Palliative Medicine:Scoping the level and extent of service provision to people with intellectual disability at end of life Poster Presentation

Background: Concerns exist about the end of life care
that people with intellectual disabilities receive. This population
are seldom referred to palliative care services and
inadequate data sets exist about their place of death.
Aim: To scope the extent of service provision to people
with intellectual disabilities at the end of life by specialist
palliative care and intellectual disability services in one
region of the United Kingdom.
Methods: As part of a larger doctoral study a regional survey
took place of a total sample (n=66) of specialist palliative
care and intellectual disability services using a postal
questionnaire containing forty items. The questionnaire
was informed by the literature and consultation with an
expert reference group. Data were analysed using SPSS to
obtain descriptive statistics.
Results: A total response rate from services of 71.2%
(n=47) was generated. Findings showed a range of experience
among services in providing end of life care to people
with intellectual disabilities in the previous five years, but
general hospitals were reported the most common place of
death. A lack of accessible information on end of life care
for people with learning disabilities was apparent. A few
services (n=14) had a policy to support this population to
make decisions about their care or had used adapted Breaking
Bad News guidelines (n=5) to meet their additional
needs. Both services recognised the value of partnership
working in assessing and meeting the holistic needs of
people with intellectual disabilities at end of life.
Conclusions: A range of experience in caring for people
with intellectual disabilities was present across services,
but more emphasis is required on adapting communication
for this population to facilitate them to participate in their
care. These findings could have international significance
given that studies in other countries have highlighted a
need to widen access to palliative care for this group of
people.

The preparation of reach to grasp movements in adults with Down syndrome

The aim of this study was to determine the extent to which adults with Down syndrome (DS) are able to utilise advance information to prepare reach to grasp movements. The study comprised ten adults with DS; ten children matched to an individual in the group with DS on the basis of their intellectual ability, and twelve adult controls. The participants used their right hand to reach out and grasp illuminated perspex blocks. Four target blocks were positioned on a table surface, two to each side of the midsagittal plane. In the complete precue condition, participants were provided with information specifying the location of the target. In the partial precue condition, participants were given advance information indicating the location of the object relative to the midsagittal plane (left or right). In the null condition, advance information concerning the position of the target object was entirely ambiguous. It was found that both reaction times and movement times were greater for the participants with DS than for the adults without DS. The reaction times exhibited by individuals with DS in the complete precue condition were lower than those observed in the null condition, indicating that they had utilised advance information to prepare their movements. In the group with DS, when advance information specified only the location of the target object relative to the midline, reaction times were equivalent to those obtained when ambiguous information was given. In contrast, the adults without DS exhibited reaction times that were lower in both the complete and partial precue conditions when compared to the null condition. The pattern of results exhibited by the children was similar to that of the adults without DS. The movement times exhibited by all groups were not influenced by the precue condition. In summary, our findings indicate that individuals with DS are able to use advance information if it specifies precisely the location of the target object in order to prepare a reach to grasp movement. The group with DS were unable, however, to obtain the normal advantage of advance information specifying only one dimension of the movement goal (i.e., the position of an object relative to the body midline). (C) 2001 Elsevier Science B.V. All rights reserved.

'Saig in Machai Fothúaid': On the Application and Extent of ‘the Macha’ in North-west Armagh

The seventh-century Patrician documents in the Book of Armagh, and other early sources such as Bethu Phátraic, contain references to the toponym Macha, which has been identified by the Dictionary of the Irish Language with either the ecclesiastical centre of Ard Macha or the ‘royal seat’ of Emain Macha. This article examines the evidence for the name in the sources and illustrates that Macha applies primarily to the plain in which both Ard Macha and Emain Macha are located. It is to be identified with Mag Macha ‘the plain of Macha’, familiar to us from the Dindshenchus, and further evidence of the organic potential of a given toponym is witnessed in later sources where the plain is referred to as Mag/Machaire na hE(a)mna ‘the plain of Emain’ and Machaire Aird/Arda Macha ‘the plain of Armagh’. The extent of Macha is difficult to establish with certainty, but it seems very likely that it stretched north to the River Blackwater as well as south towards Slíab Fúait.

The extent of grazing release from epiphytism for Sargassum muticum (Phaeophyceae) within the invaded range

The overall biotic pressure on a newly introduced species may be less than that experienced within its native range, facilitating invasion. The brown alga Sargassum muticum (Yendo) Fensholt is a conspicuous and successful invasive species originally from Japan and China. We compared S. muticum and native macroalgae with respect to the biotic pressures of mesoherbivore grazing and ectocarpoid fouling. In Strangford Lough, Northern Ireland, S. muticum thalli were as heavily overgrown with seasonal blooms of epiphytic algae as native macroalgal species were. The herbivorous amphipod Dexamine spinosa was much more abundant on S. muticum than on any native macroalga. When cultured with this amphipod, S. muticum lost more tissue than three native macroalgae, Saccharina latissima (Linnaeus) Lane et al., Halidrys siliquosa (Linnaeus) Lyngbye and Fucus serratus Linnaeus. Sargassum muticum cultured with both ectocarpoid fouling and amphipods showed a severe impact, consistent with our previous findings of large declines in the density of S. muticum observed in the field during the peak of fouling. Despite being a recent introduction into the macroalgal community in Strangford Lough, S. muticum appears to be under biotic pressure at least equal to that on native species, suggesting that release from grazing and epiphytism does not contribute to the invasiveness of this species in Strangford Lough.

Distribution, extent of inter-annual variability and diet of the bloom-forming jellyfish Rhizostoma in European waters

Jellyfish (Cnidaria: Scyphozoa) are increasingly thought to play a number of important ecosystem roles, but often fundamental knowledge of their distribution, seasonality and inter-annual variability is lacking. Bloom forming species, due to their high densities, can have particularly intense trophic and socio-economic impacts. In northern Europe it is known that one particularly large (up to 30 kg wet weight) bloom forming jellyfish is Rhizostoma spp. Given the potential importance, we set out to review all known records from peer-reviewed and broader public literature of the jellyfish R. octopus (Linnaeus) and R. pulmo (Macri) (Scyphozoa: Rhizostomae) across western Europe. These data revealed distinct hotspots where regular Rhizostoma spp. aggregations appeared to form, with other sites characterized by occasional abundances and a widespread distribution of infrequent observations. Surveys of known R. octopus hotspots around the Irish Sea also revealed marked inter-annual variation with particularly high abundances forming during 2003. The location of such consistent aggregations and inter-annual variances are discussed in relation to physical, climatic and dietary variations.

Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of approximate to 28% of the population of Northern Ireland.
Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

Mucoadhesive, syringeable drug delivery systems for controlled application of metronidazole to the periodontal pocket: In vitro release kinetics, syringeability, mechanical and mucoadhesive properties

Novel mucoadhesive formulations containing hydroxyethylcellulose (HEC; 3 and 5%, w/w) or Carbopol (3 and 5%, w/w), polycarbophil (PC; 1 and 3%, w/w) and metronidazole (5%, w/w) at pH 6.8 were designed for the treatment of periodontal diseases. Each formulation was characterised in terms of hardness, compressibility, adhesiveness and cohesiveness (using Texture Profile Analysis), drug release, adhesion to a mucin disc (measured as a detachment force using the texture analyser in tensile mode) and, finally, syringeability (using the texture analyser in compression mode). Drug release from all formulations was non-diffusion controlled. Drug release was significantly decreased as the concentration of each polymeric component was increased, due to both the concomitant increased viscosity of the formulations and, additionally, the swelling kinetics of PC following contact with dissolution fluid. Increasing the concentrations of each polymeric component significantly increased formulation hardness, compressibility, adhesiveness, mucoadhesion and syringeability, yet decreased cohesiveness. Increased product hardness, compressibility and syringeability were due to polymeric effects on formulation viscosity. The effects on cohesiveness may be explained both by increased viscosity and also by the increasing semi-solid nature of products containing 5% HEC or Carbopol and PC (1 or 3%). The observations concerning formulation adhesiveness/mucoadhesion illustrate the adhesive nature of each polymeric component. Greatest adhesion was noted in formulations where neutralisation of PC was maximally suppressed. For the most part, increased time of contact between formulation and mucin significantly increased the required force of detachment, due to the greater extent of mucin polymer hydration and interpenetration with the formulations. Significant statistical interactions were observed between the effects of each polymer on drug release and mechanical/mucoadhesive properties. These interactions may be explained by formulatory effects on the extent of swelling of PC. In conclusion, the formulations described offered a wide range of mechanical and drug release characteristics. Formulations containing HEC exhibited superior physical characteristics for improved drug delivery to the periodontal pocket and are now the subject of long-term clinical investigations. (C) 1997 Elsevier Science B.V.

Use of adhesion counts to help predict symptomatic infection and the ability of fluoroquinolones to penetrate bacterial biofilms on the bladder cells of spinal cord injured patients

There were three objectives to the present study: (1) compare the bladder infection rate and extent of biofilm formation for seven untreated spinal cord injured (SCI) patients and seven given prophylactic co-trimoxazole, (2) identify a level of bacterial adhesion to bladder cells which could be used to help predict symptomatic infection, and (3) determine from in vivo and in vitro studies whether fluoroquinolones were effective at penetrating bacterial biofilms. The results showed that the infection rate had not changed with the introduction of prophylaxis. However, the uropathogenic population had altered subsequent to the introduction of prophylaxis with E. coli being replaced by E. faecalis as the most common cause of infection. In 63% of the specimens from asymptomatic patients, the bacterial counts per cell were <20, while 81% of specimens from patients with at least one sign and one symptom of urinary tract infection (UTI) had > 20 adherent bacteria per bladder cell. Therefore, it is proposed that counts of > 20 bacteria adherent to sediment transitional epithelial bladder cells may be predictive of symptomatic UTI. Clinical data showed that fluoroquinolone therapy reduced the adhesion counts to <20 per cell in 63% of cases, while trimethoprim-sulfamethoxazole only did so in 44%. Further in vitro testing showed that ciprofloxacin (0.1, 0.5 and 1.0 micrograms/ml) partially or completely eradicated adherent biofilms from 92% of spinal cord injured patients' bladder cells, while ofloxacin did so in 71% cases and norfloxacin in 56%. These findings have important implications for the detection and treatment of bacteriuria in spinal cord injured patients.

Visual target separation determines the extent of generalisation between opposing visuomotor rotations

Here we investigated the influence of angular separation between visual and motor targets on concurrent adaptation to two opposing visuomotor rotations. We inferred the extent of generalisation between opposing visuomotor rotations at individual target locations based on whether interference (negative transfer) was present. Our main finding was that dual adaptation occurred to opposing visuomotor rotations when each was associated with different visual targets but shared a common motor target. Dual adaptation could have been achieved either within a single sensorimotor map (i.e. with different mappings associated with different ranges of visual input), or by forming two different internal models (the selection of which would be based on contextual information provided by target location). In the present case, the pattern of generalisation was dependent on the relative position of the visual targets associated with each rotation. Visual targets nearest the workspace of the opposing visuomotor rotation exhibited the most interference (i.e. generalisation). When the minimum angular separation between visual targets was increased, the extent of interference was reduced. These results suggest that the separation in the range of sensory inputs is the critical requirement to support dual adaptation within a single sensorimotor mapping.

Organised Criminals as 'Agents of Obligation': The Case of Ireland

Relying on Brown’s (2005a, b) thesis that contemporary shifts in penal policy are best understood as a reprisal of colonial rationality, so that offenders become ‘non-citizens’ or ‘agents of obligation’, this article argues that this framework finds support in developments in Irish criminal justice policy. Recent legislation aimed at offenders suspected of involvement in ‘organised crime’ is examined through this lens. These offenders have found themselves reconstituted as ‘agents of obligation’ with duties to furnish information about their property and movements, report to the police concerning their location and, importantly, refrain from criminal activity or face extraordinary sanctions. It is therefore argued that this paradigm is a useful heuristic device through which to understand recent developments in Irish criminal justice and elsewhere. In light of the trends observed in Ireland, certain refinements and extensions to Brown’s argument are put forward for consideration.

Hermit crabs perceive the extent of their virtual bodies

A flexible body image is required by animals if they are to adapt to body changes and move effectively within a structurally complex environment. Here, we show that terrestrial hermit crabs, Coenobita rugosus, which frequently change shells, can modify walking behaviour, dependent on the shape of the shell. Hermit crabs walked along a corridor that had alternating left and right corners; if it was narrow at the corner, crabs rotated their bodies to avoid the wall, indicating an awareness of environmental obstacles. This rotation increased when a plastic plate was attached to the shell. We suggest that the shell, when extended by the plate, becomes assimilated to the hermit crab's own body. While there are cases of a tool being assimilated with the body, our result is the first example of the habitat where an animal lives and/or carries being part of a virtual body. This journal is © 2012 The Royal Society.

Source depletion and extent of melting in the Tongan sub-arc mantle

The fluid immobile High Field Strength Elements (HFSE) Nb and Ta can be used to distinguish between the effects of variable extents of melting and prior source depletion of the Tongan sub-arc mantle. Melting of spinel Iherzolite beneath the Lau Basin back-arc spreading centres has the ability to fractionate Nb from Ta due to the greater compatibility of the latter in clinopyroxene. The identified spatial variation in plate velocities and separation of melt extraction zones, combined with extremely depleted lavas make Tonga an ideal setting in which to test models for arc melt generation and the role of back-arc magmatism. We present new data acquired by laser ablation-ICPMS of fused sample glasses produced without the use of a melt fluxing agent. The results show an arc trend towards strongly sub-chondritic Nb/Ta (