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Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements.To assess the reliability of the LMPI for use in neurological physiotherapy practice.Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability.Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795-0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test-retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%).RESULTS indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.

Purpose\ud \ud To establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery.\ud \ud Methods\ud \ud We carried out a retrospective study of 120 eyes from 120 patients with pre-operative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phaco-vitrectomy for symptomatic ERM.\ud \ud Results\ud \ud Evaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in post-operative logMAR score (95% confidence interval −0.001–0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13–0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more).\ud \ud Conclusion\ud \ud We conclude that early surgery is associated with a lower (ie, better) post-operative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation.

Purpose The aim of this project was to develop, deliver, and evaluate a brief evidenced-based education package to enhance physical health literacy in mental health nurses. Design and Methods Pre- and post-test survey of knowledge of physical health in serious mental illness, satisfaction with the workshop, and applicability to practice. Findings Participants were motivated to attend and complete the questions. There was statistically significant knowledge gain immediately post workshop and participants described satisfaction with the content and a willingness to apply learning from the session to their practice. Practice Implications If such workshops are provided as a collaborative and relatively inexpensive way of education, they can contribute to building the capacity of mental health nurses to be literate in physical health interventions.

The aim of this study was to evaluate mental health and learning disability nursing students’ perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses’ administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

Aim To present the anatomical and visual outcomes of patients with hypo-reflective cystic defects in outer fovea (outer foveal defect; OFD) in macular holes repaired with non-posturing vitrectomy and short term gas tamponade. To identify the incidence and risk factors for developing OFD foveal defect. Method A prospective consecutive case series of 58 patients undergoing macular hole surgery was undertaken. OFD detected on 2-week postoperative Optical coherence tomography (OCT) was measured. In these patients OCT was performed monthly until resolution of OCT. Results 27 eyes (46.6%) had an outer defect at 2 weeks, the presence of which was significantly associated with macular holes with larger base diameters preoperatively (p=0.006). All defects closed spontaneously without further intervention, and the final vision was not affected by the presence of an OFD. Visual recovery was only slightly (and not significantly) delayed by the presence of an outer defect. Conclusions This is the first study of outcomes of OFDs following macular hole surgery in patients who did not posture postoperatively. OFDs are common but do not adversely affect visual outcomes.

The benefit of supersteep retrograde (SSR) channel doping for suppressing short-channel effects in planar bulk MOSFET performance is studied via technology computer-aided design simulation of devices with gate length Lg = 28 nm. It is found that drain-induced barrier lowering is reduced by more than 40%, and variation in saturation threshold voltage (σ VT,Sat), caused by random dopant fluctuation, is reduced by ~50%, with SSR channel doping. However, degraded drive current is observed for SSR channel doping due to enhanced body effect. Estimations of six-transistor static random access memory (SRAM) cell yield indicate that 33% reduction in the minimum operating voltage (VMIN,SRAM) can be achieved with SSR channel doping.

The spiral reliefs of the Column of Trajan at Rome present the narrative of the Dacian Wars upon a continuous and elongated cartographic landscape, in which a wealth of landforms, including mountains, rivers, streams, springs, and forests serve not only as a setting of human actions, but become elements of the narrative in themselves, as they yield to the relentless efforts of Trajan and his army and engineers. In depicting the campaigns, the reliefs celebrate to a remarkable degree the military engineers and agrimensores (surveyors) who transformed the land as they cleared, measured, and built during the wars. In a circuit from participation in the historical events to their commemoration, the work of these surveyors ultimately contributed to the design of the Column and the stylistic choices of the Column reliefs themselves. Not only the subjects, but the innovative spiral format and the mode of depiction of the Reliefs are indebted in part to the conventions ofcartographic practice, while the conceptual framework within which the column’s topographic depictions communicatetheir ideological freight is tied to traditions of ancient geography. Writers such as Strabo, Pliny and Dio Cassius, whileproviding inconclusive evidence on the locations of topography in the Reliefs, point to the worldview they express: civilizing,imperial, scopic, rational, organizing, controlling nature. This essay examines the Column reliefs as embedded in widertopographical and geographical traditions during Trajan’s reign and in Roman antiquity, and proposes some new avenuesfor understanding the reliefs in these terms

Purpose\ud \ud To describe the incidence and features of intraoperative retinal breaks caused by induction of posterior hyaloid face (PHF) separation during 23-gauge pars plana vitrectomy (PPV).\ud \ud Methods\ud \ud A prospective, consecutive, single surgeon, observational study of patients undergoing 23-gauge transconjunctival sutureless vitrectomy for macular pathology or floaters, was carried out between 2009 and 2011 at Calderdale Royal Hospital, UK. PHF separations were categorised as either suction induced or requiring membrane blue (DORC Limited) with suction (adherent). The outcome measure was dichotomised into retinal break or tear and no retinal break or tear. Forced entry and parsimonious multiple logistic regression analyses were conducted, using statistical software, to test for significance of association of the set of recorded factors and covariates with the dichotomised outcome measure.\ud \ud Results\ud \ud Data were collected and analysed from 137 patients. The incidence of iatrogenic retinal breaks associated with PHF separation during 23-gauge PPV was 18.2%. Under both forced entry and parsimonious multiple logistic regression models, the odds of a retinal break or tear reduce by about 3–4% for each increasing year of age. Findings also showed some substantive association in the forced entry model, with the odds of a retinal break or tear for adherent cases being around 3.8 times those for suction-only cases.\ud \ud Conclusions\ud \ud Mechanical detachment of the PHF represents an important risk factor in the formation of retinal breaks. Particular care should be taken to examine intraoperatively for iatrogenic breaks in order to prevent missed breaks and subsequent rhegmatogenous retinal detachments.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions.

Background\ud Surgical site infection (SSI) is a serious potential complication of spinal surgery. SSI can impact significantly on in-patient hospitalisation and the costs associated with extra care.\ud Aim\ud To investigate the management of patients experiencing SSI following surgery for spinal metastatic tumours, and to estimate the costs associated with SSI in this context.\ud Methods\ud Patients experiencing SSI following spinal tumour surgery at a large spinal surgery centre between January 2009 and December 2012 were identified. Existing case notes were reviewed and patient and procedural data, details of the infection and treatment interventions were collected. A bottom-up approach to calculating costs associated with infection was used for patients experiencing SSI and compared with a quasi-random sample of similar patients without SSI.\ud Findings\ud The mean cost of treating patients with SSI was significantly greater than costs associated with those without SSI (p=0.019). Mean cost of in-patient hospital stay was 60% higher in patients with SSI compared to those without SSI (p=0.004). In-patient hospital stay alone accounted for 59% of total costs. Return to theatre was the second most costly intervention overall, accounting for 38% of costs, and was the most expensive single intervention involved in the treatment of SSI.\ud Conclusion\ud SSI significantly increases healthcare costs for patients undergoing surgery for spinal metastasis, with prolonged in-patient hospitalisation and return to theatre for wound management being major contributors. The actual total cost to society derived from SSI in this patient group is likely to be far beyond just the direct costs to healthcare providers.

Practitioners can often experience feelings of disgust when exposed to malodorous wounds and this can manifest by facial expression, involuntary gagging and vomiting. This study reports on an investigation to measure a group of psychology and nursing students (n = 158) perceptions of disgust using three previously validated tools: The Disgust Scale-Revised and the Perceived Vulnerability to disease Scale.\ud Method: Data were collected via anonymous on line survey of 158 psychology and nursing students at two Universities in the UK between June and July 2015.\ud Results: Statistical analysis of the data revealed that the majority of the sample were female (97.3%) with nursing students being more resilient to disgust. Disgust scores diminished with increasing age. Psychology students are more sensitive to actual and perceived vulnerability to disease. Levels of perceived vulnerability falls with increasing age.\ud Discussion: Nursing students undertake 50% of their pre-registration programme in clinical practice where they may have been exposed to potentially disgust provoking situations that may sensitize them to such situations. It is unclear whether their disgust diminishes because they become more tolerant, or accustomed to such situations or to other factors. Previous and repeated exposure to situations provoking disgust may however, explain why nursing student responses differ to their psychology counterparts.\ud Conclusions: Nursing students are disgusted less easily than psychology students; although all\ud individuals become slightly more tolerant to certain issues over time. Psychology students are significantly more sensitive to actual and perceived vulnerability to disease than nursing students. Perceived vulnerability falls with increasing age. In order to fully examine the impact of gender on disgust more research is required with a purposive sample.

We have given an overview of a modeling strategy aimed at exploiting the spatial geometry of the sample distributions in order to maximize the retrieval of thermal history information from the thermochronological data. Philosophically, we aim to find thermal history solutions that fit the observations well, but do not have unwarranted complexity. These two requirements are quantified through the Bayesian Information Criterion, which combines the data likelihood and the number of model parameters. The overall approach relies on exploiting the spatial geometry of the sample locations to combine data from individual samples and identify a common thermal history. The combination of different data sets has the advantage of improving the resolution in the inferred thermal history, and also reducing the complexity. Markov chain Monte Carlo sampling provides a means of constructing reliable representations on the probability distributions for the parameters. 1D modeling is relevant to vertical profiles, and provides an estimate of the paleotemperature gradient directly from the data. The 2D approach relies on a partition model, in which each partition contains a subgroup of the samples with a common thermal history. The partition model approach allows for an unknown number of discontinuities, whose locations are also unknown. The extension to 3D combines the 1D and 2D approaches to find partitions in which samples at different elevations have experienced a common form of thermal history, but the actual temperatures depend on the elevation. As presented here, it is implicit that the spatial relationship between samples has not changed over time, at least not in a way that will lead to differential thermal histories. The approach presented here is different to 3D thermal models (Braun 2003, 2005; Ehlers 2005) but complementary. Thus, we infer the thermal history directly from the data, while the other 3D models are specified and certain parameters are adjusted to match the observed data. Both approaches assume thatthe predictive models for fission track annealing or helium diffusion in apatite are correct. In principle, this assumption can be relaxed and appropriate predictive model parameters can be estimated as part of the modelling process. However, this will lead to significant trade-off between annealing of diffusion parameters and the thermal history (Gallagher and Evans 1991). Future modifications to this approcah will include more generalized sampling of the thermal histories during th MCMC sampling of the partition structure, incorporation of mutiple data types (e.g., apatite fission track and (U-Th)/He data) and potentially allowing for irregularly shaped partition boundaries. Copyright © Mineralogical Society of America.

Background An investigation was undertaken to compare the effect of multi-component compression bandages and compression hosiery kits on individuals’ range of ankle motion whilst wearing typical and medical footwear, and barefoot. Methods A convenience sample of 30 healthy individuals recruited from the staff and student population at the University of Huddersfield, UK. Plantarflexion/dorsiflexion range of ankle motion (ROAM) was measured in participants over 6 steps in every combination of typical, medical and no footwear; and multi-component bandages, compression hosiery and no garments. Results Controlling for age, gender and garments, the use of typical footwear was associated with a mean increase in ROAM of 2.54° at best estimate compared with barefoot; the use of medical footwear was associated with a mean decrease in ROAM of 1.12° at best estimate compared with barefoot. Controlling for age, gender and footwear, the use of bandaging was associated with a mean decrease in ROAM of 2.51° at best estimate compared with no garments. Controlling for age, gender and footwear, the use of hosiery was not associated with a significant change in ROAM compared with no garments. Conclusions Bandages appear to restrict ROAM more than hosiery when used in conjunction with a variety of footwear types. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0151-8) contains supplementary material, which is available to authorized users.

Summary Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190–334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76–0.89; P P =0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI ( P =0.075). Conclusion Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significant.

To investigate the clinical effectiveness of silver nitrate (95%) for the treatment of verruca pedis comparing professional and self-application treatments.A single-centre, two-armed randomized evaluation was conducted at a University podiatry clinic. A total of 113 participants (101 analysed) with verruca pedis were included. Participants were randomized to either a clinical group, where silver nitrate was applied by a healthcare professional or a home group, where silver nitrate was self-applied. The main outcome measure was post-treatment pain, controlling for pre-treatment pain, and resolution of the verruca. Secondary outcome measures were participant satisfaction, partial reduction in the verruca and ease of use of the product.The study showed no significant difference between home treatment and clinically applied treatment for the treatment of verruca pedis in either primary outcome; however, a substantive difference in resolution between groups was recorded, with 34.0% full resolution and 26.4% partial resolution in the clinical treatment group, and 18.8% full resolution and 37.5% partial resolution in the home treatment group. Participants widely reported general ease of use of the product. All participants reported a reduction in pain as a result of the intervention.Silver nitrate has been shown to be a safe and effective treatment for verruca pedis, with equal success rates when compared between home and clinical applications.

Background Context\ud \ud Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature.\ud \ud Purpose\ud \ud This study aimed to identify predictors of gain in SH following corrective surgery for AIS. We present a unique model to predict postoperative height prior to intervention, which could contribute to the preoperative counseling and consenting process.\ud \ud Study Design\ud \ud This was a retrospective case series. All surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3.5-year period.\ud \ud Patient Sample\ud \ud There were 104 patients who had instrumented posterior spinal fusion for AIS included. There were 93 females, and the age range was from 11 to 17 years. All patients had posterior instrumented fusion using rods and anchors (pedicle screws±hooks).\ud \ud Outcome Measures\ud \ud Postoperative SH was the primary outcome measure. The SH (C7–L5) and Cobb angles were measured from a pre- and postoperative standing X-ray of each patient.\ud \ud Methods\ud \ud Variables associated with patients (demographic and radiological) and the surgical constructs were analyzed for predictability of height gain. A model was derived including only significant predictors of substantive importance using hierarchical regression methods. Cross-validation procedures verified the adequacy of the model fit. Analysis was performed using IBM SPSS Statistics for Windows version 20.0 (IBM Corp. Armonk, NY, USA).\ud \ud Results\ud \ud The major curve was thoracic in 90% of cases. The number of vertebrae fused ranged from 5 to 15. The average preoperative Cobb angle was 66°, with an average correction of 45°. The average change in SH was 4.66 cm (SD 2.13 cm). The model presented included preoperative height, preoperative Cobb angle, and number of vertebrae within the construct, with coefficients of 1.00 (95% CI: 0.90, 1.09), 0.067 (95% CI: 0.039, 0.095), and 0.26 (95% CI: 0.11, 0.41), respectively. This model had an adjusted-R2 value of 0.83 and a R2 for prediction of 0.79, and can be shown to have similar predictive capability as a model comprising a wider range of predictors.\ud \ud Conclusion\ud \ud The greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae.

Caring for a person with a mental illness can have adverse effects on caregivers; however, little is known about how best to help such caregivers. The aim of the present study was to examine the efficacy of a cognitive behaviour therapy-guided self-help manual in increasing resilience in caregivers of individuals with depression, in comparison to caregivers who receive routine support only. A randomized, controlled trial was conducted, following CONSORT guidelines, with 54 caregivers allocated to parallel intervention (self-help manual) (n = 27) or control (standard support) (n = 27) groups. Resilience was assessed at baseline, post-test (week 8), and follow up (week 12). Intention-to-treat analyses were undertaken. Repeated-measures ANOVA indicated a significant difference in resilience scores between the three time points, showing a large effect. Pairwise comparisons between intervention and control groups indicated resilience to be significantly different between baseline and post-test, and between baseline and follow up, but not between post-test and follow up. Overall, the intervention group showed a slightly greater increase in resilience over time than the control group; however, the time-group interaction was not significant. Guided self-help is helpful in improving caregivers' resilience and could be used as an adjunct to the limited support provided to carers by mental health nurses and other clinicians.

Background\ud Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure.\ud \ud Methods\ud A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated.\ud \ud Results\ud All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p

Aims and objectives- The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse, or physical abuse/assault) perpetrated against the nurse or other health professional by patients/relatives or staff. In light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers.\ud Background – Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings.\ud Design- Systematic review with meta-analysis\ud Data Sources- The databases of Medline (1966 to 2015), CINAHL (1982 to 2015) and PsychInfo (1920 to 2015).\ud Methods- Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or non-mental health/psychiatric).\ud Results - A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to non-mental health nurses.\ud Conclusions – The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had 3 times higher odds of physical assault than other nurses.\ud Relevance to clinical practice- In light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programs.

Objective: To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. Method: Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Results: Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. Conclusion: Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly necessary, as levels of the older population who may require assisted living continue to rise.

It has been claimed that King James VI/I, an antecedent of King George III, suffered from acute porphyria, and that the disease was passed on to George III through his grand-daughter Sophie, mother of George I. The life of James is reviewed and previously-proposed diagnoses are considered. James’s medical history is discussed in detail and, where possible, examined with validated symptom scales. Using an online database of neurological diseases, the authors show that James’s symptomatology is compatible with a diagnosis of Attenuated (mild) Lesch-Nyhan disease; no evidence was found to support a diagnosis of acute porphyria. In addition, there is evidence of associated Asperger traits which may explain some of the King’s unusual behavioural and psycho-social features.

Background \ud Patients undergoing surgery for basal and early squamous cell carcinomas are rarely offered psychological support as their malignancies have a low mortality. Nonetheless, 80 % of non-melanoma skin cancers occur in the head and neck, rendering both the malignancy and subsequent surgical scar clearly visible. This study was designed to quantify the social and emotional impact of facial skin malignancies pre- and postoperatively and to identify vulnerable groups who may benefit from increased support irrespective of tumour severity.\ud \ud Methods \ud Fifty-three patients with facial skin malignancies were prospectively evaluated before and 3 months after surgery using the Skin Cancer Index (SCI); a 15-item, validated, disease-specific quality-of-life (QOL) assessment tool with emotion, social and appearance subscales. Higher scores reflect improvements in QOL.\ud \ud Results \ud Surgical excision of the malignancy led to a significant increase in SCI (p

Background/Aims To compare several methods of macular hole measurement using optical coherence tomography (OCT), and to assess their predictive capability against anatomical and visual outcomes in a single cohort of patients. Methods A retrospective study of 50 eyes undergoing standardised macular hole surgery. All patients underwent preoperative OCT scanning with measurement of macular hole inner opening diameter, minimum linear diameter, base diameter and macular hole height. Values were calculated for the macular hole index and the tractional hole index. Results Logistic regression analyses indicated that the preoperative base diameter, macular hole inner opening and minimum linear diameter were associated with both anatomical and visual success. Derived parameters as alternatives to these basic ophthalmic parameters add little to the modelling of either anatomical or visual success. Conclusion Base diameter, macular hole inner opening and minimum linear diameter can each be used to predict anatomical and/or functional success in macular hole surgery. Preoperative base diameter is the most useful variable in this regard, as it holds the strongest association with anatomical and visual outcome and is easily measured on a OCT scan.

Objective To ascertain the perspectives of parents of children conceived via oocyte donation regarding donor anonymity and disclosure of the nature of their conception to their children. Methods Information was gathered by means of an anonymous online survey initiated by the Donor Sibling Registry, in which 108 parents with 143 children conceived following oocyte donation and aged between one year and 15 years participated. Results Parental use of an anonymous or open-identity donor-and regardless of parental choice of donor-makes very little difference to the timing of parental disclosure to their donor-conceived child about their conception. The median age of children at disclosure is about 3.5 years; UK/Australian parents seem more ready to tell their children at an early stage (median age around two years) than North American parents (median age around 4.5 years), although about three quarters of all children have been told by the age of six years. Considerable ambiguity among parents who intend to disclose to their children as to the optimal age of disclosure is evidenced. Conclusions Parents' experiences of disclosure to children at different ages need to be more thoroughly examined in order to establish a coherent body of knowledge that may facilitate improved evidence-based parental decision making.

Recently methods of caries quantification in the primary dentition have moved away from summary ‘whole mouth’ measures at the individual level to methods based on generalised linear modelling (GLM) approaches or survival analysis approaches. However, GLM approaches based on logistic transformation fail to take into account the time-dependent process of tooth/surface survival to caries. There may also be practical difficulties associated with casting parametric survival-based approaches in a complex multilevel hierarchy and the selection of an optimal survival distribution, while non-parametric survival methods are not generally suitable for the assessment of supplementary information recorded on study participants. In the current investigation, a hybrid semi-parametric approach comprising elements of survival-based and GLM methodologies suitable for modelling of caries occurrence within fixed time periods is assessed, using an illustrative multilevel data set of caries occurrence in primary molars from a cohort study, with clustering of data assumed to occur at surface and tooth levels. Inferences of parameter significance were found to be consistent with previous parametric survival-based analyses of the same data set, with gender, socio-economic status, fluoridation status, tooth location, surface type and fluoridation status-surface type interaction significantly associated with caries occurrence. The appropriateness of the hierarchical structure facilitated by the hybrid approach was also confirmed. Hence the hybrid approach is proposed as a more appropriate alternative to primary caries modelling than non-parametric survival methods or other GLM-based models, and as a practical alternative to more rigorous survival-based methods unlikely to be fully accessible to most researchers.

While the Hadoop MapReduce paradigm offers a linearly scalable approach to solving many complex problems, it does not work for every problem type. General examples of problems that can and cannot be solved with MapReduce have been discussed in a number of sources but the requirements for effective use of MapReduce are not clear. This paper takes the approach that it is not the problem type but the characteristics of the algorithm and the data that must be understood to implement a solution in MapReduce. The paper examines the MapReduce paradigm and derives the key requirements and constraints it implies. These requirements and constraints are stated as a set of rules than can be applied to various problem solutions such that the algorithm and data specifications make effective use of MapReduce. These characteristics can also provide guidance to refactoring incompatible algorithms so that they may be used effectively under MapReduce. Examples of using these characteristics to create effective MapReduce solutions in the healthcare analytics space will be used to illustrate the concepts presented.

Nurses on registration are expected to have sufficient knowledge and skills in medicine management to practice safely and competently. This article reports on research involving midwifery and nursing students, who were asked to complete a questionnaire related to their experiences of medicines-related training and education, and how it prepared them for practice. The results showed an overall satisfaction with the pre-registration delivery, but differences emerged in the perceived efficacy of different educational strategies. Clinically-based and simulated aspects of the programme delivery were highly rated, with theoretical delivery scoring poorly in contrast. A stepped approach is suggested, with medicine course delivery needing to be strongly highlighted as a lead up to safe and competent nursing interventions when administering medication and all other related interventions. A grant from the innovation fund at the University of Huddersfield funded an evaluation of students' experiences of medicines management education and training using a self-administered questionnaire.

Krishna Murari Goel was born in Agra, India, on 4 September 1936. He was the youngest of five children of devout Hindu parents who used their limited resources to fund their children’s education. His early medical training in Lucknow made him acutely aware of the poverty and the high morbidity and mortality in mothers and children he found there. Therefore, he decided to devote his career to paediatric medicine. His mother tongue was Hindi and his command of English good. Inspired by reading the first edition of Practical Paediatric Problems , written by James Holmes Hutchison und published in 1964, he applied and was accepted for a registrar post with Hutchison, starting in October 1964. He was met at Glasgow airport by a taxi driver organised by Hugh Park, superintendent of the Yorkhill Royal Hospital for Sick Children and Queen Mother’s Maternity Hospital. That welcome had a lasting effect on him, particularly when coupled with his initial disbelief that he could treat or admit any child according to their illness without first asking how much money their families could afford to pay. Krishna worked with Hutchison and Robert Shanks, forming a critical link between Glasgow’s neonatal services at the Southern General Hospital and Rotten Row Maternity Hospital, together with the Yorkhill co-located Queen Mother’s Maternity Hospital and Royal Hospital for Sick Children. Hutchison retired from his Glasgow chair in 1976 to take the chair of paediatrics in Hong Kong. His successor in Glasgow was Forrester Cockburn, and they shared the editorship of the sixth edition of Practical Paediatric Problems . Krishna was delighted when in 1986 the publishers, Lloyd Luke, issued a low priced Asian postgraduate economy edition of the sixth edition, printed in …

This paper outlines a risk assessment of a lead-contaminated residential site in Lake Macquarie, New South Wales, near the Pasminco Metals-Sulphide lead and zinc smelter. The assessment includes a hazard identification and a dose-response assessment based on recent research findings; an exposure assessment based on two interrelated indicators, soil/dust lead and blood lead; a risk characterisation; and finally, a discussion of environmental and behavioural options for the management of risk. The exposure assessment showed lead concentrations of 20 to 21,460 parts per million in soil survey samples, 23 to 35,870 parts per million in household dust, and a range of mean values for blood lead concentration of 11 micrograms/dl to 17 micrograms/dl, in four study groups. The proportions of children within these groups having blood lead concentrations of 10 micrograms/dl or greater, the current level of known health effect, ranged from 57 per cent to 85 per cent. The decision by the National Health and Medical Research Council in June 1993 to set a goal for blood lead of below 10 micrograms/dl has important implications for the definition and the management of the environmental health risk from 'living with lead' in the area assessed.

In recent years a strategy of selective, symptom-based intervention of carious primary teeth has been developed amongst some British general dental practitioners. Practice-based studies appear to provide evidence that policies of restoration of symptomless carious primary teeth do not confer any significant benefits above those associated with non-restorative care. However, results from these studies contrast with those of many clinical trials and prospective studies of primary molar restorations. In the current investigation, cohort study data from 5,168 carious primary molar teeth from 2,654 British children aged 4–5 years at baseline, augmented with Dental Practice Board treatment data, was utilised to assess the effect of restorative treatment on the likelihood of carious teeth subsequently progressing to either exfoliation or extraction. The effect of demographic and tooth level covariates on the fate of these teeth was also assessed. Multivariate multilevel parametric survival models were applied to the analysis of the carious-exfoliation and carious-extraction transitions to which the teeth were subject, assuming an underlying data hierarchy with teeth nested within individuals. Time of occurrence of caries affected survival experience, with teeth in which caries occurred later in life being associated with higher survival rates to extraction. Amongst filled teeth, later fillings were also associated with higher survival rates to extraction. Demographic and tooth level variables had a limited effect on survival experience. Treatment was found to be significantly associated with survival with respect to extraction, with survival rates of over 80% at 14 years, double those of untreated teeth.

In the context of data on cities, we present an example of how to make statistics relevant and meaningful to non-expert users. While the cities of the world are emerging as key players in global processes, from climate change to migration, the body of data on the cities of the world is neither extensive nor well-organized. Towards the end of organizing, understanding, and presenting this data, we have created an online framework called CityRank. To make this data relevant to users, CityRank allows users to upload new data sets and create and share personalized rankings of cities based on the data included in CityRank’s data repository.

Background: Intravenous cannulation enables administration of fluids or drugs by paramedics in prehospital settings. Inappropriate use and poor technique carry risks for patients, including pain and infection. We aimed to investigate the effect of an educational intervention designed to reduce the rate of inappropriate cannulation and to improve cannulation technique. Method: We used a non-randomised control group design, comparing two counties in the East Midlands (UK)as intervention and control areas. The educational intervention was based on Joint Royal Colleges Ambulance Liaison Committee guidance and delivered to paramedic team leaders who cascaded it to their teams. We analysed rates of inappropriate cannulation before and after the intervention using routine clinical data. We also assessed overall cannulation rates before and after the intervention. A sample of paramedics was assessed post-intervention on cannulation technique with a ‘‘model’’ arm using a predesigned checklist. Results: There was a non-significant reduction in inappropriate (no intravenous fluids or drugs given) cannulation rates in the intervention area (1.0% to 0%) compared with the control area (2.5% to 2.6%). There was a significant (p,0.001) reduction in cannulation rates in the intervention area (9.1% to 6.5%; OR 0.7, 95% CI 0.48 to 1.03) compared with an increase in the control area (13.8% to 19.1%; OR 1.47, 95% CI 1.15 to 1.90), a significant difference (p,0.001). Paramedics in the intervention area were significantly more likely to use correct hand-washing techniques post-intervention (74.5% vs. 14.9%; p,0.001). Conclusion: The educational intervention was effective in bringing about changes leading to enhanced quality and safety in some aspects of prehospital cannulation.

As impaired insulin signalling (IIS) is a risk factor for Alzheimer's disease we crossed mice (Tg2576) over-expressing human amyloid precursor protein (APP), with insulin receptor substrate 2 null (Irs2(-/-)) mice which develop insulin resistance. The resulting Tg2576/Irs2(-/-) animals had increased tau phosphorylation but a paradoxical amelioration of Abeta pathology. An increase of the Abeta binding protein transthyretin suggests that increased clearance of Abeta underlies the reduction in plaques. Increased tau phosphorylation correlated with reduced tau-phosphatase PP2A, despite an inhibition of the tau-kinase glycogen synthase kinase-3. Our findings demonstrate that disruption of IIS in Tg2576 mice has divergent effects on pathological processes-a reduction in aggregated Abeta but an increase in tau phosphorylation. However, as these effects are accompanied by improvement in behavioural deficits, our findings suggest a novel protective effect of disrupting IRS2 signalling in AD which may be a useful therapeutic strategy for this condition., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

We report a quantitative proteomic study to investigate the changes induced in membrane rafts by the inhibition of glycogen synthase kinase-3. Sensitive quantitation of membrane raft proteins using isobaric tagging chemistries was enabled by a novel hybrid proteomic method to isolate low-microgram (10-30 microg) membrane raft protein preparations as unresolved bands in a low-density acrylamide gel. Samples were in-gel digested, differentially tagged and combined for 2-D LC and quantitative MS. Analysis of hippocampal membrane preparations using this approach resulted in a sixfold increase in sensitivity and a threefold increase in the number of quantifiable proteins compared with parallel processing using a traditional in-solution method. Quantitative analysis of membrane raft preparations from a human neuronal cell line treated with glycogen synthase kinase-3 inhibitors SB415286 or lithium chloride, that have been reported to modulate processing of the Alzheimer amyloid precursor protein, identified several protein changes. These included decreases in lamin B1 and lamin B receptor, as well as increases in several endosome regulating rab proteins, rab5, rab7 and rab11 that have been implicated in processing of the amyloid precursor protein in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by the presence of neurofibrillary tangles of hyperphosphorylated, aggregated tau protein and extracellular deposits of beta-amyloid peptide. Increased beta-amyloid levels are thought to precede tangle formation, but tau pathology is more closely related to neuronal death. Minocycline, a tetracycline derivative, has potent antiinflammatory, antiapoptotic, and neuroprotective effects in several models of neurodegenerative disease, including models of AD with amyloid pathology. We have used both in vitro and in vivo models of AD to determine whether minocycline may have therapeutic efficacy against tau pathology. In primary cortical neurons, minocycline prevents beta-amyloid-induced neuronal death, reduces caspase-3 activation, and lowers generation of caspase-3-cleaved tau fragments. Treatment of tangle-forming transgenic mice (htau line) with minocycline results in reduced levels of tau phosphorylation and insoluble tau aggregates. The in vivo effects of minocycline are also associated with reduced caspase-3 activation and lowered tau cleavage by caspase-3. In tau mice, we find that conformational changes in tau are susceptible to minocycline treatment, but are not directly associated with the amount of tau fragments produced, highlighting a dissociation between the development of these pathological tau species. These results suggest a possible novel therapeutic role for minocycline in the treatment of AD and related tauopathies.

Glycogen synthase kinase-3 (GSK-3) is a serine ⁄threonine kinase regulating diverse cellular functions including metabolism, transcription and cell survival. Numerous intracellular signalling pathways converge on GSK-3 and regulate its activity via inhibitory serine-phosphorylation. Recently, GSK-3 has been involved in learning and memory and in neurodegeneration. Here, we present evidence that implicates GSK-3 in synaptic plasticity. We show that phosphorylation at the inhibitory Ser9 site on GSK-3b is increased upon induction of long-term potentiation (LTP) in both hippocampal subregions CA1 and the dentate gyrus (DG) in vivo. The increase in inhibitory GSK-3b phosphorylation is robust and persists for at least one hour postinduction. Furthermore, we find that LTP is impaired in transgenic mice conditionally overexpressing GSK-3b. The LTP deficits can be attenuated ⁄rescued by chronic treatment with lithium, a GSK-3 inhibitor. These results suggest that the inhibition of GSK-3 facilitates the induction of LTP and this might explain some of the negative effects of GSK-3 on learning and memory. It follows that this role of GSK-3b in LTP might underlie some of the cognitive dysfunction in diseases where GSK-3 dysfunction has been implicated, including Alzheimer’s and other dementias.

Background\ud \ud Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL).\ud \ud Methods\ud \ud Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ-5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot-related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life.\ud \ud Results\ud \ud The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot-related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns.\ud \ud Conclusions\ud \ud The effect of pain was shown to mediate the relationship between sex and foot-related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter-digital corns.\ud \ud Trial registration\ud \ud ISRCTN 13166839

Fibre-Optic Distributed Temperature Sensing (DTS) has been integrated into sand control completions in the giant Azeri Chirag Guneshli (ACG) field offshore Azerbaijan to provide real time production logging and assist with the management of the field’s complex reservoirs. The optimization of gas lift for better well performance, well integrity risk identification and the determination of gas and water breakthrough locations are some of the benefits that the DTS data has provided. Deployment of the fibre-optic system in the ACG field required a fiber-optic wet-mate and the ability to deploy fiber to distances up to 12km. Lessons learned from those deployments have yielded a number of best practices and design optimizations for the integrated completion system. These optimizations include hardware and software advancements, procedural changes for improved deployment reliability and the incorporation of critical pre-job checks at the vendor’s workshop prior to equipment load out to the rig. Maximizing reservoir potential and optimizing reservoir drainage is a critical part of the project economics for the ACG field and reliable sand control completions providing real time reservoir surveillance by means of DTS has proven to be a key technology for achieving this.

Beginning with the elasticity of the concept “sacrament,” which in Lutheran usage could accommodate more or fewer rites, this essay emphasizes how Lutheranism downplayed (while not wholly abandoning) the Augustinian “sign of a sacred thing” definition of sacrament in favor of an understanding of “means of salvation [or grace]” that emphasized certain rites as “bestowing instruments” (media dotika) of grace, particularly justification. Reformed incursions through the “Second Reformation” and the impact of Pietism caused private absolution and Eucharistic worship to move from the center to the periphery of Lutheran church life by the end of the time frame addressed here, while the internal development of Lutheran orthodoxy saw Luther’s understanding of the real presence replaced by Melanchthon’s quasi-Reformed view.

Objective: The AeroChamber Plus (AC) valved holding chamber has been enhanced to include the Flow-Vu (FV) inspiratory flow indicator that provides visual inhalation feedback during use. We have investigated if FV alters asthma control and whether parents accept it. Methods: At visit 1, children with asthma, age 1–5 years, used an AC with their pressurised metered dose inhaler and 2 weeks later (visit 2) they were randomised to use either AC or FV. Subjects returned 6 (visit 3) and 12 (visit 4) weeks later. The Asthma Control (ACQ) and Paediatric Asthma Caregiver’s Quality of Life (PACQLQ) questionnaires were scored at each visit, and their peak inhalation flow (PIF) when they used their spacer was measured. Results: Forty participants in each group completed the study. There was no difference in the ACQ scores from visits 2 to 4 between the two groups. The improvements in the PACQLQ scores were greater in the FV group (p = 0.029). The mean difference (95% confidence interval) for the change from visits 2 to 4 between FV and AC groups was 0.05 (−0.33, 0.43) and 0.39 (0.035, 0.737) for the ACQ and PACQLQ, respectively. Most parents preferred the FV (p

I am delighted to see this subject taking a prominent position in discussions on human resources for …

Background: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. Results: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. Conclusions: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood.\ud \ud Purpose\ud To identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate.\ud \ud Study design\ud Retrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University Teaching Hospital, adult spine division which is a tertiary referral centre for complex spinal surgery.\ud \ud Patient sample\ud Ninety-eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data.\ud \ud Outcome measures\ud Physiological measures, with presence or absence of microbiologically proven infection.\ud \ud Methods\ud Various demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study.\ud \ud Results\ud Higher probabilities of infection were associated with low albumin level, seven or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery were found to be statistically significant at the 5 % significance level.\ud \ud Conclusion\ud Risk of infection is high (17.9 %) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increase the risk of infection significantly (p < 0.05). Low albumin level and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material, age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection.

The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have recently published, in both the Journal of the American College of Cardiology (JACC) and Circulation, a Scientific Statement on the Evaluation of Syncope ('Statement'). This Scientific Statement was commissioned to provide guidance for clinicians regarding the evaluation of patients who present with 'syncope'. The Statement was not intended to be a formal set of practice guidelines. However, in the absence of generally accepted practice guidelines in North America, the Statement's potential impact on clinical care may be more far-reaching than expected; it may erroneously be considered to be the authoritative 'de-facto' guideline document. This commentary, submitted by a multidisciplinary consortium of more than 60 physicians with expertise in the management of transient loss of consciousness (TLOC), points out that in many respects the ACCF/AHA Syncope Statement fails to address long-standing clinical errors associated with the evaluation of episodes of apparent TLOC, including syncope. If not appropriately revised, the current Statement may lead to both inadequate patient care as well as a potentially damaging legal environment for physicians undertaking evaluation of patients who present with transient loss of consciousness.