Guidance on the management of diarrhoea during cancer chemotherapy

Diarrhoea induced by chemotherapy in cancer patients is common, causes notable morbidity and mortality, and is managed inconsistently. Previous management guidelines were based on poor evidence and neglect physiological causes of chemotherapy-induced diarrhoea. In the absence of level 1 evidence from randomised controlled trials, we developed practical guidance for clinicians based on a literature review by a multidisciplinary team of clinical oncologists, dietitians, gastroenterologists, medical oncologists, nurses, pharmacist, and a surgeon. Education of patients and their carers about the risks associated with, and management of, chemotherapy-induced diarrhoea is the foundation for optimum treatment of toxic effects. Adequate—and, if necessary, repeated—assessment, appropriate use of loperamide, and knowledge of fluid resuscitation requirements of affected patients is the second crucial step. Use of octreotide and seeking specialist advice early for patients who do not respond to treatment will reduce morbidity and mortality. In view of the burden of chemotherapy-induced diarrhoea, appropriate multidisciplinary research to assess meaningful endpoints is urgently required.

Regional integration of biogas – developing an intersectoral research action plan for Northern Ireland

Bioenergy is a key component of the European Union long term energy strategy across all sectors, with a target contribution of up to 14% of the energy mix by 2020. It is estimated that there is the potential for 1TWh of primary energy from biogas per million persons in Europe, derived from agricultural by-products and waste. With an agricultural sector that accounts for 75% of land area and a large number of advanced engineering firms, Northern Ireland is a region with considerable potential for an integrated biogas industry. Northern Ireland is also heavily reliant on imported fossil fuels. Despite this, the industry is underdeveloped and there is a need for a collaborative approach from research, business and policy-makers across all sectors to optimise Northern Ireland’s abundant natural resources. ‘Developing Opportunities in Bio-Energy’ (i.e. Do Bioenergy) is a recently completed project that involved both academic and specialist industrial partners. The aim was to develop a biogas research action plan for 2020 to define priorities for intersectoral regional development, co-operation and knowledge transfer in the field of production and use of biogas. Consultations were held with regional stakeholders and working groups were established to compile supporting data, decide key objectives and implementation activities. Within the context of this study it was found that biogas from feedstocks including grass, agricultural slurry, household and industrial waste have the potential to contribute from 2.5% to 11% of Northern Ireland’s total energy consumption. The economics of on-farm production were assessed, along with potential markets and alternative uses for biogas in sectors such as transport, heat and electricity. Arising from this baseline data, a Do Bioenergy was developed. The plan sets out a strategic research agenda, and details priorities and targets for 2020. The challenge for Northern Ireland is how best to utilise the biogas – as electricity, heat or vehicle fuel and in what proportions. The research areas identified were: development of small scale solutions for biogas production and use; solutions for improved nutrient management; knowledge supporting and developing the integration of biogas into the rural economy; and future crops and bio-based products. The human resources and costs for the implementation were estimated as 80 person-years and £25 million respectively. It is also clear that the development of a robust bio-gas sector requires some reform of the regulatory regime, including a planning policy framework and a need to address social acceptance issues. The Action Plan was developed from a regional perspective but the results may be applicable to other regions in Europe and elsewhere. This paper presents the methodology, results and analysis, and discussion and key findings of the Do Bioenergy report for Northern Ireland.

A techno-economic feasibility study of high altitude wind power in Northern Ireland

Globally the amount of installed terrestrial wind power both onshore and offshore has grown rapidly over the last twenty years. Most large onshore and offshore wind turbines are designed to harvest winds within the atmospheric boundary layer, which can be vary variable due to terrain and weather effects. The height of the neutral atmospheric boundary layer is estimated at above 1300m. A relatively new concept is to harvest more consistent wind conditions above the atmospheric boundary layer using high altitude wind harvesting devices such as tethered kites, air foils and dirigible rotors. This paper presents a techno-economic feasibility study of high altitude wind power in Northern Ireland. First this research involved a state of the art review of the resource and the technologies proposed for high altitude wind power. Next the techno-economic analysis involving four steps is presented. In step one, the potential of high altitude wind power in Northern Ireland using online datasets (e.g. Earth System Research Laboratory) is estimated. In step two a map for easier visualisation of geographical limitations (e.g. airports, areas of scenic beauty, flight paths, military training areas, settlements etc.) that could impact on high altitude wind power is developed. In step three the actual feasible resource available is recalculated using the visualisation map to determine the ‘optimal’ high altitude wind power locations in Northern Ireland. In the last step four the list of equipment, resources and budget needed to build a demonstrator is provided in the form of a concise techno-economic appraisal using the findings of the previous three steps.

A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

Aim: To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy.

Background: International research demonstrates that 25-30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness.

Design: A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy.

Data Sources: Cochrane library (1898-2013), PubMed (1996-2013), MEDLINE (1946-2013), AMED (1985-2013), Embase (1974-2013), Cinahl (1937-2013), Index to Thesis (1716-2013) and Ethos (1914-2013).

Review Methods: Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool.

Results: Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.

Conclusion: There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform

Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge (www.trialforge.org) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.

This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.

General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.

Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.

New transiting exoplanets from the SuperWASP-North survey

The Wide Angle Search for Planet (WASP) project is one of the leading projects in the discovery of transiting exoplanets. We present 1) the current status of the WASP-North survey, 2) our recent exoplanet discoveries, and 3) we exemplify how these results fit into our understanding of transiting exoplanet properties and how they can help to understand exoplanet diversity.

◦‘She said she was in the family way’: Pregnancy and infancy in Modern Ireland'

I wrote the preface to this collection of essays by my former student, Dr Elaine Farrell

Investigation of the temperature homogeneity of die melt flows in polymer extrusion

Polymer extrusion is fundamental to the processing of polymeric materials and melt flow temperature homogeneity is a major factor which influences product quality. Undesirable thermal conditions can cause problems such as melt degradation, dimensional instability, weaknesses in mechanical/optical/geometrical properties, and so forth. It has been revealed that melt temperature varies with time and with radial position across the die. However, the majority of polymer processes use only single-point techniques whose thermal measurements are limited to the single point at which they are fixed. Therefore, it is impossible for such techniques to determine thermal homogeneity across the melt flow. In this work, an extensive investigation was carried out into melt flow thermal behavior of the output of a single extruder with different polymers and screw geometries over a wide range of processing conditions. Melt temperature profiles of the process output were observed using a thermocouple mesh placed in the flow and results confirmed that the melt flow thermal behavior is different at different radial positions. The uniformity of temperature across the melt flow deteriorated considerably with increase in screw rotational speed while it was also shown to be dependent on process settings, screw geometry, and material properties. Moreover, it appears that the effects of the material, machine, and process settings on the quantity and quality of the process output are heavily coupled with each other and this may cause the process to be difficult to predict and variable in nature

The effect of melt viscosity on thermal efficiency for single screw extrusion of HDPE

In this work, a highly instrumented single screw extruder has been used to study the effect of polymer rheology on the thermal efficiency of the extrusion process. Three different molecular weight grades of high density polyethylene (HDPE) were extruded at a range of conditions. Three geometries of extruder screws were used at several set temperatures and screw rotation speeds. The extruder was equipped with real-time quantification of energy consumption; thermal dynamics of the process were examined using thermocouple grid sensors at the entrance to the die. Results showed that polymer rheology had a significant effect on process energy consumption and thermal homogeneity of the melt. Highest specific energy consumption and poorest homogeneity was observed for the highest viscosity grade of HDPE. Extruder screw geometry, set extrusion temperature and screw rotation speed were also found to have a direct effect on energy consumption and melt consistency. In particular, specific energy consumption was lower using a barrier flighted screw compared to single flighted screws at the same set conditions. These results highlight the complex nature of extrusion thermal dynamics and provide evidence that rheological properties of the polymer can significantly influence the thermal efficiency of the process.

Concentration effects of 1,2-dichlorobenzene on soil microbiology

The effect of increasing concentrations (65, 130, 325, 1,300, and 3,250 μg/g soil dry weight) of 1,2-dichlorobenzene (1,2-DCB) on the microbial biomass, metabolic potential, and diversity of culturable bacteria was investigated using soil microcosms. All doses caused a significant (p < 0.05) decrease in viable hyphal fungal length. Bacteria were more tolerant, only direct total counts in soils exposed to 3,250 μg/g were significantly (p < 0.05) lower than untreated controls, and estimates of culturable bacteria showed no response. Pseudomonads counts were stimulated by 1,2-DCB concentrations of up to 325 μg/g; above this level counts were similar to controls. Fatty acid methyl ester analysis of taxonomic bacterial composition reflected the differential response of specific genera to increasing 1,2-DCB concentrations, especially the tolerance of Bacillus to the highest concentrations. The shifts in community composition were reflected in estimates of metabolic potential assessed by carbon assimilation (Biolog) ability. Significantly fewer (p < 0.05) carbon sources were utilized by communities exposed to 1,2-DCB concentrations greater than 130 μg/g (<64 carbon sources utilized) than control soils (83); the ability to assimilate individual carbohydrates sources was especially compromised. The results of this study demonstrate that community diversity and metabolic potential can be used as effective bioindicators of pollution stress and concentration effects.

Toxicity of chlorobenzenes to a lux-marked terrestrial bacterium, Pseudomonas fluorescens

Insertion of lux genes, encoding for bioluminescence in naturally bioluminescent marine bacteria, into the genome of Pseudomonas fluorescens resulted in a bioluminescent strain of this terrestrial bacterium. The lux- marked bacterium was used to toxicity test the chlorobenzene series. By correlating chlorobenzenes 50% effective concentration (EC50) values against physiochemical parameters, the physiochemical properties of chlorobenzenes that elicit toxic responses were investigated. The results showed that the more chlorinated the compounds, the more toxic they were to lux-marked P. fluorescens. Furthermore, it was shown that the more symmetrical the compound, the greater its toxicity to P. fluorescens. In general, the toxicity of a chlorobenzene was inversely proportional to its solubility (S) and directly proportional to its lipophilicity (K(ow). By correlating lux- marked P. fluorescens EC50 values, determined for chlorobenzenes, with toxicity values determined using Pimephales promelas (fathead minnow), Cyclotella meneghiniana (diatom), and Vibrio fischeri (marine bacterium), it was apparent that lux-marked P. fluorescens correlated well with freshwater species such as the diatoms and fathead minnow but not with the bioluminescent marine bacterium V. fischeri. The implications of these findings are that a terrestrial bacterium such as P. fluorescens should be used for toxicity testing of soils and freshwaters rather than the marine bacterium V. fischeri.

Assessment of toxicological interactions of benzene and its primary degradation products (catechol and phenol) using a lux-modified bacterial bioassay

A bacterial bioassay has been developed to assess the relative toxicities of xenobiotics commonly found in contaminated soils, rivers, waters, and ground waters. The assay utilized decline in luminescence of lux- marked Pseudomonas fluorescens on exposure to xenobiotics. Pseudomonas fluorescens is a common bacterium in the terrestrial environment, providing environmental relevance to soil, river, and ground water systems. Three principal environmental contaminants associated with benzene degradation were exposed to the luminescence-marked bacterial biosensor to assess their toxicity individually and in combination. Median effective concentration (EC50) values for decline in luminescence were determined for benzene, catechol, and phenol and were found to be 39.9, 0.77, and 458.6 mg/L, respectively. Catechol, a fungal and bacterial metabolite of benzene, was found to be significantly more toxic to the biosensor than was the parent compound benzene, showing that products of xenobiotic biodegradation may be more toxic than the parent compounds. Combinations of parent compounds and metabolites were found to be significantly more toxic to the bioassay than were the individual compounds themselves. Development of this bioassay has provided a rapid screening system suitable for assessing the toxicity of xenobiotics commonly found in contaminated soil, river, and ground-water environments. The assay can be utilized over a wide pH range and is therefore more applicable to such environmental systems than bioluminescence-based bioassays that utilize marine organisms and can only be applied over a limited pH and salinity range.