Picture Quiz: Know your anatomy.

A 25 year old man was brought into the emergency
department by ambulance. He was involved in a road
traffic incident and had an obvious site of blood loss from
a fracture of an upper limb. On his arrival at the
emergency department, you are told that the ambulance
paramedic was unable to gain intravenous access and
are asked by the person in charge of resuscitation to try
to gain access. You are unable to find any peripheral
veins because he is hypovolemic. You attempt to put in a
central line via the femoral vein (fig 1).

Clothing and Colonialism: The Dungiven costume and the fashioning of early modern identities

The entanglement of identity and personal attire in colonial settings is explored through consideration of a tattered set of clothes from late sixteenth-early seventeenth-century Ireland incorporating elements of Irish, English, and Scots fashion. Reconsideration of the clothing, recovered from a bog, provides a rare opportunity to explore the physical manifestations of processes of hybridity and mimesis, as well as the pragmatic accommodations of impoverishment and displacement in colonial settings. In addition to considering the role of material culture in colonial identity formation and negotiation, examination of what has become known as the Dungiven costume also speaks to the ongoing legacy of early modern colonial encounters, as the cultural associations of the garments, and by extension their past wearer(s), continue to be subjected to the politically charged nature of identity politics in contemporary Northern Ireland.

Common community-acquired infections and subsequent risk of multiple myeloma: a population-based study

The role of bacteria and viruses as aetiological agents in the pathogenesis of cancer has been well established for several sites, including a number of haematological malignancies. Less clear is the impact of such exposures on the subsequent development of multiple myeloma (MM). Using the population-based U.S. Surveillance Epidemiology and End Results-Medicare dataset, 15,318 elderly MM and 200,000 controls were identified to investigate the impact of 14 common community-acquired infections and risk of MM. Odds ratios (ORs) and associated 95% confidence intervals (CIs) were adjusted for sex, age and calendar year of selection. The 13-month period prior to diagnosis/selection was excluded. Risk of MM was increased by 5-39% following Medicare claims for eight of the investigated infections. Positive associations were observed for several infections including bronchitis (adjusted OR 1.14, 95% CI 1.09-1.18), sinusitis (OR 1.15, 95% CI 1.10-1.20) pneumonia (OR 1.27, 95% CI 1.21-1.33), herpes zoster (OR 1.39, 95% CI 1.29-1.49) and cystitis (OR 1.09, 95% CI 1.05-1.14). Each of these infections remained significantly elevated following the exclusion of more than 6 years of claims data. Exposure to infectious antigens may therefore play a role in the development of MM. Alternatively, the observed associations may be a manifestation of an underlying immune disturbance present several years prior to MM diagnosis and thereby part of the natural history of disease progression.

Effective grain size distribution analysis for interpretation of tidal-deltaic facies: West Bengal Sundarbans

Research over the past two decades on the Holocene sediments from the tide dominated west side of the lower Ganges delta has focussed on constraining the sedimentary environment through grain size distributions (GSD). GSD has traditionally been assessed through the use of probability density function (PDF) methods (e.g. log-normal, log skew-Laplace functions), but these approaches do not acknowledge the compositional nature of the data, which may compromise outcomes in lithofacies interpretations. The use of PDF approaches in GSD analysis poses a series of challenges for the development of lithofacies models, such as equifinal distribution coefficients and obscuring the empirical data variability. In this study a methodological framework for characterising GSD is presented through compositional data analysis (CODA) plus a multivariate statistical framework. This provides a statistically robust analysis of the fine tidal estuary sediments from the West Bengal Sundarbans, relative to alternative PDF approaches.

Marine organisms for bone repair and regeneration

Bioprospecting has led to increased interest in potential applications for marine organisms and their by-products. As a rich source of mineralising porous organisms, our seas and oceans could provide new directions for bone tissue engineering particularly in the supply of biomimetic templates that may enhance in vivo and ex vivo bone formation. In this chapter we examine the history of marine organism use in this field; exploring how these organisms could be utilised, given the problems of sustainability, and reviewing the current evidence to support their use for bone repair and regeneration.

Empathy in UK pharmacy students: assessing differences by gender, level in the degree programme, part-time employment and medical status

Background: Empathy is an important aspect of patient–healthcare professional interactions.Aims: To investigate whether gender, level in the degree programme, employment and health status affected empathy scores of undergraduate pharmacy students.Method: All undergraduate pharmacy students (n=529) at Queen’s University Belfast were invited via email to completean online validated empathy questionnaire. Empathy scores were calculated and non-parametric tests used to determine associations between factors.Results: Response rate was 60.1% (318/529) and the mean empathy score was 106.19. Scores can range from 20 to 140,with higher scores representing a greater degree of empathy. There was no significant difference between genders (p=0.211). There was a significant difference in scores across the four levels of the programme (p<0.001); scores were lowest at Level 1 and greatest at Level 4 (final year). There were no significant differences in scores for respondents who had a part-time job, a chronic condition, or took regular medication in comparison to those who did not (p=0.028,p=0.880, p=0.456, respectively).Conclusion: A reasonable level of empathy was found relative to other studies; this could be further enhanced at lower levels of the degree pathway.

Effectiveness of a biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use: protocol for a randomised controlled trial (VAPrapid-2):Study protocol for a randomised controlled trial

Background Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. Methods/Design This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management. Patients with clinically suspected VAP undergo BAL, and VAP is confirmed by growth of a potential pathogen at > 104 colony-forming units per millilitre (CFU/ml). Patients are randomised 1:1, to either a ‘biomarker-guided recommendation on antibiotics’ in which BAL fluid is tested for IL-1β and IL-8 in addition to routine microbiology testing, or to ‘routine use of antibiotics’ in which BAL undergoes routine microbiology testing only. Clinical teams are blinded to intervention until 6 hours after randomisation, when biomarker results are reported to the clinician. The primary outcome is a change in the frequency distribution of antibiotic-free days (AFD) in the 7 days following BAL. Secondary outcome measures include antibiotic use at 14 and 28 days; ventilator-free days; 28-day mortality and ICU mortality; sequential organ failure assessment (SOFA) at days 3, 7 and 14; duration of stay in critical care and the hospital; antibiotic-associated infections; and antibiotic-resistant pathogen cultures up to hospital discharge, death or 56 days. A healthcare-resource-utilisation analysis will be calculated from the duration of critical care and hospital stay. In addition, safety data will be collected with respect to performing BAL. A sample size of 210 will be required to detect a clinically significant shift in the distribution of AFD towards more patients having fewer antibiotics and therefore more AFD. Discussion This trial will test whether a rapid biomarker-based exclusion of VAP results in rapid discontinuation of antibiotics and therefore improves antibiotic management in patients with suspected VAP.

Increasing fruit and vegetable intake has no effect on retinal vessel caliber in adults at high risk of developing cardiovascular disease

BACKGROUND AND AIM: Retinal vessel abnormalities are associated with cardiovascular disease (CVD) risk. To date, there are no trials investigating the effect of dietary factors on the retinal microvasculature. This study examined the dose response effect of fruit and vegetable (FV) intake on retinal vessel caliber in overweight adults at high CVD risk.

METHODS AND RESULTS: Following a 4 week washout period, participants were randomized to consume either 2 or 4 or 7 portions of FV daily for 12 weeks. Retinal vessel caliber was measured at baseline and post-intervention. A total of 62 participants completed the study. Self-reported FV intake indicated good compliance with the intervention, with serum concentrations of zeaxanthin and lutein increasing significantly across the groups in a dose-dependent manner (P for trend < 0.05). There were no significant changes in body composition, 24-h ambulatory blood pressure or fasting blood lipid profiles in response to the FV intervention. Increasing age was a significant determinant of wider retinal venules (P = 0.004) whereas baseline systolic blood pressure was a significant determinant of narrower retinal arterioles (P = 0.03). Overall, there was no evidence of any short-term dose-response effect of FV intake on retinal vessel caliber (CRAE (P = 0.92) or CRVE (P = 0.42)).

CONCLUSIONS: This study demonstrated no effect of increasing FV intake on retinal vessel caliber in overweight adults at high risk of developing primary CVD.

Treatment of aqueous effluents contaminated with ionic liquids

Ionic liquids are a class of solvents that, due to their unique properties, have been proposed in the past few years as alternatives to some hazardous volatile organic compounds. They are already used by industry, where it was possible to improve different processes by the incorporation of this kind of non-volatile and often liquid solvents. However, even if ionic liquids cannot contribute to air pollution, due to their negligible vapour pressures, they can be dispersed thorough aquatic streams thus contaminating the environment. Therefore, the main goals of this work are to study the mutual solubilities between water and different ionic liquids in order to infer on their environmental impact, and to propose effective methods to remove and, whenever possible, recover ionic liquids from aqueous media. The liquid-liquid phase behaviour of different ionic liquids and water was evaluated in the temperature range between (288.15 and 318.15) K. For higher melting temperature ionic liquids a narrower temperature range was studied. The gathered data allowed a deep understanding on the structural effects of the ionic liquid, namely the cation core, isomerism, symmetry, cation alkyl chain length and the anion nature through their mutual solubilities (saturation values) with water. The experimental data were also supported by the COnductor-like Screening MOdel for Real Solvents (COSMO-RS), and for some more specific systems, molecular dynamics simulations were also employed for a better comprehension of these systems at a molecular level. On the other hand, in order to remove and recover ionic liquids from aqueous solutions, two different methods were studied: one based on aqueous biphasic systems, that allowed an almost complete recovery of hydrophilic ionic liquids (those completely miscible with water at temperatures close to room temperature) by the addition of strong salting-out agents (Al2(SO4)3 or AlK(SO4)2); and the other based on the adsorption of several ionic liquids onto commercial activated carbon. The first approach, in addition to allowing the removal of ionic liquids from aqueous solutions, also makes possible to recover the ionic liquid and to recycle the remaining solution. In the adsorption process, only the removal of the ionic liquid from aqueous solutions was attempted. Nevertheless, a broad understanding of the structural effects of the ionic liquid on the adsorption process was attained, and a final improvement on the adsorption of hydrophilic ionic liquids by the addition of an inorganic salt (Na2SO4) was also achieved. Yet, the development of a recovery process that allows the reuse of the ionic liquid is still required for the development of sustainable processes.

Heritability and The Units of Selection: A defense of Genic Selectionism

Tesina elaborada para obtener el MPhil en la Universidad de Cambridge, Inglaterra, 1987

Satisfação do cliente na área da restauração

Dissertação de Mestrado , Ciências Económicas e Empresariais, Faculdade de Economia, Universidade do Algarve, 2008

An efficient parallel implementation of a least squares problem

Least squares solutions are a very important problem, which appear in a broad range of disciplines (for instance, control systems, statistics, signal processing). Our interest in this kind of problems lies in their use of training neural network controllers.

Die Generation Y : Arbeitnehmer der Zukunft. Herausforderungen für das Personalmanagement

Die Generation der ab den 1980er Jahren Geborenen, genannt Generation Y, tritt seit einiger Zeit als Arbeitnehmer in die Arbeitsmärkte ein. Im Jahr 2020 wird diese Gruppe die Hälfte der Arbeitnehmer in der Bundesrepublik ausmachen. Lebensstil, Globalisierung, kulturelles und mediales Angebot führen bei dieser Generation auch in der Arbeitswelt zu anderen Erwartungen und Ansprüchen als dies bei vorherigen Generationen der Fall war. In Literatur und Studien wird diese Generation fast ausschließlich als selbstbewusst, ehrgeizig, aufstrebend, sozial engagiert und mobil beschrieben. Vor dem Hintergrund des zu erwartenden Fachkräftemangels widmet sich diese Arbeit unter anderem der Frage, mit welchen Instrumenten das Personalmanagement der Unternehmen auf diese Situation reagieren kann, um bei der Gewinnung und Bindung von Mitarbeitern erfolgreich zu sein.