Changes in microbial diversity associated with two coral species recovering from a stressed state in a public aquarium system:Microbial diversity associated with aquarium corals

Coral diseases are a major factor in the decline of coral reefs worldwide, and a large proportion of studies focusing on disease causation use aquaria to control variables that affect disease occurrence and development. Public aquaria can therefore provide an invaluable resource to study the factors contributing to health and disease. In November 2010 the corals within the main display tank at the Horniman Museum and Gardens, London, UK, underwent a severe stress event due to reduced water quality, which resulted in death of a large number of coral colonies. Three separate colonies of two species of reef coral, Seritopora hystrix and Montipora capricornis showing signs of stress and acute tissue loss were removed from the display tank and placed in a research tank with improved water quality. Both coral species showed a significant difference in 16S rRNA gene bacterial diversity between healthy and stressed states (S. hystrix; ANOSIM, R=0.44, p=0.02 and M. capricornis; ANOSIM, R=0.33, p=0.01), and between the stressed state and the recovering corals. After four months the bacterial communities had returned to a similar state to that seen in healthy corals of the same species. The bacterial communities associated with the two coral species were distinct, despite them
being reared under identical environmental conditions. Despite the environmental perturbation being identical different visual signs were seen in each species and distinctly different bacterial communities associated with the stressed state occurred within them. Recovery of the visually healthy state was associated with a return of the bacterial community, within two months, to the pre-disturbance state. These observations suggest that coral-associated microbial communities are remarkably resilient and return to a very similar stable state following disturbance.

Soft Budget Constraints and Regional Industrial Policy: Reinterpreting the Rise and fall of De Lorean

The rise and fall of De Lorean Motor Cars Limited (DMCL) has been traditionally interpreted as either the result either of John De Lorean’s psychological flaws or as confirming the supposed limitations of activist industrial policy. However, when the episode is examined in greater historical detail, neither of these interpretations are compelling. The reinterpretation outlined here draws on institutional analysis as well as a range of archival sources, much of it previously unreleased. The inefficiencies within the original contractual agreement are highlighted. The lack of credibility associated with this agreement was in turn traceable to the institutional environment (with its associated risk-reward implications) under which industrial policy operated. This environment had a political element - it had been distorted by the Troubles and the resulting fears policymakers had of a cumulative causation relationship between violence and unemployment. Officials in Belfast, against Treasury opposition, advocated state-led entrepreneurship as a policy response.

The Relationship between Materialistic Aspirations and Distinct Aspects of Psychological Well-being in a UK sample

The purpose of this research is to gain a deeper understanding of how materialistic aspirations are related to distinct aspects of psychological well-being. Research has consistently found a negative relationship between materialistic goals and well-being, but a review of the literature identified that the measures of well- being used in the majority of studies were measures of what Keyes (2002) describes as “subjective well-being” or “hedonic happiness”. Criticisms of these types of measures are that they fixate too much on the momentary experience of pleasure and don’t take into account what is meaningful and or what contributes to long lasting fulfilment. Very little research was found investigating the impact of materialism on “eudaimonic” well-being, which is found through doing what is worthwhile and realising ones potential and has been found to have a longer lasting impact on overall well-being (Huta & Ryan, 2010). To address this gap in the literature, a convenience sample of 113 adult subjects in the UK were recruited through Facebook and asked to respond to the Aspiration Index and the Psychological wellbeing scale. The relative importance placed on extrinsic (materialistic) and intrinsic aspirations was compared to the six dimensions of psychological well-being. In line with previous research, higher importance placed on materialistic aspirations for wealth, status and image were found to be negatively correlated with all aspects of psychological well-being. However, the strongest and only statistically significant negative correlation was between extrinsic aspirations and positive relations with others (r = -.256, p< 0.01). Positive relationships with other people form a central component of many theories of well- being and so this negative relationship may help to explain why materialistic aspirations are so consistently found to be negatively correlated to a variety of measures of well-being. Further research is needed to explore this relationship as no causation could be inferred.

The effect of alcohol consumption on household income in Ireland

This paper presents a study of the effects of alcohol consumption on household income in Ireland using the Slán National Health and Lifestyle Survey 2007 dataset, accounting for endogeneity and selection bias. Drinkers are categorised into one of four categories based on the recommended weekly drinking levels by the Irish Health Promotion Unit; those who never drank, non-drinkers, moderate and heavy drinkers. A multinomial logit OLS Two Step Estimate is used to explain individual's choice of drinking status and to correct for selection bias which would result in the selection into a particular category of drinking being endogenous. Endogeneity which may arise through the simultaneity of drinking status and income either due to the reverse causation between the two variables, income affecting alcohol consumption or alcohol consumption affecting income, or due to unobserved heterogeneity, is addressed. This paper finds that the household income of drinkers is higher than that of non-drinkers and of those who never drank. There is very little difference between the household income of moderate and heavy drinkers, with heavy drinkers earning slightly more. Weekly household income for those who never drank is €454.20, non-drinkers is €506.26, compared with €683.36 per week for moderate drinkers and €694.18 for heavy drinkers.

Warfare in the West Highlands and Isles of Scotland, c. 1544-1615

Warfare has long been associated with Scottish Highlanders and Islanders, especially in the period known in Gaelic tradition as ‘Linn nan Creach’ (the ‘Age of Forays’), which followed the forfeiture of the Lordship of the Isles in 1493. The sixteenth century in general is remembered as a particularly tumultuous time within the West Highlands and Isles, characterised by armed conflict on a seemingly unprecedented scale. Relatively little research has been conducted into the nature of warfare however, a gap filled by this thesis through its focus on a series of interconnected themes and in-depth case studies spanning the period c. 1544-1615. It challenges the idea that the sixteenth century and early seventeenth century was a time of endless bloodshed, and explores the rationale behind the distinctive mode of warfare practised in the West Highlands and Isles. The first part of the thesis traces the overall ‘Process of War’. Chapter 1 focuses on the mentality of the social elite in the West Highlands and Isles and demonstrates that warfare was not their raison d'être, but was tied inextricably to chiefs’ prime responsibility of protecting their lands and tenants. Chapter 2 assesses the causation of warfare and reveals that a recurrent catalyst for armed conflict was the assertion of rights to land and inheritance. There were other important causes however, including clan expectation, honour culture, punitive government policies, and the use of proxy warfare by prominent magnates. Chapter 3 takes a fresh approach to the military capacity of the region through analysis of armies and soldiers, and the final thematic chapter tackles the conduct of warfare in the West Highlands and Isles, with analysis of the tactics and strategy of militarised personnel. The second part of this thesis comprises five case studies: the Clanranald, 1544-77; the Colquhouns of Luss and the Lennox, 1592-1603; the MacLeods of Harris and MacDonalds of Sleat, 1594-1601; the Camerons, 1569-1614; and the ‘Islay Rising’, 1614-15. This thesis adopts a unique approach by contextualising the political background of warfare in order to instil a deeper understanding of why early modern Gaelic Scots resorted to bloodshed. Overall, this period was defined by a sharp rise in military activity, followed by an even sharper decline, a trajectory that will be evidenced vividly in the final case study on the ‘Islay Rising’. Although warfare was widespread, it was not unrestrained or continuous, and the traditional image of a region riven by perpetual bloodshed has been greatly exaggerated.

Causalité et explication causale chez James Woodward

Certains philosophes affirment que les relations causales sont fondées sur les lois de la nature. Cette conception cadre mal avec la réalité des sciences biomédicales et des sciences humaines. Pour se rapprocher de la pratique réelle des diverses sciences, James Woodward propose une conception de la causalité et de l’explication causale fondée sur une relation beaucoup moins exigeante que celle de loi de la nature, qu’il appelle l’invariance. Le but de ce mémoire est de présenter le concept d’invariance et les autres concepts causaux qui s’y rattachent et, d’identifier certaines difficultés, dans le but de cerner l’usage approprié de cette famille de concepts. La conception causale de Woodward suppose que le but de la recherche des causes est pratique plutôt que simplement épistémique : il s’agit pour les agents de s’appuyer sur les causes pour modifier les phénomènes. Cette conception est également non-réductive; elle utilise des contrefactuels et reflète les méthodes expérimentales des diverses sciences. La cohérence de cette conception avec les généralisations causales réelles des sciences fait en sorte qu’elle abandonne l’objectif d’universalité rattaché à la notion de loi de la nature, en faveur d’un objectif de fiabilité temporaire. De plus, comme le critère d’invariance est peu exigeant, d’autres critères doivent lui être ajoutés pour identifier, parmi les relations causales (c’est-à-dire invariantes), les relations les plus susceptibles d’être employées pour modifier les phénomènes de façon fiable.

Lateral epicondylitis: New evidence for work relatedness.

International audience

Estimation of whole body muscle, adipose/fat mass, validation in health and during weight loss. Development of prediction equations using MRI as reference method

Background: Body composition is affected by diseases, and affects responses to medical treatments, dosage of medicines, etc., while an abnormal body composition contributes to the causation of many chronic diseases. While we have reliable biochemical tests for certain nutritional parameters of body composition, such as iron or iodine status, and we have harnessed nuclear physics to estimate the body’s content of trace elements, the very basic quantification of body fat content and muscle mass remains highly problematic. Both body fat and muscle mass are vitally important, as they have opposing influences on chronic disease, but they have seldom been estimated as part of population health surveillance. Instead, most national surveys have merely reported BMI and waist, or sometimes the waist/hip ratio; these indices are convenient but do not have any specific biological meaning. Anthropometry offers a practical and inexpensive method for muscle and fat estimation in clinical and epidemiological settings; however, its use is imperfect due to many limitations, such as a shortage of reference data, misuse of terminology, unclear assumptions, and the absence of properly validated anthropometric equations. To date, anthropometric methods are not sensitive enough to detect muscle and fat loss. Aims: The aim of this thesis is to estimate Adipose/fat and muscle mass in health disease and during weight loss through; 1. evaluating and critiquing the literature, to identify the best-published prediction equations for adipose/fat and muscle mass estimation; 2. to derive and validate adipose tissue and muscle mass prediction equations; and 3.to evaluate the prediction equations along with anthropometric indices and the best equations retrieved from the literature in health, metabolic illness and during weight loss. Methods: a Systematic review using Cochrane Review method was used for reviewing muscle mass estimation papers that used MRI as the reference method. Fat mass estimation papers were critically reviewed. Mixed ethnic, age and body mass data that underwent whole body magnetic resonance imaging to quantify adipose tissue and muscle mass (dependent variable) and anthropometry (independent variable) were used in the derivation/validation analysis. Multiple regression and Bland-Altman plot were applied to evaluate the prediction equations. To determine how well the equations identify metabolic illness, English and Scottish health surveys were studied. Statistical analysis using multiple regression and binary logistic regression were applied to assess model fit and associations. Also, populations were divided into quintiles and relative risk was analysed. Finally, the prediction equations were evaluated by applying them to a pilot study of 10 subjects who underwent whole-body MRI, anthropometric measurements and muscle strength before and after weight loss to determine how well the equations identify adipose/fat mass and muscle mass change. Results: The estimation of fat mass has serious problems. Despite advances in technology and science, prediction equations for the estimation of fat mass depend on limited historical reference data and remain dependent upon assumptions that have not yet been properly validated for different population groups. Muscle mass does not have the same conceptual problems; however, its measurement is still problematic and reference data are scarce. The derivation and validation analysis in this thesis was satisfactory, compared to prediction equations in the literature they were similar or even better. Applying the prediction equations in metabolic illness and during weight loss presented an understanding on how well the equations identify metabolic illness showing significant associations with diabetes, hypertension, HbA1c and blood pressure. And moderate to high correlations with MRI-measured adipose tissue and muscle mass before and after weight loss. Conclusion: Adipose tissue mass and to an extent muscle mass can now be estimated for many purposes as population or groups means. However, these equations must not be used for assessing fatness and categorising individuals. Further exploration in different populations and health surveys would be valuable.

MEN WRITING WOMEN: “THE WOMAN QUESTION” AND MALE DISCOURSE OF IRANIAN MODERNITY"

In this dissertation I explore “The Woman Question” in the discourse of Iranian male authors. A pro-modernity group, they placed women’s issues at the heart of their discourse. This dissertation follows the trajectory of the representation of “The Woman Question” as it is reflected in the male discourse over the course of a century. It discusses the production of a literature that was anchored in the idea of reform and concerned itself with issues pertaining to women. These men challenged lifelong patriarchal notions such as veiling, polygamy, gender segregation, and arranged marriages, as well as traditional roles of women and gender relations. This study is defined under the rubrics of “The Woman Question” and “The New Woman,” which I have borrowed from the Victorian and Edwardian debates of similar issues as they provide clearer delineations. Drawing upon debates on sexuality, and gender, this dissertation illustrates the way these men championed women was both progressive and regressive. This study argues that the desire for women’s liberation was couched in male ideology of gender relations. It further illustrates that the advancement of “The Woman Question,” due to its continuous and yet gradual shifting concurrent with each author’s nuanced perception of women’s issues, went through discernible stages that I refer to as observation, causation, remedy, and confusion. The analytical framework for this project is anchored in the “why” and the “how” of the Iranian male authors’ writings on women in addition to “what” was written. This dissertation examines four narrative texts—two in prose and two in poetry—entitled: “Lankaran’s Vizier,” “The Black Shroud,” “‘Arefnameh,” and “Fetneh” written respectively by Akhundzadeh, ‘Eshqi, Iraj Mirza, and Dashti. Chapter one outlines the historical background, methodology, theoretical framework, and literature review. The following chapters examine, the advocacy for companionate marriage and romantic love, women and nationalistic cause, veiling and unveiling, and the emerging figure of the New Iranian Woman as morally depraved.

Efectividad de la deslaminación mecánica con bisturí en la eliminación de helomas e hiperqueratosis

Introducción El motivo principal por el que acuden los pacientes a las consultas de podología es el dolor producido por los callos y callosidades plantares. El dolor producido por las callosidades y callos plantares provocan en el paciente cambios de presiones y alteraciones en el apoyo, dificultando la deambulación correcta. Existen numerosos estudios sobre la eliminación de callosidades en pacientes diabéticos, con AR, pero pocos en personas sanas. La eliminación de estos callos y callosidades se puede realizar mediante deslaminación mecánica con bisturí o mediante queratolíticos. Objetivos Objetivo principal Analizar el efecto de la deslaminación mecánica con bisturí de las callosidades y callos plantares sobre el dolor y la calidad de vida en sujetos sanos Objetivos secundarios Determinar la existencia de modificaciones en los parámetros de la marcha con la eliminación de callosidades y callos plantares Observar las diferencias y efectividad de tratamientos de la eliminación de callosidades plantares mediante la técnica de deslaminación mecánica con bisturí versus parches de ácido salicílico Comprobar los cambios producidos en los parámetros psíquicos y fiscos del paciente antes y después de las diferentes técnicas de eliminación de las callosidades empleadas Método Se realizan dos estudios: un estudio cuasi experimental aleatorizado no controlado, en el que a un grupo de 34 pacientes con callosidades plantares dolorosas se les mide el dolor con una escala visual analógica y para analizar los parámetros de la marcha, la paltaformaWin-Track, antes del tratamiento de deslaminación mecánica con bisturí y a las 24 horas. El segundo estudio es un ensayo clínico aleatorizado inscrito en Australian New ZelandClinicalstrials y aprobado por el Comité ético de la Universidad de Málaga, en el que 62 participantes con callosidades plantares dolorosas se dividieron en dos grupos de tratamiento. El grupo A recibió tratamiento con parche de ácido salicílico y el grupo B recibió tratmiento de deslaminación con bisturí. Se utilizó la escala visual analógica para la medida de dolor antes, inmediatamente después de la intervención, a las 2 semanas y a las 6 semanas. Para el dolor y la discapacidad funcional del pie se utilizó el cuestionario Manchester FootPain and Disability antes del tratamiento, a las 2 semanas y a las 6 semanas. Para medir la calidad de vida general se utilizó el cuestionario SF-12 Conclusiones La deslaminación mecánica con bisturí de los callos y callosidades plantares es efectiva para su eliminación a nivel de la sensación de dolor, aunque no tanto en lo que se refiere a la mejora de calidad de vida. No hay resultados significativos de que la eliminación mecánica con bisturí de callos y callosidades plantares modifican los parámetros de la marcha medido con la plataforma Win-track. Se observa como la deslaminación mecánica con bisturí para la eliminación de callos y callosidades plantares pueden ser más efectiva a corto plazo que la eliminación mediante parche con ácido salicílico. Se observa cómo se modifica los paramentos psíquicos en el grupo de tratamiento con parche con ácido salicílico, aunque con una significación baja. Bibliografía Balanowski, K. R., & Flynn, L. M. (2005). Effect of painful keratoses debridement on foot pain, balance and function in older adults. Gait & Posture, 22(4), 302-307. http://doi.org/10.1016/j.gaitpost.2004.10.006 Collins, S. L., Moore, R. A., &McQuay, H. J. (1997). The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain, 72(1-2), 95-97. Coughlin, M. J. (2000).Common Causes of Pain in the Forefoot in Adults. Journal of Bone & Joint Surgery, British Volume, 82-B(6), 781-790. Farndon, L. J., Vernon, W., Walters, S. J., Dixon, S., Bradburn, M., Concannon, M., & Potter, J. (2013). The effectiveness of salicylic acid plasters compared with «usual» scalpel debridement of corns: a randomised controlled trial. Journal of Foot and Ankle Research, 6(1), 40. http://doi.org/10.1186/1757-1146-6-40 Freeman, D. B. (2002). Corns and calluses resulting from mechanical hyperkeratosis. American FamilyPhysician, 65(11), 2277-2280. Gijon-Nogueron, G., Ndosi, M., Luque-Suarez, A., Alcacer-Pitarch, B., Munuera, P. V., Garrow, A., & Redmond, A. C. (2014). Cross-cultural adaptation and validation of the Manchester Foot Pain and Disability Index into Spanish. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 23(2), 571-579. http://doi.org/10.1007/s11136-013-0507-5 Grouios, G. (2005). Footedness as a potential factor that contributes to the causation of corn and callus formation in lower extremities of physically active individuals. The Foot, 15(3), 154-162. http://doi.org/10.1016/j.foot.2005.05.003 Landorf, K. B., Morrow, A., Spink, M. J., Nash, C. L., Novak, A., Potter, J., &Menz, H. B. (2013). Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial. Trials, 14, 243. http://doi.org/10.1186/1745-6215-14-243 Lang, L. M. G., Simmonite, N., West, S. G., & Day, S. (1994). Salicylic acid in the treatment of corns. The Foot, 4(3), 145-150. http://doi.org/10.1016/0958-2592(94)90019-1 Luo, X., Lynn George, M., Kakouras, I., Edwards, C. L., Pietrobon, R., Richardson, W., & Hey, L. (2003). Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine, 28(15), 1739-1745. http://doi.org/10.1097/01.BRS.0000083169.58671.96 Ramachandra, P., Maiya, A. G., & Kumar, P. (2012). Test-retest reliability of the Win-Track platform in analyzing the gait parameters and plantar pressures during barefoot walking in healthy adults. Foot & Ankle Specialist, 5(5), 306-312. http://doi.org/10.1177/1938640012457680 Siddle, H. J., Redmond, A. C., Waxman, R., Dagg, A. R., Alcacer-Pitarch, B., Wilkins, R. A., &Helliwell, P. S. (2013). Debridement of painful forefoot plantar callosities in rheumatoid arthritis: the CARROT randomised controlled trial. Clinical Rheumatology, 32(5), 567-574. http://doi.org/10.1007/s10067-012-2134-x

Approaches to population health care : the emerging context!

This paper provides a review of recent developments in population-based approaches to community health and explores the origins of the population health concept and its implications for the operation of health service management. There is a growing perception among health professionals that the key to improving health outcomes will be the implementation of integrated and preventive population-based resource management rather than investment in systems that respond to crises and health problems at the acute end of the service provision spectrum only. That is, we will need increasingly to skew our community health and welfare investments towards preventive care, education, lifestyle change, self-management and environmental improvement if we are to reduce the rate of growth in the incidence of chronic disease and mitigate the impact of these diseases upon the acute health care system. While resources will still need to be devoted to the treatment and management of physical trauma, infectious diseases, inherited illness and chronic conditions, it is suggested we could reduce the rate at which demand for these services is increasing at present by managing our environment and communities better, and through the implementation of more effective early intervention programs across particular population groups. Such approaches are known generally as population health management, as opposed to individual or illness - based health management' or even public health - and suggest that health systems might productively focus in the future on population level causation and not just upon disease-specific problems or illness management after the fact. Population health approaches attempt to broaden our understanding of causation and manage health through an emphasis on the health of whole populations and by building healthy communities rather than seeing "health care" as predominantly about illness management or responses to health crises. The concept also presupposes the existence of cleaner and healthier environments, clean water and food, and the existence of vibrant social contexts in which individuals are able to work for the overall good of communities and, ultimately, of each other.

FLOOD RISK ASSESSMENT UNDER HISTORICAL AND PREDICTED LAND USE CHANGE USING CONTINUOUS HYDROLOGIC MODELING

Current procedures for flood risk estimation assume flood distributions are stationary over time, meaning annual maximum flood (AMF) series are not affected by climatic variation, land use/land cover (LULC) change, or management practices. Thus, changes in LULC and climate are generally not accounted for in policy and design related to flood risk/control, and historical flood events are deemed representative of future flood risk. These assumptions need to be re-evaluated, however, as climate change and anthropogenic activities have been observed to have large impacts on flood risk in many areas. In particular, understanding the effects of LULC change is essential to the study and understanding of global environmental change and the consequent hydrologic responses. The research presented herein provides possible causation for observed nonstationarity in AMF series with respect to changes in LULC, as well as a means to assess the degree to which future LULC change will impact flood risk. Four watersheds in the Midwest, Northeastern, and Central United States were studied to determine flood risk associated with historical and future projected LULC change. Historical single framed aerial images dating back to the mid-1950s were used along with Geographic Information Systems (GIS) and remote sensing models (SPRING and ERDAS) to create historical land use maps. The Forecasting Scenarios of Future Land Use Change (FORE-SCE) model was applied to generate future LULC maps annually from 2006 to 2100 for the conterminous U.S. based on the four IPCC-SRES future emission scenario conditions. These land use maps were input into previously calibrated Soil and Water Assessment Tool (SWAT) models for two case study watersheds. In order to isolate effects of LULC change, the only variable parameter was the Runoff Curve Number associated with the land use layer. All simulations were run with daily climate data from 1978-1999, consistent with the 'base' model which employed the 1992 NLCD to represent 'current' conditions. Output daily maximum flows were converted to instantaneous AMF series and were subsequently modeled using a Log-Pearson Type 3 (LP3) distribution to evaluate flood risk. Analysis of the progression of LULC change over the historic period and associated SWAT outputs revealed that AMF magnitudes tend to increase over time in response to increasing degrees of urbanization. This is consistent with positive trends in the AMF series identified in previous studies, although there are difficulties identifying correlations between LULC change and identified change points due to large time gaps in the generated historical LULC maps, mainly caused by unavailability of sufficient quality historic aerial imagery. Similarly, increases in the mean and median AMF magnitude were observed in response to future LULC change projections, with the tails of the distributions remaining reasonably constant. FORE-SCE scenario A2 was found to have the most dramatic impact on AMF series, consistent with more extreme projections of population growth, demands for growing energy sources, agricultural land, and urban expansion, while AMF outputs based on scenario B2 showed little changes for the future as the focus is on environmental conservation and regional solutions to environmental issues.

Partner relationship in couples living with atrial fibrillation

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses. The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics. Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care. In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

Using a discussion about scientific controversy to teach central concepts in experimental design

Students may need explicit training in informal statistical reasoning in order to design experiments or use formal statistical tests effectively. By using scientific scandals and media misinterpretation, we can explore the need for good experimental design in an informal way. This article describes the use of a paper that reviews the measles mumps rubella vaccine and autism controversy in the UK to illustrate a number of threshold concepts underlying good study design and interpretation of scientific evidence. These include the necessity of sufficient sample size, representative and random sampling, appropriate controls and inferring causation.

Cystatin C and cardiovascular disease : A mendelian randomization study

BACKGROUND: Epidemiological studies show that high circulating cystatin C is associated with risk of cardiovascular disease (CVD), independent of creatinine-based renal function measurements. It is unclear whether this relationship is causal, arises from residual confounding, and/or is a consequence of reverse causation. OBJECTIVES: The aim of this study was to use Mendelian randomization to investigate whether cystatin C is causally related to CVD in the general population. METHODS We incorporated participant data from 16 prospective cohorts (n ¼ 76,481) with 37,126 measures of cystatin C and added genetic data from 43 studies (n ¼ 252,216) with 63,292 CVD events. We used the common variant rs911119 in CST3 as an instrumental variable to investigate the causal role of cystatin C in CVD, including coronary heart disease, ischemic stroke, and heart failure. RESULTS: Cystatin C concentrations were associated with CVD risk after adjusting for age, sex, and traditional risk factors (relative risk: 1.82 per doubling of cystatin C; 95% confidence interval [CI]: 1.56 to 2.13; p ¼ 2.12 1014). The minor allele of rs911119 was associated with decreased serum cystatin C (6.13% per allele; 95% CI: 5.75 to 6.50; p ¼ 5.95 10211), explaining 2.8% of the observed variation in cystatin C. Mendelian randomization analysis did not provide evidence for a causal role of cystatin C, with a causal relative risk for CVD of 1.00 per doubling cystatin C (95% CI: 0.82 to 1.22; p ¼ 0.994), which was statistically different from the observational estimate (p ¼ 1.6 105 ). A causal effect of cystatin C was not detected for any individual component of CVD. CONCLUSIONS: Mendelian randomization analyses did not support a causal role of cystatin C in the etiology of CVD. As such, therapeutics targeted at lowering circulating cystatin C are unlikely to be effective in preventing CVD.