The relationship between breastfeeding and postpartum weight change-a systematic review and critical evaluation

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.International Journal of Obesity advance online publication, 20 August 2013; doi:10.1038/ijo.2013.132.

Counselling for sight loss: Using systematic case study research to build a client informed practice model

There is compelling evidence to suggest that acquired sight loss negatively impacts on emotional well-being. Despite increasing recognition of the need to provide emotional support for people with sight loss, we still do not fully understand what counselling interventions help and why they help. The aim of this study was to examine the process and outcome of counselling for a 70-year-old client who had experienced complete, irreversible, post-operative sight loss in order to gain a deeper understanding of client-defined helpful aspects of therapy. A Hermeneutic Single-Case Efficacy Design study was undertaken having received ethical approval from the University's Research Ethics Committee. The client received six sessions of counselling from a vision-impaired counsellor working within a pluralistic framework. Measures were completed by the client at every session, as well as at pre-and post-counselling. All sessions were recorded and transcribed. The client also participated in pre-and post-counselling interviews. Data formed a rich case record that was analysed by a quasi-judicial enquiry team. Results suggested that this was a successful outcome case. Client-defined helpful aspects of therapy were (1) feeling understood; (2) being able to express emotions around the loss of sight; (3) finding a new identity; (4) finding ways to cope with fear, loss, dependency, and other people's perceptions; (5) exploring the possibility of a positive future without sight; (6) making sense of things; and (7) finding ways to become more socially connected. Relevant therapeutic tasks are proposed, and four key aspects of therapy are identified, which may have implications for the development of a practice model.

How common are myeloproliferative neoplasms? A systematic review and meta-analysis

Myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases including polycythemia vera (PV), essential thrombocythemia (ET), and primary(idiopathic) myelofibrosis (PMF). In this systematic review, we provide a comprehensive report on the incidence and prevalence of MPNs across the globe. Electronic databases (PubMed, EMBASE, MEDLINE, and Web of Science) were searched from their inception to August 2012 for articles reporting MPN incidence or prevalence rates. A random effects meta-analysis was undertaken to produce combined incidence rates for PV, ET, and PMF. Both heterogeneity and small study bias were assessed. Thirty-four studies were included. Reported annual incidence rates ranged from 0.01 to 2.61, 0.21 to 2.27, and 0.22 to 0.99 per 100,000 for PV, ET, and PMF, respectively. The combined annual incidence rates for PV, ET, and PMF were 0.84, 1.03, and 0.47 per 100,000. There was high heterogeneity across disease entities (I(2) 97.1-99.8%) and evidence of publication bias for ET and PMF (Egger test, P = 50.007 and P ≤ 0.001, respectively).The pooled incidence reflects the rarity of MPNs. The calculated pooled incidence rates do not reflect MPN incidence across the globe due to the high unexplained heterogeneity. Improved, widespread registration of MPNs would provide better information for global comparison of the incidence and prevalence of MPNs.

Educational interventions in neurology:A comprehensive systematic review

A fear of neurology and neural sciences (neurophobia) may have clinical consequences. There is therefore a need to formulate an evidence-based approach to neurology education. A comprehensive systematic review of educational interventions in neurology was performed. BEI, Cochrane Library, Dialog Datastar, EBSCO Biomedical, EBSCO Psychology & Behavioral Sciences, EMBASE, ERIC, First Search, MDConsult, Medline, Proquest Medical Library and Web of Knowledge databases were searched for all published studies assessing interventions in neurology education among undergraduate students, junior medical doctors and residents up to and including July 2012. Two independent literature searches were performed for relevant studies, which were then classified for level of evidence using the Centre of Evidence-based Medicine criteria and four levels of Kirkpatrick educational outcomes. One systematic review, 16 randomized controlled trials (RCTs), nine non-randomized cohort/follow-up studies, 33 case series or historically controlled studies and three mechanism-based reasoning studies were identified. Educational interventions showed favourable evaluation or assessment outcomes in 15 of 16 (94%) RCTs. Very few studies measured subsequent clinical behaviour (two studies) and patient outcomes (one study). There is very little high quality evidence of demonstrably effective neurology education. However, RCTs are emerging, albeit without meeting comprehensive educational criteria. An improving evidence base in the quality of neurology education will be important to reduce neurophobia. © 2013 EFNS.

Software as a Service: Analysing Security Issues

Software-as-a-service (SaaS) is a type of software service delivery model which encompasses a broad range of business opportunities and challenges. Users and service providers are reluctant to integrate their business into SaaS due to its security concerns while at the same time they are attracted by its benefits. This article highlights SaaS utility and applicability in different environments like cloud computing, mobile cloud computing, software defined networking and Internet of things. It then embarks on the analysis of SaaS security challenges spanning across data security, application security and SaaS deployment security. A detailed review of the existing mainstream solutions to tackle the respective security issues mapping into different SaaS security challenges is presented. Finally, possible solutions or techniques which can be applied in tandem are presented for a secure SaaS platform.

Lifestyle factors and small intestine adenocarcinoma risk: a systematic review and meta-analysis.

Background: Although the incidence of small intestinal adenocarcinoma (SIA) is low, rates are increasing and little information regarding modifiable lifestyle risk factors is available.

Aim: To provide a systematic review of lifestyle factors and SIA risk.

Methods: Ovid MEDLINE, EMBASE and WEB OF SCIENCE were searched from inception to Week 1 October 2013. Nine publications that reported on SIA risk in relation to alcohol intake (n=6), tobacco smoking (n=6), diet (n=5), body mass (n=3), physical activity (n=1), hormone use (n=1) and/or socio-economic status (n=3) were retrieved. Results for alcohol, smoking and SIA risk were pooled using random-effects meta-analyses to produce relative risks (RR) and 95% confidence intervals (CI).

Results: The summary RR for individuals consuming the highest versus lowest category of alcohol intake was 1.51 (95% CI 0.83-2.75; n=5 studies) with significant increased risks emerging in sensitivity analysis with reduced heterogeneity (RR: 1.82, 95% CI: 1.05-3.15; n=4 studies). The pooled SIA RR for individuals in the highest versus lowest category of smoking was 1.24 (95% CI 0.71-2.17; n=5 studies). In relation to dietary factors, high fibre intakes and normal body weight may be protective, while high intakes of red/processed meat and sugary drinks may increase SIA risk. Evidence on socio-economic status and SIA risk was equivocal. Data on other factors were too sparse to draw any conclusions.

Conclusions: Alcohol may be associated with an increased risk of SIA. Further investigation of lifestyle factors, particularly alcohol, smoking and diet, in the aetiology of this cancer is warranted in large consortial studies.

Infra-Éireann: Making Ireland Modern - Irish Pavilion for the 14th Architectural biennale, Venice 2014.

After an open competition, we were selected to commission, curate and design the Irish pavilion for the Venice biennale 2014. Our proposal engage with the role of infrastructure and architecture in the cultural development of the new Irish state 1914-2014. This curatorial programme was realised in a demountable, open matrix pavilion measuring 12 x 5 x 6 metres.

How modernity is absorbed into national cultures usually presupposes an attachment to previous conditions and a desire to reconcile the two. In an Irish context, due to the processes of de-colonisation and political independence, this relationship is more complicated.

In 1914, Ireland was largely agricultural and lacked any significant industrial complex. The construction of new infrastructures after independence in 1921 became central to the cultural imagining of the new nation. The adoption of modernist architecture was perceived as a way to escape the colonial past. As the desire to reconcile cultural and technological aims developed, these infrastructures became both the physical manifestation and concrete identity of the new nation with architecture an essential element in this construct.

Technology and infrastructure are inherently cosmopolitan. Beginning with the Shannon hydro-electric facility at Ardnacrusha (1929) involving the German firm of Siemens-Schuckert, Ireland became a point of various intersections between imported international expertise and local need. By the turn of the last century, it had become one of the most globalised countries in the world, site of the European headquarters of multinationals such as Google and Microsoft. Climatically and economically expedient to the storing and harvesting of data, Ireland has subsequently become an important repository of digital information farmed in large, single-storey sheds absorbed into dispersed suburbs. In 2013, it became the preferred site for Intel to design and develop its new microprocessor board, the Galileo, a building block for the internet of things.

The story of the decades in between, of shifts made manifest in architecture and infrastructure, from the policies of economic protectionism to the embracing of the EU is one of the influx of technologies and cultural references into a small country on the edges of Europe: Ireland as both a launch-pad and testing ground for a series of aspects of designed modernity.

New exoplanets from the SuperWASP-North survey

We present the current status of the WASP search for transiting exoplanets, focusing on recent planet discoveries from SuperWASP-North and the joint equatorial region (-20≤Dec≤+20) observed by both WASP telescopes. We report the results of monitoring of WASP planets, and discuss how these contribute to our understanding of planet properties and their diversity.

Towards a general framework for social media research using big data

The increasing adoption of cloud computing, social networking, mobile and big data technologies provide challenges and opportunities for both research and practice. Researchers face a deluge of data generated by social network platforms which is further exacerbated by the co-mingling of social network platforms and the emerging Internet of Everything. While the topicality of big data and social media increases, there is a lack of conceptual tools in the literature to help researchers approach, structure and codify knowledge from social media big data in diverse subject matter domains, many of whom are from nontechnical disciplines. Researchers do not have a general-purpose scaffold to make sense of the data and the complex web of relationships between entities, social networks, social platforms and other third party databases, systems and objects. This is further complicated when spatio-temporal data is introduced. Based on practical experience of working with social media datasets and existing literature, we propose a general research framework for social media research using big data. Such a framework assists researchers in placing their contributions in an overall context, focusing their research efforts and building the body of knowledge in a given discipline area using social media data in a consistent and coherent manner.

Resilience

Over the past decade the concept of ‘resilience’ has been mobilised across an increasingly wide range of policy arenas. For example, it has featured prominently within recent discussions on the nature of warfare, the purpose of urban and regional planning, the effectiveness of development policies, the intent of welfare reform and the stability of the international financial system. The term’s origins can be traced back to the work of the ecologist Crawford S. Holling and his formulation of a science of complexity. This paper reflects on the origins of these ideas and their travels from the field of natural resource management, which it now dominates, to contemporary social practices and policy arenas. It reflects on the ways in which a lexicon of complex adaptive systems, grounded in an epistemology of limited knowledge and uncertain futures, seeks to displace ongoing ‘dependence’ on professionals by valorising self-reliance and responsibility as techniques to be applied by subjects in the making of the resilient self. In so doing, resilience is being mobilised to govern a wide range of threats and sources of uncertainty, from climate change, financial crises and terrorism, to the sustainability of development, the financing of welfare and providing for an aging population. As such, ‘resilience’ risks becoming a measure of its subjects’ ‘fitness’ to survive in what are pre-figured as natural, turbulent orders of things.

Abdominal Aortic Aneurysm Genetic Associations: Mostly False? A Systematic Review and Meta-analysis

OBJECTIVE/BACKGROUND: Many associations between abdominal aortic aneurysm (AAA) and genetic polymorphisms have been reported. It is unclear which are genuine and which may be caused by type 1 errors, biases, and flexible study design. The objectives of the study were to identify associations supported by current evidence and to investigate the effect of study design on reporting associations.

METHODS: Data sources were MEDLINE, Embase, and Web of Science. Reports were dual-reviewed for relevance and inclusion against predefined criteria (studies of genetic polymorphisms and AAA risk). Study characteristics and data were extracted using an agreed tool and reports assessed for quality. Heterogeneity was assessed using I(2) and fixed- and random-effects meta-analyses were conducted for variants that were reported at least twice, if any had reported an association. Strength of evidence was assessed using a standard guideline.

RESULTS: Searches identified 467 unique articles, of which 97 were included. Of 97 studies, 63 reported at least one association. Of 92 studies that conducted multiple tests, only 27% corrected their analyses. In total, 263 genes were investigated, and associations were reported in polymorphisms in 87 genes. Associations in CDKN2BAS, SORT1, LRP1, IL6R, MMP3, AGTR1, ACE, and APOA1 were supported by meta-analyses.

CONCLUSION: Uncorrected multiple testing and flexible study design (particularly testing many inheritance models and subgroups, and failure to check for Hardy-Weinberg equilibrium) contributed to apparently false associations being reported. Heterogeneity, possibly due to the case mix, geographical, temporal, and environmental variation between different studies, was evident. Polymorphisms in nine genes had strong or moderate support on the basis of the literature at this time. Suggestions are made for improving AAA genetics study design and conduct.

Risk factors (excluding hormone therapy) for endometrial hyperplasia: a systematic review.

Objective: To conduct a systematic review of risk factors associated with the development of Endometrial Hyperplasia (EH).

Data sources: Ovid MEDLINE, EMBASE and Web of Science databases were searched from inception to 30 June 2015.

Study eligibility: Fifteen observational studies that reported on EH risk in relation to lifestyle factors (n=14), medical history (n=11), reproductive and menstrual history (n=9) and measures of socio-economic status (n=2) were identified. Pooled relative risk estimates and corresponding 95% confidence intervals (CI) were able to be derived for EH and Body Mass Index (BMI), smoking, diabetes and hypertension, using random effects models comparing high versus low categories.

Results: The pooled relative risk for EH when comparing women with the highest versus lowest BMI was 1.82 (95% CI 1.22–2.71; n=7 studies, I2=90.4%). No significant associations were observed for EH risk for smokers compared with non-smokers (RR 0.88, 95% CI 0.66-1.17; n=3, I2=0.0%), hypertensive versus normotensive women (RR 1.51, 95% CI 0.72–3.15; n=5 studies, I2=79.1%), or diabetic versus non-diabetic women (RR 1.77, 95% CI 0.79–3.96; n=5 studies, I2=31.8%) respectively although the number of included studies was limited. There were mixed reports on the relationship between age and risk of EH. Too few studies reported on other factors to reach any conclusions in relation to EH risk.

Conclusions: A high BMI was associated with an increased risk of EH, providing additional rationale for women to maintain a normal body weight. No significant associations were detected for other factors and EH risk, however relatively few studies have been conducted and few of the available studies adequately adjusted for relevant confounders. Therefore, further aetiological studies of endometrial hyperplasia are warranted.

Seasons, Family and Nation in American Horror Story

Arguably, the title of American Horror Story sets out an agenda for the program: this is not just a horror story, but it is a particularly American one. This chapter examines the way that the program uses seasonal celebrations as a way of expressing that national identity, with special emphasis on the importance of family to those celebrations. The particular seasonal celebrations focused on are those of Halloween and Christmas, each of which has associations with the supernatural. However, the use of the supernatural at those seasons is one which is particularly associated with the US, presenting Halloween as a time of supernatural incursion and horror, and of disruption to society and the normal order of things, while Christmas is presented more as a time of unity for the family. Where the supernatural emerges in American Christmas television, it is typically as a force to encourage togetherness and reconciliation, rather than as a dark reminder of the past. While these interpretations of these festivals have been broadcast abroad by American cultural products, not least American television, they have different associations and implications elsewhere, as will be shown. So the particular uses of these festivals is part of what marks American Horror Story out as American, as is the way that the program's narratives have been structured to fit in with US television scheduling. This chapter, then, argues that the structures of the narratives combines with their use of the festivals of Halloween and Christmas in order to enhance the sense of this series as a particularly American horror story.

Scalable semantic aware context storage

In recent years the Internet has grown by incorporating billions of small devices, collecting real-world information and distributing it though various systems. As the number of such devices grows, it becomes increasingly difficult to manage all these new information sources. Several context representation schemes have tried to standardize this information, however none of them have been widely adopted. Instead of proposing yet another context representation scheme, we discuss an efficient way to deal with this diversity of representation schemes. We define the basic requirements for context storage systems, analyse context organizations models and propose a new context storage solution. Our solution implements an organizational model that improves scalability, semantic extraction and minimizes semantic ambiguity.