Management of varicella contacts in pregnancy: VZIG or Vaccination?

Background Varicella infection during pregnancy poses a serious risk for both foetus and mother. It has been suggested that it would be more cost-effective to screen antenatally with post-partum vaccination, which occurs in the US, than the current policy of checking immune status post varicella exposure, with VZIG administration where necessary. Additionally, it is doubtful whether the current policy provides best patient care, when a vaccine is available. Objectives The study aims to retrospectively compare the cost of the current policy with a cost estimate for antenatal screening with post-partum vaccination in NI. Study design A cost estimate of antenatal screening of primigravidas, with post-partum vaccination, was calculated for two models: (1) verbal screening, with serological testing of those with no history of varicella infection and (2) serological screening of all primigravidas. Results The cost of VZIG issued to pregnant women in 2006 was £100,800; 43% of births were to primigravidas therefore the estimated cost of VZIG issued to multigravidas was £58,100. The cost of verbal screening with post-partum vaccination is estimated at £23,750 p.a., saving £34,350 over current policy. The estimated cost of screening all primigravidas with post-partum vaccination is £43,000, saving £15,100. Conclusions This retrospective study suggests that in NI either of the proposed antenatal screening strategies would be less costly than current practice. This finding supports the suggestion that varicella immunity testing should be included in the Antenatal Infectious Diseases Screening Programme, either as part of the universal vaccination programme or solely as an antenatal programme.

Lichen-induced biomodification of calcareous surfaces: Bioprotection versus biodeterioration

Studies demonstrate the active and passive capability of lichens to inhibit or retard the weathering of calcareous surfaces. Lichen coverage may actively protect a surface through shielding by the thallus and the binding and waterproofing of the rock surface and subsurface by fungal hyphae. Passive protection of rock surfaces may be induced by the formation of an insoluble encrustation, such as calcium oxalate, at the lichen-rock interface. Recent research suggests that the decay of hyphae, induced by changes in microenvironmental conditions, necrosis, parasitism or the natural physiological traits of particular lichen species, may expose a chemically and physically weakened substrate to dissolution triggering relatively rapid weathering-related surface lowering. Consequently, certain epilithic crustose and endolithic lichens may induce a period of surface stability throughout the course of their lifespan, followed by a phase of instability and rapid episodic microtopographical evolution after death and decay. A series of conceptual models is proposed to illustrate this idea over short (single lichen lifespan) and long (multiple lichen lifespans) timescales. The models suggest that the microscale biogeomorphological system of lichen-rock interaction is underpinned by nonlinear dynamical system theory as it exhibits dynamical instability and is consequently difficult to predict over a long timescale. Dominance by biodeterioration or bioprotection may be altered by changes in lichen species or in environmental conditions over time.

Psychosocial and academic characteristics of extremely low birth weight (<or =800 g) adolescents who are free of major impairment compared with term-born control subjects

To compare academic and cognitive ability, attention, attitudes, and behavior of extremely low birth weight (ELBW) adolescents who are free of major impairments at 17 years of age with term-born control subjects.

Process of debonding in RC beams shear-strengthened with FRP U-strips or side strips

Reinforced concrete (RC) beams may be strengthened for shear using externally bonded fiber reinforced polymer (FRP) composites in the form of side bonding, U-jacketing or complete wrapping. The shear failure of almost all RC beams shear-strengthened with side bonded FRP and the majority of those strengthened with FRP U-jackets, is due to debonding of the FRP. The bond behavior between the externally-bonded FRP reinforcement (referred to as FRP strips for simplicity) and the concrete substrate therefore plays a crucial role in the failure process of these beams. Despite extensive research in the past decade, there is still a lack of understanding of how debonding of FRP strips in such a beam propagates and how the debonding process affects its shear behavior. This paper presents an analytical study on the progressive debonding of FRP strips in such strengthened beams. The complete debonding process is modeled and the contribution of the FRP strips to the shear capacity of the beam is quantified. The validity of the analytical solution is verified by comparing its predictions with numerical results from a finite element analysis. This analytical treatment represents a significant step forward in understanding how interaction between FRP strips, steel stirrups and concrete affects the shear resistance of RC beams shear-strengthened with FRP strips.

Stated choices and benefit estimates in the context of traffic calming schemes:Utility maximization, regret minimization, or both?

This paper proposes a discrete mixture model which assigns individuals, up to a probability, to either a class of random utility (RU) maximizers or a class of random regret (RR) minimizers, on the basis of their sequence of observed choices. Our proposed model advances the state of the art of RU-RR mixture models by (i) adding and simultaneously estimating a membership model which predicts the probability of belonging to a RU or RR class; (ii) adding a layer of random taste heterogeneity within each behavioural class; and (iii) deriving a welfare measure associated with the RU-RR mixture model and consistent with referendum-voting, which is the adequate mechanism of provision for such local public goods. The context of our empirical application is a stated choice experiment concerning traffic calming schemes. We find that the random parameter RU-RR mixture model not only outperforms its fixed coefficient counterpart in terms of fit-as expected-but also in terms of plausibility of membership determinants of behavioural class. In line with psychological theories of regret, we find that, compared to respondents who are familiar with the choice context (i.e. the traffic calming scheme), unfamiliar respondents are more likely to be regret minimizers than utility maximizers. © 2014 Elsevier Ltd.

Intermittent chemotherapy plus either intermittent or continuous cetuximab for first-line treatment of patients with KRAS wild-type advanced colorectal cancer (COIN-B): a randomised phase 2 trial

Background: Advanced colorectal cancer is treated with a combination of cytotoxic drugs and targeted treatments. However, how best to minimise the time spent taking cytotoxic drugs and whether molecular selection can refine this further is unknown. The primary aim of this study was to establish how cetuximab might be safely and effectively added to intermittent chemotherapy.

Methods: COIN-B was an open-label, multicentre, randomised, exploratory phase 2 trial done at 30 hospitals in the UK and one in Cyprus. We enrolled patients with advanced colorectal cancer who had received no previous chemotherapy for metastases. Randomisation was done centrally (by telephone) by the Medical Research Council Clinical Trials Unit using minimisation with a random element. Treatment allocation was not masked. Patients were assigned (1:1) to intermittent chemotherapy plus intermittent cetuximab or to intermittent chemotherapy plus continuous cetuximab. Chemotherapy was FOLFOX (folinic acid and oxaliplatin followed by bolus and infused fluorouracil). Patients in both groups received FOLFOX and weekly cetuximab for 12 weeks, then either had a planned interruption (those taking intermittent cetuximab) or planned maintenance by continuing on weekly cetuximab (continuous cetuximab). On RECIST progression, FOLFOX plus cetuximab or FOLFOX was recommenced for 12 weeks followed by further interruption or maintenance cetuximab, respectively. The primary outcome was failure-free survival at 10 months. The primary analysis population consisted of patients who completed 12 weeks of treatment without progression, death, or leaving the trial. We tested BRAF and NRAS status retrospectively. The trial was registered, ISRCTN38375681.

Findings: We registered 401 patients, 226 of whom were enrolled. Results for 169 with KRAS wild-type are reported here, 78 (46%) assigned to intermittent cetuximab and 91 (54%) to continuous cetuximab. 64 patients assigned to intermittent cetuximab and 66 of those assigned to continuous cetuximab were included in the primary analysis. 10-month failure-free survival was 50% (lower bound of 95% CI 39) in the intermittent group versus 52% (lower bound of 95% CI 41) in the continuous group; median failure-free survival was 12·2 months (95% CI 8·8–15·6) and 14·3 months (10·7–20·4), respectively. The most common grade 3–4 adverse events were skin rash (21 [27%] of 77 patients vs 20 [22%] of 92 patients), neutropenia (22 [29%] vs 30 [33%]), diarrhoea (14 [18%] vs 23 [25%]), and lethargy (20 [26%] vs 19 [21%]).

Interpretation: Cetuximab was safely incorporated in two first-line intermittent chemotherapy strategies. Maintenance of biological monotherapy, with less cytotoxic chemotherapy within the first 6 months, in molecularly selected patients is promising and should be validated in phase 3 trials.

Biogeography, macroecology and species’ traits mediate competitive interactions in the order Lagomorpha

1. In addition to abiotic determinants, biotic factors, including competitive, interspecific interactions, limit species’ distributions. Environmental changes in human disturbance, land use and climate are predicted to have widespread impacts on interactions between species, especially in the order Lagomorpha due to the higher latitudes and more extreme environmental conditions they occupy.
2. We reviewed the published literature on interspecific interactions in the order Lagomorpha, and compared the biogeography, macroecology, phylogeny and traits of species known to interact with those of species with no reported interactions, to investigate how projected future environmental change may affect interactions and potentially alter species’ distributions.
3. Thirty-three lagomorph species have competitive interactions reported in the literature; the majority involve hares (Lepus sp.) or the eastern cottontail rabbit (Sylvilagus floridanus). Key regions for interactions are located between 30-50°N of the Equator, and include eastern Asia (southern Russia on the border of Mongolia) and North America (north western USA).
4. Closely related, large-bodied, similarly sized species occurring in regions of human-modified, typically agricultural landscapes, or at high elevations are significantly more likely to have reported competitive interactions than other lagomorph species.
5. We identify species’ traits associated with competitive interactions, and highlight some potential impacts that future environmental change may have on interspecific interactions. Our approach using bibliometric and biological data is widely applicable, and with relatively straightforward methodologies, can provide insights into interactions between species.
6. Our results have implications for predicting species’ responses to global change, and we advise that capturing, parameterizing and incorporating interspecific interactions into analyses (for example, species distribution modelling) may be more important than suggested by the literature.

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

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

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

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

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

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

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

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

Institutional Hybridity in Public Sector Reform: Replacement, Blending, or Layering of Administrative Paradigms

Despite an abundance of studies on hybridization and hybrid forms of organizing, scholarly work has failed to distinguish consistently between specific types of hybridity. As a consequence, the analytical category has become blurred and lacks conceptual clarity. Our paper discusses hybridity as the simultaneous appearance of institutional logics in organizational contexts, and differentiates the parallel co-existence of logics from transitional combinations (eventually leading to the replacement of a logic) and more robust combinations in the form of layering and blending. While blending refers to hybridity as an ‘amalgamate’ with original components that are no longer discernible, the notion of layering conceptualizes hybridity in a way that the various elements, or clusters thereof, are added on top of, or alongside, each other, similar to sediment layers in geology. We illustrate and substantiate such conceptual differentiation with an empirical study of the dynamics of public sector reform. In more detail, we examine the parliamentary discourse around two major reforms of the Austrian Federal Budget Law in 1986 and in 2007/2009 in order to trace administrative (reform) paradigms. Each of the three identified paradigms manifests a specific field-level logic with implications for the state and its administration: bureaucracy in Weberian-style Public Administration, market-capitalism in New Public Management, and democracy in New Public Governance. We find no indication of a parallel co-existence or transitional combination of logics, but hybridity in the form of robust combinations. We explore how new ideas fundamentally build on – and are made resonant with – the central bureaucratic logic in a way that suggests layering rather than blending. The conceptual findings presented in our article have implications for the literature on institutional analysis and institutional hybridity.

Connectivity patterns and early life history of the black-faced blenny Tripterygion delaisi (Cadenat and Blache, 1970)

Tese de doutoramento, Ciências do Mar, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Unpacking the Link Between Entrepreneurialism and Employability: an Assessment of the Relationship Between Entrepreneurial Attitudes and Likelihood of Graduate Employment in a Professional Field

Purpose This research investigates the relationship between students’ entrepreneurial attitudes and traits and their classification of employment six months after university graduation. It aims to identify what specific attitudes and traits of entrepreneurial graduates are linked to employability in a professional or managerial field. Design/Methodology The research adopts a quantitative approach to measure the entrepreneurial drive of final-year undergraduate business school students and regresses this measurement against the employment level of the same students six months after their graduation. The employment classification of each respondent was classified as ‘professional/managerial’ or ‘non-professional/non-managerial’, in line with the Standard Occupational Classification (SOC) 2010. Findings The research found that both proactive disposition and achievement motivation were statistically linked to the likelihood of graduates being employed in a professional or managerial position six months after graduation. Originality/Value This research goes beyond existing literature linking entrepreneurship to employability to quantitatively examine what specific attitudes and traits can be linked to employability in recent graduates. By identifying the aspects of entrepreneurialism that have a relationship with employability, more information is available for educators who are designing entrepreneurial education programs and allows for greater focus on aspects that may be of greatest benefit to all students.

Transgenerational Inheritance of Paternal Neurobehavioral Phenotypes: Stress, Addiction, Ageing and Metabolism

Epigenetic modulation is found to get involved in multiple neurobehavioral processes. It is believed that different types of environmental stimuli could alter the epigenome of the whole brain or related neural circuits, subsequently contributing to the long-lasting neural plasticity of certain behavioral phenotypes. While the maternal influence on the health of offsprings has been long recognized, recent findings highlight an alternative way for neurobehavioral phenotypes to be passed on to the next generation, i.e., through the male germ line. In this review, we focus specifically on the transgenerational modulation induced by environmental stress, drugs of abuse, and other physical or mental changes (e.g., ageing, metabolism, fear) in fathers, and recapitulate the underlying mechanisms potentially mediating the alterations in epigenome or gene expression of offsprings. Together, these findings suggest that the inheritance of phenotypic traits through male germ-line epigenome may represent the unique manner of adaptation during evolution. Hence, more attention should be paid to the paternal health, given its equivalently important role in affecting neurobehaviors of descendants.

Access of WetAMD and DME patients to treatment in public hospitals

Degeneration (WetAMD) and Diabetic Macular Edema (DME) patients’ access to treatment in public hospitals, by identifying bottlenecks and stress points that prevent timely and adequate care to patients who suffer from a degenerative disease, and consequently for whom the lack of access to treatment can have disastrous consequences. Considering the specificity and degenerative traits of these conditions, the long queues for specialty appointments in public hospitals are a significant threat to patients’ health, as the disease may be misdiagnosed and or progress significantly, causing unnecessary permanent and non-reversible loss in visual acuity. Therefore optimizing the patient journey will increase patients’ access to adequate treatment, and prevent avoidable progress of a degenerative condition which causes permanent and non-reversible blindness. Following the investigation which supports this thesis, the patient journey was broken down into its different phases, so that key issues could be identified, and referred back to the main stress points highlighted during the interviews with physicians and administrators. Finally results were scrutinized and systematized, and a set of action points was proposed, considering what may cause major impact and is actually feasible to implement.