Epidemiology of myopia in a United Kingdom urban child population

The Aston Eye Study (AES) was instigated in October 2005 to determine the distribution of refractive error and associated ocular biometry in a sample of UK urban school children. The AES is the first study to compare outcome measures separately in White, South Asian and Black children. Children were selected from two age groups (Year 2 children aged 6/7 years, Year8 children aged 12/13 years of age) using random cluster sampling of schools in Birmingham, West Midlands UK. To date, the AES has examined 598 children (302 Year 2,296 Year 8). Using open-field cycloplegic autorefraction, the overall prevalence of myopia (=-0.50D SER in either eye) determined was 19.6%, with a higher prevalence in older (29.4%) compared to younger (9.9%) children (p<0.001). Using multiple logistic regression models, the risk of myopia was higher in Year 8 South Asian compared to White children and higher in children attending grammar schools relative to comprehensive schools. In addition, the prevalence of uncorrected ametropia was found to be high (Year 8: 12.84%, Year 2: 15.23%), which will be of concern to bodies responsible for the implementation of school vision screening strategies. Biometric data using non-contact partial coherence interferometry revealed a contributory effect of axial length (AL) and central corneal radius (CR) on myopic refraction, resulting in a strong coefficient of determination of the AL/CR ratio on refractive error. Ocular biometric measures did not vary significantly as a function of ethnicity, suggesting a greater miscorrelation of components in susceptible ethnic groups to account for their higher myopia prevalence. Corneal radius was found to be steeper in myopes in both age groups, but was found to flatten with increasing axial length. Due to the inextricable link between myopia and axial elongation, the paradoxical finding of the cornea demands further longitudinal investigation, particularly in relation to myopia onset. Questionnaire analysis revealed a history of myopia in parents and siblings to be significantly associated with myopia in Year 8 children, with a dose-dependent rise in the odds ratio of myopia evident with increasing number of myopic parents. By classifying socioeconomic status (SES) using Index of Multiple Deprivation values, it was found that Year 8 children from moderately deprived backgrounds were more at risk of myopia compared with children located at both extremities of the deprivation spectrum. However, the main effect of SES weakened following multivariate analysis, with South Asian ethnicity and grammar schooling remaining associated with Year 8 myopia after adjustment.

Accountability, organisational learning and risks to patient safety in England: conflict or compromise?

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Corporate responsibility reporting of biodiversity in the supply chain

Industrial development, accompanying human population growth, has had a major role in creating the situation where bio-diverse materials and services essential for sustaining business are under threat. A major contributory factor to biodiversity decline comes from the cumulative impacts of extended supply chain business operations. However, within Corporate Responsibility (CR) reporting impacts on biodiversity due to supply chain operations have not traditionally been given equal weighting with other environmental issues. This paper investigates the extent of CR reporting in managing and publicising company biodiversity supply chain issues by reviewing a cross-sector sample of publicly available CR reports. The report contents were examined for suggestions of industrial sectorial trends in the level of biodiversity consideration. The reporting of environmental management system use within company supply chain management is assessed in the samples and is considered as a mechanism for responsible supplier partnership working.

A novel role for the adipokine visfatin/pre-B cell colony-enhancing factor 1 in prostate carcinogenesis

Adipose tissue is now well established as an endocrine organ and multiple hormones termed ‘adipokines’ are released from it. With the rapidly increasing obese population and the increased risk mortality from prostate cancer within the obese population we looked to investigate the role of the adipokine visfatin in LNCaP and PC3 prostate cancer cell lines. Using immunohistochemistry and immunocytochemistry we demonstrate visfatin expression in LNCaP (androgen-sensitive) and PC3 (androgen-insensitive) human prostate cancer cell lines as well as human prostate cancer tissue. Additionally, we show that visfatin increases PC3 cell proliferation and demonstrate the activation of the MAPKs ERK-1/2 and p38. Moreover we also demonstrate that visfatin promotes the expression and activity of MMP-2/9 which are important proteases involved in the breakdown of the extracellular matrix, suggesting a possible role for visfatin in prostate cancer metastases. These data suggest a contributory and multifunctional role for visfatin in prostate cancer progression, with particular relevance and emphasis in an obese population.

Women's experiential journey toward voluntary childlessness

Voluntary childlessness is a relatively novel yet growing phenomenon. This idiographic study explored three women's experiential journeys toward voluntary childlessness. Semi-structured interviews were carried out and analysed using Interpretative Phenomenological Analysis. Themes identified were: Owning the choice to be childless, social expectations, and models of mothering. Despite defining ‘voluntary childlessness’ as an unequivocal decision, the women's experiential accounts revealed an intrinsic fluidity in their journeys toward childlessness. Factors including beliefs in equality, independence and career aspirations competed with constructs of mothering/motherhood, partnership and choice to create a complex tapestry of contributory factors in these women's childlessness. The findings question the notion of choice and particularly women's ownership of that choice. The journeys toward childlessness these women shared reveal a synthesis of agentic decision-making, personal histories and challenging lifestyle choices bound up within an existential need to be a woman. More research is needed to determine the place of voluntary childlessness within society. Copyright © 2010 John Wiley & Sons, Ltd

'He was like a zombie':off-label prescription of antipsychotic drugs in dementia

This paper explores the legal position of the off-label prescription of antipsychotic medications to people with dementia who experience behavioural and psychological symptoms of dementia (BPSD). Dementia is a challenging illness, and BPSD can be very difficult for carers to manage, with evidence that this contributes to carer strain and can result in the early institutionalisation of people with dementia. As a result, the prescription of antipsychotic and other neuroleptic medications to treat BPSD has become commonplace, in spite of these drugs being untested and unlicensed for use to treat older people with dementia. In recent years, it has become apparent through clinical trials that antipsychotic drugs increase the risk of cerebrovascular accident (stroke) and death in people with dementia. In addition, these types of medication also have other risk factors for people with dementia, including over-sedation and worsening of cognitive function. Drawing on recent questionnaire (n = 185), focus group (n = 15), and interview (n = 11) data with carers of people with dementia, this paper explores the law relating to off-label prescription, and the applicability of medical negligence law to cases where adverse events follow the use of antipsychotic medication. It is argued that the practice of off-label prescribing requires regulatory intervention in order to protect vulnerable patients. © The Author [2012]. Published by Oxford University Press; all rights reserved.

Negotiating proximity:expert testimony and collective memory in the trials of environmental activists in France and the United Kingdom

This article analyzes the role of expert witness testimony in the trials of social movement actors, discussing the trial of the "Kingsnorth Six" in Britain and the trials of activists currently mobilising against airport construction at Notre Dame des Landes in western France. Though the study of expert testimony has so far overwhelmingly concentrated on fact-finding and admissibility, the cases here reveal the importance of expert testimony not simply in terms of legal argument, but in "moral" or political terms, as it reflects and constitutes movement cognitive praxis. In the so-called climate change defence presented by the Kingsnorth Six, I argue that expert testimony attained a "negotiation of proximity," connecting different types of contributory expertise to link the scales and registers of climate science with those of everyday understanding and meaning. Expert testimony in the trials of activists in France, however, whilst ostensibly able to develop similar bridging narratives, has instead been used to construct resistance to the airport siting as already proximate, material, and embedded. To explain this, I argue that attention to the symbolic, as well as instrumental, functions of expert testimony reveals the crucial role that collective memory plays in the construction of both knowledge and grievance in these cases. Collective memory is both a constraint on and catalyst for mobilisation, defining the boundaries of the sayable. Testimony in trials both reflects and reproduces these elements and is a vital explanatory tool for understanding the narrativisation and communication of movement identities and objectives. © 2013 The Author. Law & Policy © 2013 The University of Denver/Colorado Seminary.

Pharmacy legislation:public protector or professional hindrance?

Pharmacy originates from a background of medication compounding and supply. More recently, this role has developed away from an absolute focus on the supply of pharmaceuticals with, for example, the advent of pharmacist prescribing. Nevertheless, for a majority of the profession, medication supply remains a core activity. Regulation of the pharmacy profession is now the responsibility of the General Pharmaceutical Council, although up until 27 September 2010, this role fell to the Royal Pharmaceutical Society of Great Britain (RPSGB). Before this change, in one of the most high-profile legal cases involving a pharmacist in a professional capacity, R. v Lee, a pharmacist was prosecuted firstly for gross negligence manslaughter, later revised to offences under the Medicines Act 1968, for a single error relating to medication supply, and was given a suspended custodial sentence. Offences against sections 64 or 85 of the Medicines Act are absolute offences and there is no due diligence defence. Prosecution of a pharmacist for the supply of incorrect medication may seem a measured course of action to protect the public from the wrongful supply of potent pharmacotherapeutic agents; however, further analysis of Lee indicates that this approach may be counterproductive. An appeal of the original conviction in the Lee case has resulted in a clarification of the interpretation of section 85(5); however currently, prosecutions under section 64 are still a possibility. Owing to the seriousness of a criminal conviction under section 64, this continuation will potentially stifle the profession's ability to learn from dispensing errors. © The Author [2013]. Published by Oxford University Press; all rights reserved.

Low protein diet fed exclusively during mouse oocyte maturation leads to behavioural and cardiovascular abnormalities in offspring

Early embryonic development is known to be susceptible to maternal undernutrition, leading to a disease-related postnatal phenotype. To determine whether this sensitivity extended into oocyte development, we examined the effect of maternal normal protein diet (18% casein; NPD) or isocaloric low protein diet (9% casein; LPD) restricted to one ovulatory cycle (3.5 days) prior to natural mating in female MF-1 mice. After mating, all females received NPD for the remainder of gestation and all offspring were litter size adjusted and fed standard chow. No difference in gestation length, litter size, sex ratio or postnatal growth was observed between treatments. Maternal LPD did, however, induce abnormal anxiety-related behaviour in open field activities in male and female offspring (P <0.05). Maternal LPD offspring also exhibited elevated systolic blood pressure (SBP) in males at 9 and 15 weeks and in both sexes at 21 weeks (P <0.05). Male LPD offspring hypertension was accompanied by attenuated arterial responsiveness in vitro to vasodilators acetylcholine and isoprenaline (P <0.05). LPD female offspring adult kidneys were also smaller, but had increased nephron numbers (P <0.05). Moreover, the relationship between SBP and kidney or heart size or nephron number was altered by diet treatment (P <0.05). These data demonstrate the sensitivity of mouse maturing oocytes in vivo to maternal protein undernutrition and identify both behavioural and cardiovascular postnatal outcomes, indicative of adult disease. These outcomes probably derive from a direct effect of protein restriction, although indirect stress mechanisms may also be contributory. Similar and distinct postnatal outcomes were observed here compared with maternal LPD treatment during post-fertilization preimplantation development which may reflect the relative contribution of the paternal genome. © Journal compilation © 2008 The Physiological Society.

Surface damage and near-threshold fatigue crack growth in a Ni-base superalloy in vacuum

Fatigue crack growth rate tests have been performed on Nimonic AP1, a powder formed Ni-base superalloy, in air and vacuum at room temperature. These show that threshold values are higher, and near-threshold (faceted) crack growth rates are lower, in vacuum than in air, although at high growth rates, in the “structure-insensitive” regime, R-ratio and a dilute environment have little effect. Changing the R-ratio from 0.1 to 0.5 in vacuum does not alter near-threshold crack growth rates very much, despite more extensive secondary cracking being noticeable at R= 0.5. In vacuum, rewelding occurs at contact points across the crack as ΔK falls. This leads to the production of extensive fracture surface damage and bulky fretting debris, and is thought to be a significant contributory factor to the observed increase in threshold values.

EP4 prostanoid receptor-mediated vasodilatation of human middle cerebral arteries

1 Dilatation of the cerebral vasculature is recognised to be involved in the pathophysiology of migraine. Furthermore, elevated levels of prostaglandin E2 (PGE2) occur in the blood, plasma and saliva of migraineurs during an attack, suggestive of a contributory role. In the present study, we have characterised the prostanoid receptors involved in the relaxation and contraction of human middle cerebral arteries in vitro. 2 In the presence of indomethacin (3μM) and the TP receptor antagonist GR32191 (1 μM), PGE2 was found to relax phenylephrine precontracted cerebral arterial rings in a concentration-dependent manner (mean pEC50 8.0 ± 0.1, n = 5). 3 Establishment of a rank order of potency using the EP4 > EP2 agonist 11-deoxy PGE1, and the EP2 > EP4 agonist PGE1-OH (mean pEC 50 of 7.6 ± 0.1 (n = 6) and 6.4 ± 0.1 (n = 4), respectively), suggested the presence of functional EP4 receptors. Furthermore, the selective EP2 receptor agonist butaprost at concentrations < 1 μM failed to relax the tissues. 4 Blockade of EP 4 receptors with the EP4 receptor antagonists AH23848 and EP4A caused significant rightward displacements in PGE2 concentration-response curves, exhibiting pA2 and pKB values of 5.7 ± 0.1, n = 3, and 8.4, n = 3, respectively. 5 The IP receptor agonists iloprost and cicaprost relaxed phenylephrine precontracted cerebral arterial rings (mean pEC50 values 8.3 ± 0.1 (n = 4) and 8.1 ± 0.1 (n = 9), respectively). In contrast, the DP and FP receptor agonists PGD2 and PGFα2 failed to cause appreciable relaxation or contraction at concentrations of up to 30 μM. In the absence of phenylephrine contraction and GR32191, the TP receptor agonist U46619 caused concentration-dependent contraction of cerebral artery (mean pEC50 7.4 ± 0.3, n = 3). 6 These data demonstrate the presence of prostanoid EP4 receptors mediating PGE2 vasodilatation of human middle cerebral artery. IP receptors mediating relaxation and TP receptors mediating contraction were also functionally demonstrated.

A role for epigenetic modulation of the innate immune response during aging

The ageing process results from a complex interplay between genes and the environment that can precipitate an uncontrolled inflammation. Epigenetic changes are believed to provide a link between the environment and nutrition to gene expression by altering the activity of some histone-modifying protein. Epigenetic modifications of DNA and histone proteins have been proposed as important contributory mechanisms to the retention of metabolic memory over time. A thorough understanding of the posttranscriptional and epigenetic factors involved in both normal ageing and age-related disease may inform new strategies and approaches to diagnose, treat, or suppress many aspects of age-dependent frailty.

The effects of defendant account on damage award decisions

The purpose of this study was to examine whether the manner in which civil defendants account for their behavior influences compensatory and punitive damage awards. Jurors read three civil trial summaries, in which I manipulated injury severity (high vs. low), defendant reprehensibility (high vs. low), defendant status (individual vs. corporate), and account (concession, excuse, justification or refusal) in a factorial design. I also included four control groups in which the defendant stipulated liability. In all other conditions, participants read that a jury had found the defendant negligent. Only defendant reprehensibility influenced punitive awards. Both plaintiff injury and defendant reprehensibility influenced compensatory awards. When individuals offered justifications and when corporations offered excuses, jurors awarded lower compensatory awards against low reprehensibility defendants than against high reprehensibility defendants. Negligence stipulations led to lower damage awards for individuals than for corporations. Additionally, concessions tended to produce lower awards when combined with a stipulation of negligence as opposed to a jury decision. These findings support the hypothesis that in cases in which the defendant is clearly negligent, circumstances exist in which stipulating negligence and offering an apologetic account will lead to reduced damage awards decisions. Results indicate that individual and corporate defendants offering justifications and refusals should first consider the reprehensibility of their actions. In a broader realm, findings demonstrate that the manner in which a jury perceives the explanation given by the defendant is dependent upon defendant characteristics and case-specific factors. ^

True and false confessions to an intentional act: A novel experimental paradigm

Due to the powerful nature of confession evidence, it is imperative that we investigate the factors that affect the likelihood of obtaining true and false confessions. Previous research has been conducted with a paradigm limited to the study of false confessions to an act of negligence, thereby limiting the generalizability of the findings. The first goal of the current study was to introduce a novel paradigm involving a more serious, intentional act that can be used in the study of both true and false confessions. The second goal was to explore the effects of two police interrogation tactics, minimization and an offer of leniency, on true and false confession rates. ^ Three hundred and thirty-four undergraduates at a large southeastern university were recruited to participate in a study on problem-solving and decision-making. During the course of the laboratory experiment, participants were induced to intentionally break or not break an experimental rule, an act that was characterized as “cheating.” All participants (i.e., both innocent and guilty) were later accused of the act and interrogated. For half of the participants, the interrogator used minimization tactics, which involved downplaying the seriousness of the offense, expressing sympathy, and providing face-saving excuses, in order to encourage the participant to confess. An offer of leniency was also manipulated in which half the participants were offered a “deal” that involved the option of confessing and accepting a known punishment or not confessing and facing the threat of harsher punishment. Results indicated that guilty persons were more likely to confess than innocent persons, and that the use of minimization and an explicit offer of leniency increased both the true and false confession rates. Furthermore, a cumulative effect of techniques was observed, such that the diagnosticity of the interrogation (the ratio of true confessions to false confessions) decreased as the number of techniques used increased. Taken together, the results suggest that caution should be used when implementing these techniques in the interrogation room. ^

The High Cost of Hasty Hiring

Carefully reading employment applications and checking out all references and prior-employment records is vital to hotel managers and personnel directors today. Many legal suits are the result of employees who, hired quickly because of an immediate need, commit some crime in relation to guest rooms or property.