Characteristics and Treatment of Medical Device Related Infections

Medical device related infections are becoming an increasing prevalent area of infectious disease. They can be attributed to a multitude of factors from an increasing elderly population with reduced immunological status to increasing microbial resistance and evolution. Of greatest significance is the failure of standard antimicrobial regimens to eradicate biomaterial-related infections due to the formation of microbial biofilms consisting of extracellular polymeric substances. Biofilms form and thrive at the abiotic device surface where nutrients are more concentrated and symbiotic colonies can be formed. The formation of a biofilm matrix occurs in a series of steps beginning with reversible attachment of bacteria to the surface of the substrate and terminating in dispersion of mature biofilm microcolonies that aim to colonise fresh surfaces high in nutrients. Mature biofilms can resist 10-1000 times the concentrations of standard antibiotic regimens that are required to kill genetically equivalent planktonic forms. The extent of the infection and the pathogen(s) present can be attributed to both the form and location of the device. It is important that preventative measures and treatment strategies relate to combating the causative microorganisms. Preventative measures include: the use of anti-infective biomaterials that can be coated or incorporated with standard or innovative antimicrobials; modified anti-adhesive medical devices; environmental sterilisation protocols and prophylactic drug therapy. Treatment of established infection may require removal of the device or if deemed possible the device may be salvageable through the initiation of antimicrobial therapy. The increasing spectre of antibiotic resistance and medical device related infections are a large and increasing burden on health care systems and the patient’s quality of life and long term prognosis. As an infectious disease it represents one of the most difficult challenges facing modern science and healthcare.

Is Northern Ireland abnormal? An extension of the sociological debate on religion in modern Britain

This article places Northern Ireland within the unfolding sociological debate on religion in modern Britain. It measures secularization along Casanova’s three dimensions (1994): religious differentiation, decline and privatization. It finds that Northern Ireland has, in common with Britain, high levels of religious differentiation, grey areas of religious belief and little convinced secularism. However, Northern Ireland differs in that it has higher levels of religious affiliation and practice, and religion plays more roles in civil society than it does in other parts of Britain. The article explores the role of conflict in forming these religious trends, asking if they represent a persistence of the sacred, or simply mask deeper ethnic divisions. It concludes that the social dimensions of religion are just as important as the supernatural, and that they often inform each other. Finally, it suggests that the dynamics of religious change are comparable across regions and, as such, Northern Ireland might be a useful case study for British policy makers, particularly as it becomes increasingly multicultural and religiously plural.

'Ancient Enmities' and Modern Conflict: History and Politics in Northern Ireland

This article investigates the role of history and historical consciousness in deeply divided societies. It looks at the case of Northern Ireland. It argues that, while the conflict here is caused by contemporary divisions, perceptions of the past have had considerable influence. Recent years have seen efforts to change historical attitudes and this has aided political accommodation. An important lesson from the conflict in Northern Ireland points to the need to challenge such historical perceptions.

Modern humans in Sarawak, Malaysian Borneo, during Oxygen Isotope Stage 3: palaeoenvironmental evidence from the Great Cave of Niah

During recent reinvestigations in the Great Cave of Niah in Borneo, the ‘Hell Trench’ sedimentary sequence seen by earlier excavators was re-exposed. Early excavations here yielded the earliest anatomically-modern human remains in island Southeast Asia. Calibrated radiocarbon dates, pollen, algal microfossils, palynofacies, granulometry and geochemistry of the ‘Hell Trench’ sequence provide information about environmental and vegetational changes, elements of geomorphic history and information about human activity. The ‘Hell’ sediments were laid down episodically in an ephemeral stream or pool. The pollen suggests cyclically changing vegetation with forest habitats alternating with more open environments; indicating that phases with both temperatures and precipitation reduced compared with the present. These events can be correlated with global climate change sequences to produce a provisional dating framework. During some forest phases, high counts of Justicia, a plant which today colonises recently burnt forest areas, point to fire in the landscape. This may be evidence for biomass burning by humans, presumably to maintain forest-edge habitats. There is evidence from palynofacies for fire on the cave floor in the ‘Hell’ area. Since the area sampled is beyond the limit of plant growth, this is evidence for human activity. The first such evidence is during an episode with significant grassland indicators, suggesting that people may have reached the site during a climatic phase characterised by relatively open habitats ~50 ka. Thereafter, people were able to maintain a relatively consistent presence at Niah. The human use of the ‘Hell’ area seems to have intensified through time, probably because changes in the local hydrological regime made the area dryer and more suitable for human use.

Ancients inspire modern memory

A stencilling technique for depositing arrays of nanoscale ferroelectric capacitors on a surface could be useful in data storage devices.

Using the surface profiles of modern ice masses to inform palaeo-glacier reconstructions

Morphometric study of modern ice masses is useful because many reconstructions of glaciers traditionally draw on their shape for guidance Here we analyse data derived from the surface profiles of 200 modern ice masses-valley glaciers icefields ice caps and ice sheets with length scales from 10º to 10³ km-from different parts of the world Four profile attributes are investigated relief span and two parameters C* and C that result from using Nye s (1952) theoretical parabola as a profile descriptor C* and C respectively measure each profile s aspect ratio and steepness and are found to decrease in size and variability with span This dependence quantifies the competing influences of unconstrained spreading behaviour of ice flow and bed topography on the profile shape of ice masses which becomes more parabolic as span Increases (with C* and C tending to low values of 2.5-3.3 m ½) The same data reveal coherent minimum bounds in C* and C for modern ice masses that we develop into two new methods of palaeo glacier reconstruction In the first method glacial limits are known from moraines and the bounds are used to constrain the lowest palaeo ice surface consistent with modern profiles We give an example of applying this method over a three-dimensional glacial landscape in Kamchatka In the second method we test the plausibility of existing reconstructions by comparing their C* and C against the modern minimum bounds Of the 86 published palaeo ice masses that we put to this test 88% are found to be plausible The search for other morphometric constraints will help us formalise glacier reconstructions and reduce their uncertainty and subjectiveness

Missing Links, Cultural Modernity and the Dead: Anatomically Modern Humans in the Great Cave of Niah (Sarawak, Borneo)

The Great Cave of Niah in Sarawak (northern Borneo) came into the gaze of Western Science through the work of Alfred Russell Wallace, who came to Sarawak in the 1850s to search for ‘missing links’ in his pioneering studies of evolution and the natural history of Island Southeast Asia and Australasia. The work of Tom and Barbara Harrisson in the 1950s and 1960s placed the Great Cave, and particularly their key find, the ‘Deep Skull’, at the nexus of the evolving archaeological framework for the region: for decades the skull, dated in 1958 by adjacent charcoal to c.40,000 BP, was the oldest fossil of an anatomically modern human anywhere in the world and thus critical to ideas about human evolution and dispersal. Although several authorities later questioned the provenance and antiquity of the Deep Skull, renewed investigations of the Harrisson excavations since 2000 have shown that it can be attributed securely to a specific location in the Pleistocene stratigraphy, with direct U-series dating on a piece of the skull indicating an age for it of c.37,500 BP and the first evidence for associated human activity at the site going back to c.50,000 BP. The new work also indicates that the skull is part of a cultural deposit, perhaps a precursor to the long tradition in Borneo of processing of the dead and secondary burial. These indicators of cultural complexity chime with the complexity of the subsistence behaviour of the early users of the caves discussed by Philip Piper and Ryan Rabett in chapter ten of this volume.