Overview of risk factors for age-related macular degeneration (AMD)

Age related macular degeneration (AMD) is the leading cause of blindness in individuals older than 65 years of age. It is a multifactorial disorder and identification of risk factors enables individuals to make life style choices that may reduce the risk of disease. This review discusses the role of genetics, sunlight, diet, cardiovascular factors, smoking, and alcohol as possible risk factors for AMD. Genetics plays a more significant role in AMD than previously thought, especially in younger patients, histocompatibility locus antigen (HLA) and complement system genes being the most significant. Whether the risk of AMD is increased by exposure to sunlight, cardiovascular risk factors, and diet is more controversial. Smoking is the risk factor most consistently associated with AMD. Current smokers are exposed to a two to three times higher risk of AMD than non-smokers and the risk increases with intensity of smoking. Moderate alcohol consumption is unlikely to increase the risk of AMD. Optometrists as front-line informers and educators of ocular health play a significant role in increasing public awareness of the risks of AMD. Cessation of smoking, the use of eye protection in high light conditions, dietary changes, and regular use of dietary supplements should all be considered to reduce the lifetime risk of AMD.

Impact of Employee Management on Hospitality Innovation Success

The author report on a survey of 185 hospitality manager to examine which employee management practices are associated with success in hospitality innovations. The result suggest that successful new hospitality projects are guided by a strategic human resource management approach, have higher level of training, implement behavior- bared evaluation of their front-line staff and empower their employees.

A molecular analysis of the interactions of escherichia coli and macrophages

Escherichia coli (E.coli) is a diverse bacterial species that primarily forms a beneficial symbiotic relationship with the host in the human lower gastrointestinal track (GIT), however it can also be pathogenic in this environment. Furthermore, some strains can diverge from the GIT and occupy niches such as the urinary tract. In all these environments, E. coli interacts with the immune system and macrophages represent the front line of the innate immune system. In this study we characterise the immune response by macrophages to E. coli infection. It was shown that E. coli broadly provoke a similar cytokine response during macrophages infection and furthermore are degraded primarily by the phagocytosis pathway. Recently a new group of E. coli called Adherent Invasive Escherichia coli (AIEC) has been described. AIEC are present in the guts of Crohn’s disease (CD) patients at a higher frequency than in healthy patients. AIEC can replicate in macrophages but the mechanism for this is not fully understood. The processing of AIEC by macrophages was investigated and it was shown that AIEC only replicated in permissive macrophages. Furthermore, even in a permissive macrophages AIEC are trafficked through macrophages in a similar manner to commensal E. coli. This supports the hypothesis that AIEC are highly similar to commensal E. coli and only cause pathogenicity when present in the permissive environment of the gut of CD patients. Replication in macrophages requires functioning metabolic pathways and it was identified that glycolysis is important for AIEC survival in macrophages. AIEC mutants without a fully functioning glycolysis pathway induced less IL-1β cytokine release from macrophages than wild type strain suggesting that metabolism plays a role in inflammasome activation. Furthermore, AIEC mutants that could not produce the glycolytic end product acetate induced significantly reduced IL-1β release during infection. This suggest that the acetate molecule or a phenotypic effect of its production may be a driver of IL-1β release from AIEC infected macrophages. The interaction of uropathogenic E. coli (UPEC) with macrophages was also investigated. UPEC induced very high levels of cytotoxicity in human macrophages which was shown to be dependent on the production of the pore forming toxin α-hemolysin. However, UPEC did not induced high levels of cytotoxicity in murine macrophages suggesting there are species specific sensitivity to α-hemolysin that should be considered when studying UPEC pathogenicity in murine models.

Nursing and medical students as agents of change in health care: impact of schools core values and culture-a discussion paper

Within the UK the quality of care delivered in some hospitals, nursing homes and caring facilities has been the subject of significant enquiry, challenge and concern in recent years. There was need for a change in the culture of patient and client care. Traditionally a change in culture is seen as moving from an organisational head through to the organisation and in this case through to front-line care. This hasn’t necessarily achieved the desired effect and impact in terms of quality of care within the UK. Historically, certainly nurses have acted more as recipients of change, rather than agents of change
This paper suggests that schools of nursing and medicine with robust core values and a more consistently enacted culture of care, are better able and more likely to transfer this to nursing and medical students within their professional socialisation. In addition, and rather than the newly qualified nurse or doctor being absorbed into existing cultures of care delivery (which are not necessarily always reflecting high qualities of care), schools of nursing and medicine could better facilitate the development of more `agency’ within students and better equipping the students on qualification and stepping into practice, with a role and function as potential agents of change. Effective leadership within schools of nursing and medicine can both translate to quality and consistency, and enactment of organisational core values and working culture. The working culture of schools is intrinsic to developing students as agents of change

Personal and Public Involvement Consultation Scheme (PDF 149KB)

The current structure of the health and social care system in Northern Ireland has its origins in the Review of Public Administration (RPA) which was initiated by the Northern Ireland Executive in June 2002. The purpose of RPA was to review Northern Ireland’s system of public administration with a view to putting in place a modern, citizen-centred, accountable and high quality system of public administration. The structure was designed to be more streamlined and accountable and aimed at maximising resources for front-line services and ensuring that people have access to high quality health and social care. Another key feature is the placement of public health and wellbeing firmly at the centre of the system, with a greater emphasis on prevention and support for vulnerable people to live independently in the community for as long as possible.  

Ambulance Treatment Space Ergonomic Layout

This is the first time a multidisciplinary team has employed an iterative co-design method to determine the ergonomic layout of an emergency ambulance treatment space. This process allowed the research team to understand how treatment protocols were performed and developed analytical tools to reach an optimum configuration towards ambulance design standardisation. Fusari conducted participatory observations during 12-hour shifts with front-line ambulance clinicians, hospital staff and patients to understand the details of their working environments whilst on response to urgent and emergency calls. A simple yet accurate 1:1 mock-up of the existing ambulance was built for detailed analysis of these procedures through simulations. Paramedics were called in to participate in interviews and role-playing inside the model to recreate tasks, how they are performed, the equipment used and to understand the limitations of the current ambulance. The use of Link Analysis distilled 5 modes of use. In parallel, an exhaustive audit of all equipment and consumables used in ambulances was performed (logging and photography) to define space use. These developed 12 layout options for refinement and CAD modelling and presented back to paramedics. The preferred options and features were then developed into a full size test rig and appearance model. Two key studies informed the process. The 2005 National Patient Safety Agency funded study “Future Ambulances” outlined 9 design challenges for future standardisation of emergency vehicles and equipment. Secondly, the 2007 EPSRC funded “Smart Pods” project investigated a new system of mobile urgent and emergency medicine to treat patients in the community. A full-size mobile demonstrator unit featuring the evidence-based ergonomic layout was built for clinical tests through simulated emergency scenarios. Results from clinical trials clearly show that the new layout improves infection control, speeds up treatment, and makes it easier for ambulance crews to follow correct clinical protocols.

“Digital Diagnostics and Communication (DDC) system” Redesigning the Emergency Ambulance

During the development of a new treatment space for the UK emergency ambulance participatory observations with front-line clinicians revealed the need for an integrated patient monitoring, communication and navigation system. The research identified the different information touch-points and requirements through modes of use analysis, day-in-the-life study and simulation workshops with clinicians. Emergency scenario and role-play with paramedics identified 5 distinct ambulance modes of use. Information flow diagrams were created and checked by paramedics and digital User Interface (UI) wireframes were developed and evaluated by clinicians during clinical evaluations. Feedback from clinicians defined UI design specification further leading to a final design proposal. This research was a further development from the 2007 EPSRC funded “Smart Pods” project. The resulting interactive prototype was co-designed in collaboration with ambulance crews and provides a vision of what could be achieved by integrating well-proven IT technologies and protocols into a package relevant in the emergency medicine field. The system has been reviewed by over 40 ambulance crews and is part of a newly co-designed ambulance treatment space.

Live Work: The Impact of Direct Encounters in Statutory Child and Family Social Wor

The aim of this research project was to examine the impact of direct work on practitioners in the field of statutory child protection. The author’s premise was that this work was anything but straightforward and that surprisingly, given the intense scrutiny on Children’s Services following a child death, there was little research into the day-to-day practice of front line staff. The aim was to explore whether psychoanalytic theory could be useful in understanding and making sense of the social work task. Data was collected through observation and semi-structured interviews in one Local Authority Child in Need team over a period of six months. The findings indicated that practitioners experienced direct work with some individuals and families as profoundly disturbing and that this affected them physiologically as well as psychologically. These effects persisted over time and appeared very difficult for the workers to process or articulate. This could be expressed through embodied or non-verbal communication in the interview. Practitioners appeared to be ‘inhabited’ by particular clients, suggesting phenomena such as projective identification were in operation. The intensity and persistence of the impact on the practitioners appears to be directly related to the quality, nature and intensity of the psychic defences functioning for the particular client. Significantly, the research indicated that when practitioners were dealing with the negative and disturbing projections from the (adult) clients it seemed from the data that the focus on the child would slip so that the child appeared to recede from view. Symptoms experienced by the practitioners were akin to trauma and research and theory on primary and secondary trauma were considered. Other issues raised included shame, which affects the clients, practitioners and the organisation and the meaning and implications of this are explored. Links between neuroscience and projective identification are addressed as well as the role of the organisation, particularly as a container for these toxic and disturbing encounters.

Compassion and its role in the clinical encounter – An argument for compassion training

Empathic communication, (i.e. emotionally engaging with a patient), is an important part of the therapeutic relationship. It has been shown to improve the health and therapeutic outcomes for patients by improving diagnosis and compliance. In the West, front-line medical professionals, including herbal medicine practitioners, put themselves at risk of burnout and compassion fatigue by giving emotionally intensive care. While treatments for compassion fatigue and burnout are available, another way forward is needed to ensure healthcare professionals do not become ill; one that will enable both patients and healthcare professionals to receive the care needed. In this paper it is argued that compassion, which is defined in this paper, involves different neural circuitry to empathy and can protect healthcare professionals from the effects of stress that can, if not addressed, lead to burnout. Traditional Buddhist meditation techniques such as loving-kindness meditation have been shown to increase compassion in non-meditative states. Short daily sessions of such mediation practices have been shown to improve compassion in a way that protects healthcare professionals from burnout.

Validation de l’échelle de mesure de la conscience de l’environnement d’affaires

La conscience de l’environnement d’affaires est définie comme l’ensemble des savoirs détenus par les employés non-cadres par rapport à l’environnement d’affaires interne et externe de leur organisation. Elle se manifeste lorsque l’employé est impliqué dans la prise de décision ou résolution de problème affectant l’entreprise. Ce travail a comme objectifs la validation d’une échelle de mesure du concept à l’étude, ainsi que la vérification de sa validité de construit et nomologique. L’ensemble initial d’items de l’échelle de mesure a été déterminé suite à des entrevues avec les employés d’organisations participantes (Gauvreau-Jean, 2008). L’ensemble initial de 40 items a été testé avec un échantillon de 508 employés d’une manufacture. Suite à des ajustements, l’échelle modifiée couvre quatre dimensions du construit. L’adéquation de son contenu a ensuite été mise à l’épreuve par deux groupes cibles et deux évaluations expertes (Lessard, 2014). Finalement, dans le cadre de notre étude, la validité du contenu et nomologique de l’échelle modifiée (contenant 24 items) a été testée avec 330 employés de première ligne de quatre entreprises. Les quatre dimensions du construit furent supportées, la fiabilité de l’échelle était haute, puis les hypothèses reliant la conscience de l’environnement avec les caractéristiques au travail, l’évaluation de la performance par un superviseur et l’engagement affectif furent supportées également. Un autre sondage complété par les gestionnaires (n=43) avait comme but une évaluation de la performance contextuelle des employés supervisés. Le développement de l’échelle à 24 items sur la conscience de l’environnement d’affaires pourrait répondre aux questions portant sur la participation de l’employé et l’efficacité organisationnelle.

Validation de l’échelle de mesure de la conscience de l’environnement d’affaires

La conscience de l’environnement d’affaires est définie comme l’ensemble des savoirs détenus par les employés non-cadres par rapport à l’environnement d’affaires interne et externe de leur organisation. Elle se manifeste lorsque l’employé est impliqué dans la prise de décision ou résolution de problème affectant l’entreprise. Ce travail a comme objectifs la validation d’une échelle de mesure du concept à l’étude, ainsi que la vérification de sa validité de construit et nomologique. L’ensemble initial d’items de l’échelle de mesure a été déterminé suite à des entrevues avec les employés d’organisations participantes (Gauvreau-Jean, 2008). L’ensemble initial de 40 items a été testé avec un échantillon de 508 employés d’une manufacture. Suite à des ajustements, l’échelle modifiée couvre quatre dimensions du construit. L’adéquation de son contenu a ensuite été mise à l’épreuve par deux groupes cibles et deux évaluations expertes (Lessard, 2014). Finalement, dans le cadre de notre étude, la validité du contenu et nomologique de l’échelle modifiée (contenant 24 items) a été testée avec 330 employés de première ligne de quatre entreprises. Les quatre dimensions du construit furent supportées, la fiabilité de l’échelle était haute, puis les hypothèses reliant la conscience de l’environnement avec les caractéristiques au travail, l’évaluation de la performance par un superviseur et l’engagement affectif furent supportées également. Un autre sondage complété par les gestionnaires (n=43) avait comme but une évaluation de la performance contextuelle des employés supervisés. Le développement de l’échelle à 24 items sur la conscience de l’environnement d’affaires pourrait répondre aux questions portant sur la participation de l’employé et l’efficacité organisationnelle.

Consecuencias literarias del 11-S: la representación de la violencia en la novela angloamericana

In my eight years as a professional journalist, I have been a front line observer of the extreme level of violence which occurs everyday in our society. As victims, consumers or perpetrators of violence, this phenomenon is now a part of our existence. As a reporter for the Spanish national newspaper El País I have been witness to the most terrible acts of violence. In Venezuela, with one of the highest rates of criminality in the world, I saw piles of bodies stacked up in mortuaries. In Argentina, I reported on the most brutal crimes including the rape of children by policemen. I believe that my interest in the manifestations and causes of violence was aroused during my time as a journalist. On a personal level, I was deeply affected by the twin poles of attraction/repulsion which the violent images produced in me. The first time I visited New York in 2003, I talked to various people who were selling photos of the victims of the Twin Tower attacks. They had laid out their wares along the wire fence that separated Ground Zero from the main public areas. One particular photograph made an indelible impression on my mind: a ghost like corpse covered in white dust which was streaked with blood. It is an image I will never forget. If I remember well, a complete album of these gruesome images cost about ten dollars. At the same time, I also became interested in islamic terrorism: its complexity and the great impact it has made on Western society. One only has to look at the front page of the press around the world to read about war, terrorism or the constant violation of human rights. The words Al-Qaeda, Daesh, Boko Haram and Islamic State have sadly become parts of our everyday language. The nihilistic philosophy which promisess eternal life in exchange for self-inmolation is a new, highly worrying reality, especially painful when it involves young people who become indoctrinated through the social media. They have become the most loyal supporters of a fanatical and uncompromising version of Islam. The stark reality is that these young recruits to Jihad (holy war) were born in places like London, Paris, Rome or Madrid...

Understanding molecular mechanisms of resistance to immune checkpoint inhibitors in advanced non-small cell lung cancer (NSCLC)

Immune checkpoint inhibitors (ICI) that target PD-1/PD-L1 have recently emerged as an integral component of front-line treatment in metastatic NSCLC patients. The PD-1 inhibitor pembrolizumab is approved as monotherapy for advanced NSCLC with a PD-L1 tumor proportion score (TPS) of ≥1% and in combination with platinum doublet chemotherapy regardless of PD-L1 expression level. However, responses to either regimen occur in only a minority of cases, and PD-L1 TPS is limited as a biomarker in predicting whether a cancer will respond to PD-1 inhibition alone or would be more likely to benefit from PD-1 inhibition plus chemotherapy. Additional biomarkers of immunotherapy efficacy, such as tumor mutational burden (TMB), have not been incorporated into routine clinical practice for treatment selection. The identification of patients who have the greatest likelihood of responding to immunotherapies is critical for guiding treatment decisions. IN addition, early indicators of response could theoretically prevent patients from staying on an ineffective therapy where they might experience complications due to disease progression or develop toxicities from unnecessary exposure to an inactive agent. The aim of this research project is to investigate the clinicopathologic and molecular determinant of response/resistance to the currently available immune checkpoint inhibitors, in order to identify therapeutic vulnerabilities that can be exploited to improve the clinical outcomes of patients with advanced NSCLC.

Surface velocity fields, digital elevation models, ice front positions and grounding line derived from remote sensing data at Dinsmoor-Bombardier-Edgeworth glacier system, Antarctic Peninsula (1992-2014)

The northern Antarctic Peninsula is one of the fastest changing regions on Earth. The disintegration of the Larsen-A Ice Shelf in 1995 caused tributary glaciers to adjust by speeding up, surface lowering, and overall increased ice-mass discharge. In this study, we investigate the temporal variation of these changes at the Dinsmoor-Bombardier-Edgeworth glacier system by analyzing dense time series from various spaceborne and airborne Earth observation missions. Precollapse ice shelf conditions and subsequent adjustments through 2014 were covered. Our results show a response of the glacier system some months after the breakup, reaching maximum surface velocities at the glacier front of up to 8.8 m/d in 1999 and a subsequent decrease to ~1.5 m/d in 2014. Using a dense time series of interferometrically derived TanDEM-X digital elevation models and photogrammetric data, an exponential function was fitted for the decrease in surface elevation. Elevation changes in areas below 1000 m a.s.l. amounted to at least 130±15 m130±15 m between 1995 and 2014, with change rates of ~3.15 m/a between 2003 and 2008. Current change rates (2010-2014) are in the range of 1.7 m/a. Mass imbalances were computed with different scenarios of boundary conditions. The most plausible results amount to -40.7±3.9 Gt-40.7±3.9 Gt. The contribution to sea level rise was estimated to be 18.8±1.8 Gt18.8±1.8 Gt, corresponding to a 0.052±0.005 mm0.052±0.005 mm sea level equivalent, for the period 1995-2014. Our analysis and scenario considerations revealed that major uncertainties still exist due to insufficiently accurate ice-thickness information. The second largest uncertainty in the computations was the glacier surface mass balance, which is still poorly known. Our time series analysis facilitates an improved comparison with GRACE data and as input to modeling of glacio-isostatic uplift in this region. The study contributed to a better understanding of how glacier systems adjust to ice shelf disintegration.