Limbal stem cell deficiency:Concept, aetiology, clinical presentation, diagnosis and management

Defects in renewal and repair of ocular surface as a result of limbal stem cell deficiency are now known to cause varying ocular, surface morbidity including persistent photophobia, repeated and persistent surface breakdown and overt conjunctivalisation of the cornea. Ocular conditions with abnormalities of ocular surface repair include pterygium, limbal tumours, aniridia, severe scarring following burns, cicatricial pemphigoid and Stevens-Johnson Syndrome, sequelae of mustard gas exposure and Herpes simplex epithelial disease, radiation keratopathy, contact lens induced keratopathy, neuroparalytic keratitis and drug toxicity. Restoring ocular health in these eyes has traditionally been frustrating. An understanding of these intricate cell renewal and maintenance processes has spurred the evolution in recent years of new treatment methods for several blinding diseases of the anterior segment; many more exciting modalities are in the offing. However, there is inadequate awareness among ophthalmologists about the current principles of management of ocular surface disorders. The purpose of this article is to help elucidate the important principles and current treatment methods relevant to ocular surface disorders.

Amniotic membrane transplantation for ocular surface reconstruction

Aims - To evaluate the efficacy of amniotic membrane transplantation (AMT) for ocular surface reconstruction. Methods - 10 consecutive patients who underwent AMT were included. The indications were: group A, cases with persistent epithelial defect after corneal abscess (n = 1), radiation (n = 1), or chemical burn (n = 3); group B, cases with epithelial defect and severe stromal thinning and impending or recent perforation, due to chemical burn (two patients, three eyes) or corneal abscess (n = 2); group C, to promote corneal epithelium healing and prevent scarring after symblepharon surgery with extensive corneo-conjunctival adhesion (n = 1). Under sterile conditions amniotic membrane was prepared from a fresh placenta of a seronegative pregnant woman and stored at -70°C. This technique involved the use of amniotic membrane to cover the entire cornea and perilimbal area in groups A and B, and the epithelial defect only in group C. Results - The cornea healed satisfactorily in four of five patients in group A, but the epithelial defect recurred in one of these patients. After AMT three patients underwent limbal transplantation and one penetrating keratoplasty and cataract extraction. In group B amniotic membrane transplantation was not helpful, and all cases underwent an urgent tectonic corneal graft. Surgery successfully released the symblepharon, promoted epithelialisation and prevented adhesions in the case of group C. Conclusion - AMT was effective to promote corneal healing in patients with persistent epithelial defect, and appeared to be helpful after surgery to release corneo-conjunctival adhesion. Most surgery for further surface rehabilitation. Amniotic membrane used as a patch was not effective to prevent tectonic corneal graft in cases with severe stromal thinning and impending or recent perforation.

Employment Growth, Education and Skills in India: Emerging Perspectives

Using the employment and unemployment panel data of the National Sample Survey Organisation (NSSO), this paper attempts to map the spatial and temporal dimension of skills and education profiles of India’s workforce. After an assessment of India’s employment challenge, this study analyses the changing pattern of skill distribution among Indian workers by their gender, location, type, regions and broad sectors of the economy. The paper draws on the emerging literature and presents its empirical data to outline the essential skill and educational characteristics of workers, and its variations across broad sectors of the economy at both the national and sub-national levels.

Intergenerational Solidarity and Justice in Ireland: towards a new national dialogue

Gross domestic product plummets. Unemployment soars. Large-scale emigration reemerges after a decade of labor-market driven immigration. The International Monetary Fund and European Union are called to bail out the economy. Indebtedness haunts households in the aftermath of a spectacular housing market crash. The Celtic Tiger is firmly consigned to history books as Ireland’s economic fortunes have waned with unprecedented rapidity. The trials of the economy and policy are highly visible in the media and political debates. However, we know little about how these public travails are reflected in the private sphere where the recession is translated into mass emigration of young workers, defaults on mortgages, former twoearner households turning into no-earner families, and cutbacks in health and social care services that leave many younger and older citizens without the supports on which they could rely.

Tracking down the cause of proteinuria in primary care

Proteinuria originates from the kidney and occurs as a result of injury to either the glomerulus or the renal tubule or both. It is relatively common in the general population with reported point prevalence of up to 8% but the prevalence falls to around 2% on repeated testing. Chronic glomerular injury resulting in proteinuria may be secondary to prolonged duration of diabetes or hypertension. A tubular origin of proteinuria may be associated with inflammation of renal tubules triggered by prescribed drugs or ingested toxins. In the absence of obvious clues to the cause of persistent proteinuria on history or clinical examination it is worthwhile reviewing the patient's prescribed drugs to identify any potentially nephrotoxic agents e.g. NSAIDs. NICE guidelines recommend screening for proteinuria in individuals at higher risk for chronic kidney disease (CKD). These include patients with diabetes, hypertension, cardiovascular disease, connective tissue disorders, a family history of renal disease and those prescribed potentially nephrotoxic drugs. Patients with sudden onset of lower limb oedema and associated proteinuria should have a serum albumin level measured to exclude the nephrotic syndrome. Renal tract ultrasound will measure kidney size, and detect scarring associated with chronic pyelonephritis or prior renal stone disease which can cause proteinuria.

SMAD inhibition attenuates epithelial to mesenchymal transition by primary keratinocytes in vitro

Epithelial to mesenchymal transition (EMT) is a process whereby epithelial cells undergo transition to a mesenchymal phenotype and contribute directly to fibrotic disease. Recent studies support a role for EMT in cutaneous fibrotic diseases including scleroderma and hypertrophic scarring, though there is limited data on the cytokines and signalling mechanisms regulating cutaneous EMT. We investigated the ability of TGF-β and TNF-α, both over-expressed in cutaneous scleroderma and central mediators of EMT in other epithelial cell types, to induce EMT in primary keratinocytes and studied the signalling mechanisms regulating this process. TGF-β induced EMT in normal human epidermal keratinocytes (NHEK cells) and this process was enhanced by TNF-α. EMT was characterised by changes in morphology, proteome (down-regulation of E-cadherin and Zo-1, and up-regulation of vimentin and fibronectin), MMP secretion and COL1α1 mRNA expression. TGF-β and TNF-α in combination activated SMAD and p38 signalling in NHEK cells. P38 inhibition with SB203580 partially attenuated EMT, whereas SMAD inhibition using SB431542 significantly inhibited EMT and also reversed established EMT. These data highlight the retained plasticity of adult keratinocytes and support further studies of EMT in clinically relevant in vivo models of cutaneous fibrosis, and investigation of SMAD inhibition as a potential therapeutic intervention. This article is protected by copyright. All rights reserved.

Drivers of inequality in disability-free expectancy at birth and age 85 across space and time in Great Britain

Background: Although mortality and health inequalities at birth have increased both geographically and in socioeconomic terms, little is known about inequalities at age 85, the fastest growing sector of the population in Great Britain (GB).

Aim: To determine whether trends and drivers of inequalities in life expectancy (LE) and disability-free life expectancy (DFLE) at age 85 between 1991 and 2001 are the same as those at birth.

Methods: DFLE at birth and age 85 for 1991 and 2001 by gender were calculated for each local authority in GB using the Sullivan method. Regression modelling was used to identify area characteristics (rurality, deprivation, social class composition, ethnicity, unemployment, retirement migration) that could explain inequalities in LE and DFLE.

Results: Similar to values at birth, LE and DFLE at age 85 both increased between 1991 and 2001 (though DFLE increased less than LE) and gaps across local areas widened (and more for DFLE than LE). The significantly greater increases in LE and DFLE at birth for less-deprived compared with more-deprived areas were still partly present at age 85. Considering all factors, inequalities in DFLE at birth were largely driven by social class composition and unemployment rate, but these associations appear to be less influential at age 85.

Conclusions: Inequalities between areas in LE and DFLE at birth and age 85 have increased over time though factors explaining inequalities at birth (mainly social class and unemployment rates) appear less important for inequalities at age 85.

Helping the most vulnerable out of the poverty trap and reducing inequality: Policies, strategies, and services for individuals with Autism Spectrum Disorder, including intellectual and neurodevelopmental disabilities: Benchmarking Autism Services Efficacy: BASE Project (Volume 3) Secondary Data analysis

1) Executive Summary
Legislation (Autism Act NI, 2011), a cross-departmental strategy (Autism Strategy 2013-2020) and a first action plan (2013-2016) have been developed in Northern Ireland in order to support individuals and families affected by Autism Spectrum Disorder (ASD) without a prior thorough baseline assessment of need. At the same time, there are large existing data sets about the population in NI that had never been subjected to a secondary data analysis with regards to data on ASD. This report covers the first comprehensive secondary data analysis and thereby aims to inform future policy and practice.
Following a search of all existing, large-scale, regional or national data sets that were relevant to the lives of individuals and families affected by Autism Spectrum Disorder (ASD) in Northern Ireland, extensive secondary data analyses were carried out. The focus of these secondary data analyses was to distill any ASD related data from larger generic data sets. The findings are reported for each data set and follow a lifespan perspective, i.e., data related to children is reported first before data related to adults.
Key findings:
Autism Prevalence:
Of children born in 2000 in the UK,
• 0.9% (1:109) were reported to have ASD, when they were 5-year old in 2005;
• 1.8% (1:55) were reported to have ASD, when they were 7-years old in 2007;
• 3.5% (1:29) were reported to have ASD, when they were 11-year old in 2011.
In mainstream schools in Northern Ireland
• 1.2% of the children were reported to have ASD in 2006/07;
• 1.8% of the children were reported to have ASD in 2012/13.

Economic Deprivation:
• Families of children with autism (CWA) were 9%-18% worse off per week than families of children not on the autism spectrum (COA).
• Between 2006-2013 deprivation of CWA compared to COA nearly doubled as measured by eligibility for free school meals (from near 20 % to 37%)
• In 2006, CWA and COA experienced similar levels of deprivation (approx. 20%), by 2013, a considerable deprivation gap had developed, with CWA experienced 6% more deprivation than COA.
• Nearly 1/3 of primary school CWA lived in the most deprived areas in Northern Ireland.
• Nearly ½ of children with Asperger’s Syndrome who attended special school lived in the most deprived areas.

Unemployment:
• Mothers of CWA were 6% less likely to be employed than mothers of COA.
• Mothers of CWA earned 35%-56% less than mothers of COA.
• CWA were 9% less likely to live in two income families than COA.

Health:
• Pre-diagnosis, CWA were more likely than COA to have physical health problems, including walking on level ground, speech and language, hearing, eyesight, and asthma.
• Aged 3 years of age CWA experienced poorer emotional and social health than COA, this difference increased significantly by the time they were 7 years of age.
• Mothers of young CWA had lower levels of life satisfaction and poorer mental health than mothers of young COA.
Education:
• In mainstream education, children with ASD aged 11-16 years reported less satisfaction with their social relationships than COA.
• Younger children with ASD (aged 5 and 7 years) were less likely to enjoy school, were bullied more, and were more reluctant to attend school than COA.
• CWA attended school 2-3 weeks less than COA .
• Children with Asperger’s Syndrome in special schools missed the equivalent of 8-13 school days more than children with Asperger’s Syndrome in mainstream schools.
• Children with ASD attending mainstream schooling were less likely to gain 5+ GCSEs A*-C or subsequently attend university.



Further and Higher Education:
• Enrolment rates for students with ASD have risen in Further Education (FE), from 0% to 0.7%.
• Enrolment rates for students with ASD have risen in Higher Education (HE), from 0.28% to 0.45%.
• Students with ASD chose to study different subjects than students without ASD, although other factors, e.g., gender, age etc. may have played a part in subject selection.
• Students with ASD from NI were more likely than students without ASD to choose Northern Irish HE Institutions rather than study outside NI.

Participation in adult life and employment:
• A small number of adults with ASD (n=99) have benefitted from DES employment provision over the past 12 years.
• It is unknown how many adults with ASD have received employment support elsewhere (e.g. Steps to Work).
•
Awareness and Attitudes in the General Population:
• In both the 2003 and 2012 NI Life and Times Survey (NILTS), NI public reported positive attitudes towards the inclusion of children with ASD in mainstream education (see also BASE Project Vol. 2).

Gap Analysis Recommendations:
This was the first comprehensive secondary analysis with regards to ASD of existing large-scale data sets in Northern Ireland. Data gaps were identified and further replications would benefit from the following data inclusion:
• ASD should be recorded routinely in the following datasets:
o Census;
o Northern Ireland Survey of Activity Limitation (NISALD);
o Training for Success/Steps to work; Steps to Success;
o Travel survey;
o Hate crime; and
o Labour Force Survey.
• Data should be collected on the destinations/qualifications of special school leavers.
• NILT Survey autism module should be repeated in 5 years time (2017) (see full report of 1st NILT Survey autism module 2012 in BASE Project Report Volume 2).
• General public attitudes and awareness should be assessed for children and young people, using the Young Life and Times Survey (YLT) and the Kids Life and Times Survey (KLT); (this work is underway, Dillenburger, McKerr, Schubolz, & Lloyd, 2014-2015).
 

Potential of Microneedles in Enhancing Delivery of Photosensitising Agents for Photodynamic Therapy

Photodynamic therapy can be used in the treatment of pre-malignant and malignant diseases. It offers advantages over other therapies currently used in the treatment of skin lesions including avoidance of damage to surrounding tissue and minimal or no scarring. Unfortunately, systemic delivery of photosensitising agents can result in adverse effects, such as prolonged cutaneous photosensitivity; while topical administration lacks efficacy in the clearance of deeper skin lesions and those with a thick overlying keratotic layer. Therefore, enhancement of conventional photosensitiser delivery is desired. However, the physicochemical properties of photosensitising agents, such as extreme hydrophilicity or lipophilicity and large molecular weights make this challenging. This paper reviews the potential of microneedles as a viable method to overcome these delivery-limiting physicochemical characteristics and discusses the current benefits and limitations of solid, dissolving and hydrogel-forming microneedles. Clinical studies in which microneedles have successfully improved photodynamic therapy are also discussed, along with benefits which microneedles offer, such as precise photosensitiser localisation, painless application and reduction in waiting times between photosensitiser administration and irradiation highlighted.

Empleo y actividad económica en jóvenes: tendencias actuales en las economías avanzadas de Europa occidental”

This article describes the evolution of the labour market position of youth in European advanced economies in the last 3 decades, its main institutional determinants and policy instruments. In this period of time, we have witnessed the rise of the phenomenon of youth unemployment and, more recently, of joblessness. Still, youth fares quite differently across European countries. These differentials seem to be linked to institutional features of educational systems (school-to-work transitions) and labour markets (insiders-outsiders divide), and their interactions. Remedies have concentrated on the supply side of this equation (ALMP, minimum wages), leaving on the side the demand one (job creation). We conclude drawing some implications for the Chilean youth labour market concerning the necessity to develop active labour market measures to improve the transition to work processes, and to deal with the strong segmentation which still characterizes it.

Reforming civil engineering studies in recession times

The recent global economic and financial crisis has led the economies of many countries into recession, in particular at the periphery of the European Union. These countries currently face a significant contraction of both public investment in infrastructure and private investment in buildings and, as a result, the unemployment is particularly noticeable in the civil engineering and building sectors. Consequently, in all countries in recession the professional development of fresh civil engineering graduates is disproportionate to their high study effort and qualifications, since they rarely have the opportunity to gain experience in practice and their knowledge gradually becomes obsolete. Under these circumstances, it is imperative for the technical universities in countries in recession to plan and implement a substantial reform of the civil engineering studies syllabus. The objective should be to enable graduates to broaden the scope of their professional activity and increase their employability. In this paper, the widening of civil engineering studies curricula is proposed, in particular in the light of the development of the graduates’ potential on project, programme and portfolio management. In this direction, after a thorough literature review, including ASCE's Body of Knowledge for the 21st century and IPMA's Competence Baseline, it is recommended among others: to increase significantly the offered modules on project management and add new modules on strategy management, leadership behavior, delivery management, organization and environment etc; to provide adequate professional training during the university studies five year period; and to promote fresh graduates’ certification by professional bodies. The proposals are exemplified by presenting a reformed syllabus for the civil engineering studies offered currently by the National Technical University of Athens.

Effects of a green tax reform in Portugal: a general equilibrium analysis

Do ponto de vista da política económica, existe a possibilidade de utilizar a receita dos impostos ambientais para baixar os impostos sobre o trabalho, promovendo assim o emprego. Esta oportunidade surge na literatura como forma dos países industrializados responderem a um duplo desafio: um crescente nível de poluição e um decrescente nível de emprego. Alguns países tomaram já decisões no sentido de alcançar o “duplo dividendo”: melhorias ambientais e diminuição do desemprego. Os resultados teóricos, na sua maioria cépticos em relação à verificação do segundo dividendo, são substancialmente contrariados por uma série de estudos que utilizam modelos de equilíbrio geral. Pretendese com este trabalho fazer uma simulação para a economia portuguesa de uma reforma fiscal ambiental com as características referidas e a verificação da existência do “duplo dividendo”, através de um modelo computacional de equilíbrio geral. Para além disso, é feita uma análise dos impactos do Mercado Europeu de Licenças de Emissão, ao nível sectorial e regional, em Portugal, utilizando dados microeconómicos, com o objectivo de estudar as consequências ao nível das trasacções entre sectores e efeitos distributivos entre regiões.

A saúde mental dos sem abrigo: comunidades de inserção

Pretendemos com este estudo caracterizar os sem abrigo, as suas redes e relações sociais, bem como os modelos de intervenção, de forma a que se possa ter um maior conhecimento acerca desta problemática. Para a consecução destes propósitos, foram delineados os seguintes objectivos: caracterizar a população sem abrigo em termos de variáveis sócio-demográficas; identificar a sua rede social de apoio; caracterizar as dimensões sociais associadas à vinculação adulta nos sem abrigo; caracterizar a incidência de psicopatologia nesta população; analisar o seu bem estar psicológico; caracterizar os acontecimentos de vida stressantes que contribuem para a emergência desta problemática. Para atingir estes objectivos foram realizados dois estudos, um de carácter quantitativo e um segundo de carácter qualitativo. Participaram 225 indivíduos (105 sem abrigo e 120 pessoas carenciadas) garantindo a homogeneidade nas variáveis sexo e idade. A média de idades da amostra total (n= 225) é de 38 anos, sendo que a maioria dos sujeitos desta investigação pertence ao sexo masculino (78,5%). O grupo dos sem abrigo foi recolhido em duas comunidades de inserção, na zona centro do país, sendo importante destacar que todos nesta fase têm apoio residencial, satisfação das necessidades básicas, acompanhamento social e psicológico, bem como, projectos de inserção em curso. O protocolo de recolha de informação inclui dados pessoais, a versão portuguesa da (ASQ)-Questionário de Estilos de Vinculação nos Sem Abrigo (QEVSA), da escala de ocorrência de acontecimentos de vida stressantes relacionados com o surgimento do primeiro episódio de sem abrigo (EAVSSA), do Questionário de Morbilidade Psiquiátrica em Adultos (QMPA), do Medical Outcomes Study’s social support scale (MOS-SSS-P), a escala de medida de manifestação de bem-estar psicológico (EMMBEP), o programa de intervenção da CINO e uma entrevista estruturada utilizada no estudo qualitativo. Os principais resultados são: a) o perfil de sem abrigo encontrado é maioritariamente homem, em média com 39 anos, solteiro ou divorciado, com 1 filho, 2.º ciclo de escolaridade, desempregado e português; b) maioria viveu na rua mais de um ano, está na instituição há menos de meio ano, não teve nos últimos seis meses consumo de substâncias (álcool e drogas), frequenta consultas (saúde mental e toxicodependência), toma medicação (terapêutica de substituição e neurolépticos), afirma não ter comportamentos de risco, e na maioria têm patologia infecciosa (HIV ou hepatite c), tendo cerca de 40% estado detidos; c) a problemática dos sem abrigo é um fenómeno multicausal apontando como principais factores o conflito familiar, o desemprego e problemas de saúde; d) em termos de vinculação população sem abrigo parece corresponder a indivíduos com vinculação insegura, denotando uma falta de confiança generalizada; e) em termos de bem estar psicológico a média foi significativamente superior no grupo de pessoas carenciadas, quando comparado com o grupo dos sem abrigo; f) no que toca à saúde mental constatamos que 80% dos sem abrigo e 42.5% das pessoas carenciadas são portadores de transtorno mental; g) no que concerne ao apoio social os sem abrigo referem menor suporte social (apoio emocional, afectivo, instrumental e menor interacção social positiva) que as pessoas carenciadas; h) os sem abrigo têm menos familiares e amigos íntimos; i) os resultados do estudo qualitativo indicam que o programa de intervenção da CINO, parece contribuir para a emergência de uma rede social estável, activa, acessível e integrada que se constitui como um sistema salutogénico para o indivíduo, diminuindo o uso dos serviços. Parece ainda eficaz aos olhos dos próprios e destacam como factor fundamental a sua participação activa no mesmo, a importância de rotinas organizadoras, de espaços de terapia de grupo e a existência de equipa multidisciplinar. Destacam ainda como positivo o facto de existir um primeiro período de regime fechado como estratégia de prevenção de recaída, um programa faseado de aquisição de responsabilidades e autonomia, acesso a emprego no exterior da comunidade e o follow-up pós autonomização. Como implicação deste trabalho salienta-se a produção de conhecimentos acerca da realidade dos sem abrigo na região centro do país e de estratégias de intervenção.

Calculus of variations on time scales and applications to economics

We consider some problems of the calculus of variations on time scales. On the beginning our attention is paid on two inverse extremal problems on arbitrary time scales. Firstly, using the Euler-Lagrange equation and the strengthened Legendre condition, we derive a general form for a variation functional that attains a local minimum at a given point of the vector space. Furthermore, we prove a necessary condition for a dynamic integro-differential equation to be an Euler-Lagrange equation. New and interesting results for the discrete and quantum calculus are obtained as particular cases. Afterwards, we prove Euler-Lagrange type equations and transversality conditions for generalized infinite horizon problems. Next we investigate the composition of a certain scalar function with delta and nabla integrals of a vector valued field. Euler-Lagrange equations in integral form, transversality conditions, and necessary optimality conditions for isoperimetric problems, on an arbitrary time scale, are proved. In the end, two main issues of application of time scales in economic, with interesting results, are presented. In the former case we consider a firm that wants to program its production and investment policies to reach a given production rate and to maximize its future market competitiveness. The model which describes firm activities is studied in two different ways: using classical discretizations; and applying discrete versions of our result on time scales. In the end we compare the cost functional values obtained from those two approaches. The latter problem is more complex and relates to rate of inflation, p, and rate of unemployment, u, which inflict a social loss. Using known relations between p, u, and the expected rate of inflation π, we rewrite the social loss function as a function of π. We present this model in the time scale framework and find an optimal path π that minimizes the total social loss over a given time interval.

South Carolina’s employment situation-January 2014

The South Carolina Department of Employment and Workforce publishes news releases with monthly statistics about the employment situation of the state, including unemployment rate, employment by industry, and local area unemployment by county and MSA.