Living with acquired brain injury

This study found that natural community supports were comprised of two distinct groupings; firstly immediate families, friends and peer support groups; secondly neighbours and local community groups such as sporting and activity- based organisations and groups. The findings of this study indicate that living with acquired brain injury involves a process where the person moves from acute high intensity health services onto rehabilitative services and then onto re-establishing independent lives. It is evident that smooth transitions and interconnectivity of services are essential in facilitating this recovery process. Instrumental to the recovery is the support of immediate family and close friends, who form people’s immediate natural support network and go a long way towards facilitating individuals in rebuilding their lives. A key finding of this study is that broader natural community supports do not appear to play as central a role in supporting individuals to live independent lives when compared to the role of family and friends. The lack of involvement of broader community groups, in many ways, prompted individuals to contact formal support services. For the majority of participants, independence is facilitated through the combination of immediate natural community supports and formal services. The role of formal support services is key to developing broader community support networks. This study found a blurred division between formal services and broader community support networks. The authors recommended that the role of formal supports services in acting as a bridge between the needs of the individual and the development of meaningful community networks, be formally recognised and further developed. Additionally, they argued that the importance of the role of broader natural community, supports such as those provided by community and sporting groups must be enhanced. Greater awareness of the issues faced by people living with acquired brain injury and its often invisible nature is necessary in this endeavour. The authors stated it is important to recognise that there are multiple issues impacting on independent living and these issues intersect, for instance with age, gender, employment, qualifications and so on. A lack of public awareness of acquired brain injury was found to be a key barrier to independent living, along with issues relating to socialising, access to employment and finances. The findings of this study reflect the complexities of living with acquired brain injury and the need for holistic support that is cognisant of the factors which impact on integration. It is vital that flexible, personalised services are developed which are fit for purpose and meet the needs of not only people with acquired brain injury but also their immediate natural community support network. Recognition of the intersection between immediate/ broader natural community supports and formal services is also key to developing the comprehensive and practical supports required to achieve an independent life. This was a qualitative study and all participants were sourced through Headway, a community based service provider for people with ABI. Data collection was divided into two stages: firstly focus groups, followed by individual interviews. Four focus groups were convened in Cork (2), Dublin (1) and Limerick (1). Each focus group was facilitated by at least two members of the research team and a total of twenty-six individuals participated in the focus groups. Thematic analysis of the data was undertaken to guide and inform the second stage of the study; the individual interviews. Ten interviews were undertaken with individuals who presented with ABI in the Cork and Limerick regions.

Favorable effect on acute and chronic graft-versus-host disease with cyclophosphamide and in vivo anti-CD52 monoclonal antibodies for marrow transplantation from HLA-identical sibling donors for acquired aplastic anemia

Between August 1989 and November 2003, 33 patients at our center with acquired aplastic anemia underwent bone marrow transplantation (BMT) from HLA-identical sibling donors with cyclophosphamide and in vivo anti-CD52 monoclonal antibodies (MoAb) for conditioning. The median age at BMT was 17 years (range, 4-46 years). Before BMT, 58% were heavily transfused (>50 transfusions), and 42% had previously experienced treatment failure with antithymocyte globulin-based immunosuppressive therapy. Unmanipulated bone marrow was used as the source of stem cells in all patients except 1. Graft-versus-host disease (GVHD) prophylaxis was with cyclosporine alone in 19 (58%) patients; 14 received anti-CD52 MoAb in addition to cyclosporine. The conditioning regimen was well tolerated without significant acute toxicity. Graft failure was seen in 8 patients (primary, n = 4; secondary, n = 4). Of those whose grafts failed, 4 survived long-term (complete autologous recovery, n = 2; rescue with previously stored marrow, n = 1; second allograft, n = 1). The cumulative incidence of graft failure and grade II to IV acute and chronic GVHD was 24%, 14%, and 4%, respectively. None developed extensive chronic GVHD. With a median follow-up of 59 months, the 5-year survival was 81% (95% confidence interval, 68%-96%). No unexpected early or late infectious or noninfectious complications were observed. We conclude that the conditioning regimen containing cyclophosphamide and anti-CD52 MoAb is well tolerated and effective for acquired aplastic anemia with HLA-matched sibling donors. The favorable effect on the incidence and severity of GVHD is noteworthy in this study and warrants further investigation.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Climate impacts of recent multidecadal changes in Atlantic Ocean Sea Surface Temperature: A multimodel comparison

During the twentieth century sea surface temperatures in the Atlantic Ocean exhibited prominent multidecadal variations. The source of such variations has yet to be rigorously established—but the question of their impact on climate can be investigated. Here we report on a set of multimodel experiments to examine the impact of patterns of warming in the North Atlantic, and cooling in the South Atlantic, derived from observations, that is characteristic of the positive phase of the Atlantic Multidecadal Oscillation (AMO). The experiments were carried out with six atmospheric General Circulation Models (including two versions of one model), and a major goal was to assess the extent to which key climate impacts are consistent between the different models. The major climate impacts are found over North and South America, with the strongest impacts over land found over the United States and northern parts of South America. These responses appear to be driven by a combination of an off-equatorial Gill response to diabatic heating over the Caribbean due to increased rainfall within the region and a Northward shift in the Inter Tropical Convergence Zone (ITCZ) due to the anomalous cross-equatorial SST gradient. The majority of the models show warmer US land temperatures and reduced Mean Sea Level Pressure during summer (JJA) in response to a warmer North Atlantic and a cooler South Atlantic, in line with observations. However the majority of models show no significant impact on US rainfall during summer. Over northern South America, all models show reduced rainfall in southern hemisphere winter (JJA), whilst in Summer (DJF) there is a generally an increase in rainfall. However, there is a large spread amongst the models in the magnitude of the rainfall anomalies over land. Away from the Americas, there are no consistent significant modelled responses. In particular there are no significant changes in the North Atlantic Oscillation (NAO) over the North Atlantic and Europe in Winter (DJF). Additionally, the observed Sahel drying signal in African rainfall is not seen in the modelled responses. Suggesting that, in contrast to some studies, the Atlantic Multidecadal Oscillation was not the primary driver of recent reductions in Sahel rainfall.

The biology and ecology of the ocean sunfish Mola mola : a review of current knowledge and future research perspectives

Relatively little is known about the biology and ecology of the world’s largest (heaviest) bony fish, the ocean sunfish Mola mola, despite its worldwide occurrence in temperate and tropical seas. Studies are now emerging that require many common perceptions about sunfish behaviour and ecology to be re-examined. Indeed, the long-held view that ocean sunfish are an inactive, passively drifting species seems to be entirely misplaced. Technological advances in marine telemetry are revealing distinct behavioural patterns and protracted seasonal movements. Extensive forays by ocean sunfish into the deep ocean have been documented and broad-scale surveys, together with molecular and laboratory based techniques, are addressing the connectivity and trophic role of these animals. These emerging molecular and movement studies suggest that local distinct populations may be prone to depletion through bycatch in commercial fisheries. Rising interest in ocean sunfish, highlighted by the increase in recent publications, warrants a thorough review of the biology and ecology of this species. Here we review the taxonomy, morphology, geography, diet, locomotion, vision, movements, foraging ecology, reproduction and species interactions of M. mola. We present a summary of current conservation issues and suggest methods for addressing fundamental gaps in our knowledge.

Multi-Objective Pipe Smoothing Genetic Algorithm For Water Distribution Network Design

This paper describes the formulation of a Multi-objective Pipe Smoothing Genetic Algorithm (MOPSGA) and its application to the least cost water distribution network design problem. Evolutionary Algorithms have been widely utilised for the optimisation of both theoretical and real-world non-linear optimisation problems, including water system design and maintenance problems. In this work we present a pipe smoothing based approach to the creation and mutation of chromosomes which utilises engineering expertise with the view to increasing the performance of the algorithm whilst promoting engineering feasibility within the population of solutions. MOPSGA is based upon the standard Non-dominated Sorting Genetic Algorithm-II (NSGA-II) and incorporates a modified population initialiser and mutation operator which directly targets elements of a network with the aim to increase network smoothness (in terms of progression from one diameter to the next) using network element awareness and an elementary heuristic. The pipe smoothing heuristic used in this algorithm is based upon a fundamental principle employed by water system engineers when designing water distribution pipe networks where the diameter of any pipe is never greater than the sum of the diameters of the pipes directly upstream resulting in the transition from large to small diameters from source to the extremities of the network. MOPSGA is assessed on a number of water distribution network benchmarks from the literature including some real-world based, large scale systems. The performance of MOPSGA is directly compared to that of NSGA-II with regard to solution quality, engineering feasibility (network smoothness) and computational efficiency. MOPSGA is shown to promote both engineering and hydraulic feasibility whilst attaining good infrastructure costs compared to NSGA-II.

Valuation equilibrium with crubs

This paper considers model worlds in which there are a continuum of individuaIs who form finite sized associations to undertake joint activities. We show that if there are a finite set of types and the commodity space contains lotteries, then the c1assicaI equilibrium results on convex economies can be reinterpreted to apply. Furthermore, in this lottery economy deterministic aIlocations (that is, degenerate lotteries) are generally not Pareto optimal, nor are they equilibria. In the interests of making the model seem more "natural," we show that the set of equilibria in a decentraIization in which individuaIs first gamble over vaIue transfers and then trade commodities in a deterministic competitive market economy are equivalent to those of our competi tive economy with a lottery commodity space.

Further Quantum Mechanical Evidence that Difluorotoluene does not Hydrogen Bond

Calculations were run on the methylated DNA base pairs adenine:thymine and adenine:difluorotoluene to further investigate the hydrogen-bonding properties of difluorotoluene (F). Geometries were optimized using hybrid density functional theory. Single-point calculations at the MP2(full) level were performed to obtain more rigorous energies. The functional counterpoise method was used to correct for the basis set superposition error (BSSE), and the interaction energies were also corrected for fragment relaxation. These corrections brought the B3LYP and MP2 interaction energies into excellent agreement. In the gas phase, the Gibbs free energies calculated at the B3LYP and MP2 levels of theory predict that A and T will spontaneously form an A:T pair while A:F spontaneously dissociates into A and F. Solvation effects on the pairing of the bases were explored using implicit solvent models for water and chloroform. In aqueous solution, both A:T and A:F are predicted to dissociate into their component monomers. Semiempirical calculations were performed on small sections of B-form DNA containing the two pairs, and the results provide support for the concept that base stacking is more important than hydrogen bonding for the stability of the A:F pair within a DNA helix.

Comparison of Experimental and Theoretical Structures of a Transition State Analogue Used for the Induction of Anti-Cocaine Catalytic Antibodies

Comparison of the crystal structure of a transition state analogue that was used to raise catalytic antibodies for the benzoyl ester hydrolysis of cocaine with structures calculated by ab initio, semiempirical, and solvation semiempirical methods reveals that modeling of solvation is crucial for replicating the crystal structure geometry. Both SM3 and SM2 calculations, starting from the crystal structure TSA I, converged on structures similar to the crystal structure. The 3-21G(*)/HF, 6-31G*/HF, PM3, and AM1 calculations converged on structures similar to each other, but these gas-phase structures were significantly extended relative to the condensed phase structures. Two transition states for the hydrolysis of the benzoyl ester of cocaine were located with the SM3 method. The gas phase calculations failed to locate reasonable transition state structures for this reaction. These results imply that accurate modeling of the potential energy surfaces for the hydrolysis of cocaine requires solvation methods.