come to be termed the sub-prime sector.

Humour: Stylistic Approaches

An important focus in contemporary stylistics has been on the connections between style and verbal humor, and this article charts the ways in which stylisticians have used a variety of linguistic models to analyze humorous discourse. The idea of stylistic incongruity is identified as being especially important in triggering the humor reflex. The principle of incongruity applies to any level of language or discourse, as is illustrated here by examples of puns and related forms of humor as well as by incongruities that are more to do with mismatches between text and discourse context. The principle of incongruity is also aligned with the concept of irony, through which a number of points are made about the stylistic analysis of both parody and satire.

Risk factors for clinical coronary heart disease in systemic lupus erythematosus: the lupus and atherosclerosis evaluation of risk (LASER) study.

Abstract OBJECTIVE: Accelerated atherosclerosis and premature coronary heart disease (CHD) are recognized complications of systemic lupus erythematosus (SLE), but the exact etiology remains unclear and is likely to be multifactorial. We hypothesized that SLE patients with CHD have increased exposure to traditional risk factors as well as differing disease phenotype and therapy-related factors compared to SLE patients free of CHD. Our aim was to examine risk factors for development of clinical CHD in SLE in the clinical setting. METHODS: In a UK-wide multicenter retrospective case-control study we recruited 53 SLE patients with verified clinical CHD (myocardial infarction or angina pectoris) and 96 SLE patients without clinical CHD. Controls were recruited from the same center as the case and matched by disease duration. Charts were reviewed up to time of event for cases, or the same "dummy-date" in controls. RESULTS: SLE patients with clinical CHD were older at the time of event [mean (SD) 53 (10) vs 42 (10) yrs; p

Rethinking Amnesties: Atrocity, Accountability And Impunity In Post-Conflict Societies.

The notion of accountability that is propagated in transitional justice often appears limited to demands for the prosecution and imprisonment of those who have been involved in serious human rights violations. Amnesties, widely understood as the absence of punishment for wrongdoing, are in turn considered by many scholars and activists as an example par excellence of the kind of Faustian pacts which are made in the name of political expediency in transitions from conflict. Drawing from a range of interdisciplinary literature, as well as research completed by the authors in a number of societies with a violent past, this paper uses amnesties as a case-study to argue for a more rounded interrogation of the notion of accountability in transitional justice. The paper charts the various forms of intersecting accountability which both shape and delimit amnesties at key ‘moments’ concerning their remit, introduction and operation. The paper concludes that the legalistic view of amnesties as equating to impunity and retribution as accountability is inaccurate and misleading. It argues that a broader perspective of accountability speaks directly to the capacity for amnesties to play a more constructive role in post conflict justice and peacemaking.

Gemini observations of Wolf-Rayet stars in the Local Group starburst galaxy IC 10

We present Gemini-N GMOS and CFHT MOS spectroscopy of Wolf-Rayet candidates in the Local Group dwarf galaxy IC 10 that were previously identified by Massey et al. and Royer et al. From the present spectroscopic survey, the WC/WN ratio for IC 10 remains unusually high, given its low metallicity, although none of the WC9 stars suspected from narrow-band imaging are confirmed. Our spectroscopy confirms 9 newly discovered Wolf-Rayet candidates from Royer et al., whilst spectral types of 14 Wolf-Rayet stars previously observed by Massey & Armandroff are refined here. In total, there are 26 spectroscopically confirmed Wolf-Rayet stars in IC 10. All but one of the fourteen WC stars are WC4-6 stars, the exception being # 10 from Massey et al., a broad-lined, apparently single WC7 star. There are a total of eleven WN stars, which are predominantly early WN3-4 stars, but include a rare WN10 star, # 8 from Royer et al. # 5 from Massey et al. is newly identified as a transition WN/C star. Consequently, the WC/WN ratio for IC10 is 14/11similar to1.3, unusually high for a metal-poor galaxy. Re-evaluating recent photometric data of Massey & Holmes, we suggest that the true WC/WN ratio may not be as low as similar to0.3. Finally, we present ground-based finding charts for all confirmed WR stars, plus HST/WFPC2 charts for twelve cases.

Transforming the Irish Presidency: Activist Presidents and Gender Politics, 1990-2011

The election of two energetic women in succession to the office of President of Ireland challenged the notion that the presidency was a long-service reward for retiring politicians. Mary Robinson and Mary McAleese broke the male domination of the office, interpreted its functions in a more dynamic manner, and utilised the ‘soft power’ of the presidency with skill. Yet, as individuals they were very different in political focus, experience and ideological disposition. This article charts their respective backgrounds and discusses the context in which each woman came to the presidency. It explores their vision for the office. Focusing on the potential for harnessing the soft power of the presidency, it argues that Robinson adopted a classical representative view of the office, whereas McAleese chose a facilitatory style of leadership. The article concludes that in their different ways, Robinson and McAleese contributed to reshaping the office, utilising its symbolic potential and soft power to make it a more meaningful and fit-for-purpose political institution for the twenty-first century. © 2012 Political Studies Association of Ireland.

Defending the Irish Border: The Map of Watchful Architecture

This chapter offers an analysis of a map of the Irish border. The Map of Watchful Architecture charts the history of defensive structures in the border region.

Compliance with recommendations in a geriatric outreach assessment service

Objectives: to measure the extent to which the recommendations of a geriatric outreach assessment service were being followed, and to determine what patient-related factors were associated with compliance with assessment recommendations. Methods: eighty-one eligible patients or caregivers who had an assessment in a geriatric outreach service participated in a telephone interview. The interview focused on the use of health services and compliance with assessment recomendations. Patient-related variables obtained from charts included demographics, caregiver support and stability, health status and assessment recommendations. Results: overall compliance with recommendations from the geriatric outreach assessment service was 65%. Patients were less likely comply fully with recommendations if they had a high number of recommendations [odds ratio (OR) = 0.23; 95% confidence interval (CI) = 0.12-0.46; P = 0.0001], inadequate caregiver support (OR) = 0.212; 95% CI = 0.04 to 1.02; P = 0.0523), or the ability to transfer themselves independently (OR = 0.12; 95% CI = 0.02-0.63; P = 0.0124). They were more likely to have full compliance if they had normal vision (OR = 6.67; 95% CI = 1.22- 36.46; P = 0.0284). Conclusion: it is important to focus on key issues when developing service recommendations and on the role of the informal caregiver in facilitating compliance with them. Good communication between the patient or caregiver and the family physician and geriatric services can help to identify strategies which might improve acceptance of recommendations.