Annual Report to the Equality Commission 01-02 (PDF 103 KB)

The Department and its associated bodies are committed to jointly taking forward the Statutory equality obligations placed on them by Section 75 of the Northern Ireland Act 1998. This has involved collaboration in drafting and submitting their Equality Schemes and then in jointly conducting a 2-stage consultation exercise on the equality implications of our policies. Stage 1 papers were issued in November/December 2000 seeking views, amongst other things, on the equality implications of our policies, and a composite Stage 2 paper in April 2001setting out the conclusions reached on the screening of policies and proposals for an Equality Impact Assessment programme. åÊ

Genome-wide association study identifies variants associated with progression of liver fibrosis from HCV infection.

Polymorphisms in IL28B were shown to affect clearance of hepatitis C virus (HCV) infection in genome-wide association (GWA) studies. Only a fraction of patients with chronic HCV infection develop liver fibrosis, a process that might also be affected by genetic factors. We performed a 2-stage GWA study of liver fibrosis progression related to HCV infection. We studied well-characterized HCV-infected patients of European descent who underwent liver biopsies before treatment. We defined various liver fibrosis phenotypes on the basis of METAVIR scores, with and without taking the duration of HCV infection into account. Our GWA analyses were conducted on a filtered primary cohort of 1161 patients using 780,650 single nucleotide polymorphisms (SNPs). We genotyped 96 SNPs with P values <5 × 10(-5) from an independent replication cohort of 962 patients. We then assessed the most interesting replicated SNPs using DNA samples collected from 219 patients who participated in separate GWA studies of HCV clearance. In the combined cohort of 2342 HCV-infected patients, the SNPs rs16851720 (in the total sample) and rs4374383 (in patients who received blood transfusions) were associated with fibrosis progression (P(combined) = 8.9 × 10(-9) and 1.1 × 10(-9), respectively). The SNP rs16851720 is located within RNF7, which encodes an antioxidant that protects against apoptosis. The SNP rs4374383, together with another replicated SNP, rs9380516 (P(combined) = 5.4 × 10(-7)), were linked to the functionally related genes MERTK and TULP1, which encode factors involved in phagocytosis of apoptotic cells by macrophages. Our GWA study identified several susceptibility loci for HCV-induced liver fibrosis; these were linked to genes that regulate apoptosis. Apoptotic control might therefore be involved in liver fibrosis.

Endogenous Stackelberg leadership

We consider a linear quantity setting duopoly game and analyzewhich of the players will commit when both players have the possibility todo so. To that end, we study a 2-stage game in which each player caneither commit to a quantity in stage 1 or wait till stage 2. We show thatcommitting is more risky for the high cost firm and that, consequently,risk dominance considerations, as in Harsanyi and Selten (1988), allowthe conclusion that only the low cost firm will choose to commit.Hence, the low cost firm will emerge as the endogenous Stackelberg leader.

Genomewide association study using a high-density single nucleotide polymorphism array and case-control design identifies a novel essential hypertension susceptibility locus in the promoter region of endothelial NO synthase.

Essential hypertension is a multifactorial disorder and is the main risk factor for renal and cardiovascular complications. The research on the genetics of hypertension has been frustrated by the small predictive value of the discovered genetic variants. The HYPERGENES Project investigated associations between genetic variants and essential hypertension pursuing a 2-stage study by recruiting cases and controls from extensively characterized cohorts recruited over many years in different European regions. The discovery phase consisted of 1865 cases and 1750 controls genotyped with 1M Illumina array. Best hits were followed up in a validation panel of 1385 cases and 1246 controls that were genotyped with a custom array of 14 055 markers. We identified a new hypertension susceptibility locus (rs3918226) in the promoter region of the endothelial NO synthase gene (odds ratio: 1.54 [95% CI: 1.37-1.73]; combined P=2.58 · 10(-13)). A meta-analysis, using other in silico/de novo genotyping data for a total of 21 714 subjects, resulted in an overall odds ratio of 1.34 (95% CI: 1.25-1.44; P=1.032 · 10(-14)). The quantitative analysis on a population-based sample revealed an effect size of 1.91 (95% CI: 0.16-3.66) for systolic and 1.40 (95% CI: 0.25-2.55) for diastolic blood pressure. We identified in silico a potential binding site for ETS transcription factors directly next to rs3918226, suggesting a potential modulation of endothelial NO synthase expression. Biological evidence links endothelial NO synthase with hypertension, because it is a critical mediator of cardiovascular homeostasis and blood pressure control via vascular tone regulation. This finding supports the hypothesis that there may be a causal genetic variation at this locus.

Association of the hemochromatosis gene with pazopanib-induced transaminase elevation in renal cell carcinoma.

BACKGROUND & AIMS: Pazopanib has demonstrated clinical benefit in patients with advanced renal cell carcinoma (RCC) and is generally well tolerated. However, transaminase elevations have commonly been observed. This 2-stage study sought to identify genetic determinants of alanine transaminase (ALT) elevations in pazopanib-treated white patients with RCC.¦METHODS: Data from two separate clinical studies were used to examine the association of genetic polymorphisms with maximum on-treatment ALT levels.¦RESULTS: Of 6852 polymorphisms in 282 candidate genes examined in an exploratory dataset of 115 patients, 92 polymorphisms in 40 genes were significantly associated with ALT elevation (p<0.01). Two markers (rs2858996 and rs707889) in the HFE gene, which are not yet known to be associated with hemochromatosis, showed evidence for replication. Because of multiple comparisons, there was a 12% likelihood the replication occurred by chance. These two markers demonstrated strong linkage disequilibrium (r(2)=0.99). In the combined dataset, median (25-75th percentile) maximum ALT values were 1.2 (0.7-1.9), 1.1 (0.8-2.5), and 5.4 (1.9-7.6)×ULN for rs2858996 GG (n=148), GT (n=82), and TT (n=1 2) genotypes, respectively. All 12 TT patients had a maximum ALT>ULN, and 8 (67%) had ALT≥3×ULN. The odds ratio (95% CI) for ALT≥3×ULN for TT genotype was 39.7 (2.2-703.7) compared with other genotypes. As a predictor of ALT≥3×ULN, the TT genotype had a negative predictive value of 0.83 and positive predictive value of 0.67. No TT patients developed liver failure.¦CONCLUSIONS: The rs2858996/rs707889 polymorphisms in the HFE gene may be associated with reversible ALT elevation in pazo-panib-treated patients with RCC.

Identification of heart rate-associated loci and their effects on cardiac conduction and rhythm disorders.

Elevated resting heart rate is associated with greater risk of cardiovascular disease and mortality. In a 2-stage meta-analysis of genome-wide association studies in up to 181,171 individuals, we identified 14 new loci associated with heart rate and confirmed associations with all 7 previously established loci. Experimental downregulation of gene expression in Drosophila melanogaster and Danio rerio identified 20 genes at 11 loci that are relevant for heart rate regulation and highlight a role for genes involved in signal transmission, embryonic cardiac development and the pathophysiology of dilated cardiomyopathy, congenital heart failure and/or sudden cardiac death. In addition, genetic susceptibility to increased heart rate is associated with altered cardiac conduction and reduced risk of sick sinus syndrome, and both heart rate-increasing and heart rate-decreasing variants associate with risk of atrial fibrillation. Our findings provide fresh insights into the mechanisms regulating heart rate and identify new therapeutic targets.

Corynebacterium bovis shoulder prosthetic joint infection: the first reported case.

We report the first case of Corynebacterium bovis shoulder prosthetic joint infection. The organism was isolated from intraoperative tissue culture and from the removed prosthesis using sonication. A 2-stage exchange and 3 months of antibiotic therapy were performed. C. bovis may cause implant-associated infections, which can manifest as low-grade infection.

Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study.

BACKGROUND: To asses the clinical profile, treatment outcome and prognostic factors in primary breast lymphoma (PBL). METHODS: Between 1970 and 2000, 84 consecutive patients with PBL were treated in 20 institutions of the Rare Cancer Network. Forty-six patients had Ann Arbor stage IE, 33 stage IIE, 1 stage IIIE, 2 stage IVE and 2 an unknown stage. Twenty-one underwent a mastectomy, 39 conservative surgery and 23 biopsy; 51 received radiotherapy (RT) with (n = 37) or without (n = 14) chemotherapy. Median RT dose was 40 Gy (range 12-55 Gy). RESULTS: Ten (12%) patients progressed locally and 43 (55%) had a systemic relapse. Central nervous system (CNS) was the site of relapse in 12 (14%) cases. The 5-yr overall survival, lymphoma-specific survival, disease-free survival and local control rates were 53%, 59%, 41% and 87% respectively. In the univariate analyses, favorable prognostic factors were early stage, conservative surgery, RT administration and combined modality treatment. Multivariate analysis showed that early stage and the use of RT were favorable prognostic factors. CONCLUSION: The outcome of PBL is fair. Local control is excellent with RT or combined modality treatment but systemic relapses, including that in the CNS, occurs frequently.

Bone propeller flap: a staged procedure.

The ideal reconstruction technique for complex defects of the lower limb consists of replacing tissue with similar tissue in an attempt to achieve a good functional result. A 23-year-old white male sustained a crush injury with a grade IIIB open ankle dislocation. After open reduction and fixation, the patient developed severe osteomyelitis at the tibiotalar joint requiring a staged and radical debridement with a substantial combined soft tissue and bony defect over the distal tibia, fibula, and talus area. The reconstructive approach consisted of a modified model of the propeller flap, implementing the spare part concept in a 2-stage procedure using a prefabricated and vascularized "double-barrel" fibular graft. At 17 months postoperatively, a plain radiograph showed bony union with complete and stable coverage of the soft tissue defect. The patient was fully weightbearing. In conclusion, there is evidence to suggest that the established concept of a soft tissue propeller flap can be implemented on bone.

Treatment of brain metastases from non-small cell lung cancer with whole-brain radiotherapy (wbrt) in combination with gefitinib (gft) or temozolomide (tmz): a randomized multicenter phase ii trial of the swiss group of clinical cancer research (sakk #70/03)

BACKGROUND: Patients with BM rarely survive .6 months and are commonly excluded from clinical trials. We aimed at improving outcome by exploring 2 combined modality regimens with at the time novel agents for which single-agent activity had been shown. METHODS: NSCLC patients with multiple BM were randomized to WBRT (10 × 3 Gy) and either GFT 250 mg p.o. daily or TMZ 75 mg/m2 p.o. daily ×21/28 days, starting on Day 1 of RT and to be continued until PD. Primary endpoint was overall survival, a Simon's optimal 2-stage design was based on assumptions for the 3-month survival rate. Cognitive functioning and quality of life were also evaluated. RESULTS: Fifty-nine patients (36 M, 23 F; 9 after prior chemo) were included. Median age was 61 years (range 46-82), WHO PS was 0 in 18 patients, 1 in 31 patients, and 2 in 10 patients. All but 1 patients had extracranial disease; 33 of 43 (TMZ) and 15 of 16 (GFT) had adenocarcinoma histology. GFT arm was closed early after stage 1 analysis when the prespecified 3-mo survival rate threshold (66%) was not reached, causes of death were not GFT related. Main causes of death were PD in the CNS 24%, systemic 41%, both 8%, and toxicity 10% [intestinal perforation (2 patients), pneumonia (2), pulmonary emboli (1), pneumonitis NOS (1), seizure (1)]. We summarize here other patients' characteristics for the 2 trial arms: TMZ (n ¼ 43)/GFT (n ¼ 16); median treatment duration: 1.6 /1.8 mo; Grade 3-4 toxicity: lymphopenia 5 patients (12%)/0; fatigue 8 patients (19%)/2 patients (13%). Survival data for TMZ/GFT arms: 3-month survival rate: 58.1% (95% CI 42.1-73)/62.5% (95% CI 35- 85); median OS: 4.9 months (95% CI 2.5-5.6)/6.3 months (95% CI 2.2- 14.6); median PFS: 1.8 months (95% CI 1.5-1.8)/1.8 (95% CI 1.1-3.9); median time to neurol. progr.: 8.0 months (95% CI 2.2-X)/4.8 (95% CI 3.9-10.5). In a model to predict survival time including the variables' age, PS, number of BM, global QL, total MMSE score, and subjective cognitive function, none of the variables accounted for a significant improvement in survival time. CONCLUSIONS: The combinations of WBRT with GFT or TMZ were feasible. However, in this unselected patient population, survival remains poor and a high rate of complication was observed. Four patients died as a result of high-dose corticosteroids. Preliminary evaluation of cognitive function andQL failed to show significant improvement. Indications and patient selection for palliative treatment should be revisited and careful monitoring and supportive care is required. Research and progress for this frequent clinical situation is urgently needed. Trial partly supported by AstraZeneca (Switzerland), Essex Chemie (Switzerland) and Swiss Federal Government.

Patient-adapted treatment for prosthetic hip joint infection.

Hip joint replacement is 1 of the most successful surgical procedures of the last century and the number of replacements implanted is steadily growing. An infected hip arthroplasty is a disaster, it leads to patient suffering, surgeon's frustration and significant costs to the health system. The treatment of an infected hip replacement is challenging, healing rates can be low, functional results poor with decreased patient satisfaction. However, if a patient-adapted treatment of infected hip joints is used a success rate of above 90% can be obtained.Patient-adapted treatment is based on 5 important concepts: teamwork; understanding the biofilm; diagnostic accuracy; correct definition and classification of PJI; and patient-tailored treatment.This review presents a patient-adapted treatment strategy to prosthetic hip infection. It incorporates the best aspects of the single and staged surgical strategies and promotes the short interval philosophy for the 2-stage approach.

Kierrätyspolttoaineiden käyttö leijukerrospoltossa vetykaasun kanssa

Tämä diplomityö on tehty Leppäkosken Energia Oy:n ja Kemira Chemicals Oy:n yhteisyritys FC Energia Oy:lle. FC Energia Oy suunnittelee rakentaa uutta bio-vetyvoimalaitosta Sastamalaan. Voimalaitoksella tuotettaisiin Kemira Chemicals Oy:n ylijäämävedystä ja biopolttoaineista sähköä, kaukolämpöä ja prosessihöyryä. Ympäristölupaa on haettu hakkeen, turpeen ja kierrätyspuun poltolle vetykaasun kanssa. Voimalaitoksen kattilan toiminta perustuu kuplivaan leijukerrostekniikkaan. Diplomityössä selvitettiin, mitä muutoksia kierrätyspolttoaineiden käyttö vaatii leijukerrospoltossa verrattuna hakkeen ja turpeen polttoon. Kierrätyspolttoaineena käytetään hyvälaatuista kierrätyspuuta. Kierrätyspuun käytössä sovelletaan jätteenpoltto-asetusta. Jätteenpolttoasetus määrää tiukemmat päästöjen raja-arvot rinnakkaispoltolle kuin hakkeen ja turpeen poltolle sekä jatkuvatoimiset savukaasujen mittauslaitteet. Rinnakkaispolton hiukkasmaisten päästöjen tiukempi raja-arvo vaatii tehokkaamman sähkösuodattimen. Lisäksi kierrätyspuuta käytettäessä tulistimen materiaaliin tulee olla kestävämpää, mikä aiheuttaa huomattavan lisäinvestoinnin. Työn päätavoitteena oli selvittää, onko kierrätyspuun käyttö taloudellisesti kannattavaa. Oletetulla kierrätyspuun hinnalla 10 €/MWh kierrätyspuuta polttavan voimalaitoksen takaisinmaksuaika on sama kuin haketta polttavan laitoksen ja vuoden lyhyempi kuin turvetta polttavan laitoksen. Tulokseksi saatiin, että rinnakkaispoltto käyttö on taloudellisesti kannattavaa hakkeenpolttoon nähden jos kierrätyspuun hinta on alle 11,2 €/MWh. Kierrätyspuun polttoon liittyy toiminnallinen riski, koska vastaavanlaisia rinnakkaispolttolaitoksia ei ole aiemmin rakennettu.

Algorithms for two-dimensional cutting stock and strip packing problems using dynamic programming and column generation

We investigate several two-dimensional guillotine cutting stock problems and their variants in which orthogonal rotations are allowed. We first present two dynamic programming based algorithms for the Rectangular Knapsack (RK) problem and its variants in which the patterns must be staged. The first algorithm solves the recurrence formula proposed by Beasley; the second algorithm - for staged patterns - also uses a recurrence formula. We show that if the items are not so small compared to the dimensions of the bin, then these algorithms require polynomial time. Using these algorithms we solved all instances of the RK problem found at the OR-LIBRARY, including one for which no optimal solution was known. We also consider the Two-dimensional Cutting Stock problem. We present a column generation based algorithm for this problem that uses the first algorithm above mentioned to generate the columns. We propose two strategies to tackle the residual instances. We also investigate a variant of this problem where the bins have different sizes. At last, we study the Two-dimensional Strip Packing problem. We also present a column generation based algorithm for this problem that uses the second algorithm above mentioned where staged patterns are imposed. In this case we solve instances for two-, three- and four-staged patterns. We report on some computational experiments with the various algorithms we propose in this paper. The results indicate that these algorithms seem to be suitable for solving real-world instances. We give a detailed description (a pseudo-code) of all the algorithms presented here, so that the reader may easily implement these algorithms. (c) 2007 Elsevier B.V. All rights reserved.

Effect of intermittent feeding on growth in early juveniles of the crayfish Cherax quadricarinatus

Three experiments were conducted with juveniles of the crayfish Cherax quadricarinatus to investigate the effect of intermittent feeding regimes on growth and the ability to tolerate the shortage of food. In experiment 1, stage III juveniles were assigned to one of seven intermittent feeding groups (from FS1: 1 day fed/1 day non-fed to FS7: 7 days fed/7 days non-fed) and two control groups, continuously fed (CF) and continuously starved (CS) animals; this experiment comprised a short-term intermittent feeding period until the first molt, followed by a continuous feeding period. In the experiment 2, stage III juveniles were assigned to one of three intermittent feeding groups (FS2 to FS4) and one control group (CF); it consisted of a prolonged intermittent feeding period, until the end of the experiment In the experiment 3, stage VI and VII juveniles were assigned to one of three intermittent feeding groups (FS2 to FS4) and one control (CF); it also consisted of a prolonged intermittent feeding period. The red claw crayfish juveniles were able to tolerate periods of intermittent feeding and underwent compensatory growth after continuous feed was re-established. The ability of crayfish to tolerate intermittent feeding was influenced by developmental stage and duration of the intermittent feeding period. Stage III juveniles survived, but decreased growth, when subjected to prolonged intermittent feeding. However, they showed full compensatory growth when the intermittent feeding period was short and followed by continuous feeding. on the other hand, stage VI-VII tolerated 60 days of prolonged intermittent feeding without any change in growth and survival. The hepatosomatic index (based on wet weight) values of the treatments and the control were similar, suggesting that intermittent feeding may not be considered a nutritional stress condition. The relative pleon weight (based on wet weight) values of the treatments and control were similar suggesting low use of nutrients from the muscle to increase the chance for survival. The juveniles of C quadricarinatus can tolerate relatively long periods of low food availability and this is an important adaptation for their survival in changing/unpredictable environments and an attribute favorable for the production of the species. (C) 2011 Elsevier B.V. All rights reserved.

Clinical Viability for Immediate Loading of Dental Implants: Part II-Treatment Alternatives

The treatment with implants aims to obtain a direct interface between bone and implant. The implant is kept load-free during 4 to 6 months in the 2-stage procedure, which is considered a requisite for osseointegration. However, this period is based on empirical principles and uncomfortable for patient. So, the immediate loading protocol was Suggested to submit implants to occlusal function after placement. This protocol has been applied for several conditions of edentulism. The aim of this study was to evaluate the treatment alternatives for immediate loading of complete and partial edentulous patients. In general, the studies have demonstrated high previsibility for rehabilitation of complete edentulous arches with full-arch, implant-supported prosthesis. The rehabilitation with immediate loading for maxillary overdenture is questionable because there is no longitudinal study in literature. The studies with partial edentulous arches have demonstrated high success rates for implants placed in the mandibular and maxillary anterior region. Additional care is recommended for posterior region mainly in the maxillary arch, and further studies are suggested to corroborate this treatment.