The lived experience of Dupuytren's disease of the hand

This article is made available through the Brunel Open Access Publishing Fund.Aims: To describe patients’ experiences of living with Dupuytren’s disease. Background. Dupuytren’s disease is a chronic, progressive deformity of the hand which limits active extension of the fingers due to advancing and irreversible flexion deformity. It is estimated that two million people are affected by the condition in the UK. Nurses may frequently encounter patients with this condition in a wide range of settings. However, the disease is neglected in the nursing literature and little is known about patients’ experience of living with the condition. Design: A phenomenological approach, using Coliazzi’s method, was employed. Method: Semi-structured interviews were conducted with six men and one woman diagnosed with Dupuytren’s disease. Results. Four interlinking themes emerged. Theme 1: Awareness of Dupuytren’s disease describes participants’ experiences of recognising and acknowledging the disease, which often did not occur until functional ability was restricted. Theme 2: Living with Dupuytren’s disease describes how patients coped with the disease and adapted their activities to maintain independence. Theme 3: Deciding on treatment illuminates how patients decided on treatment and highlights a lack of information and support from health professionals. Theme 4: Receiving treatment articulates participants’ experience of surgical treatment and post surgical rehabilitation. Conclusions: The findings revealed that people living with Dupuytren’s disease receive little information about their condition and possible treatment from health professionals yet high quality and accurate information is required for patients to understand their condition and the treatment options available. Relevance to clinical practice. People with Dupuytren’s disease do not always recognise their condition until it has significantly progressed. Following diagnosis they need accurate and up-to-date information about their condition and treatment options. Nurses have an important role to play in raising awareness of the disease, educating patients about its features and progression and enabling them to become active partners in decisions about treatment

Improving technology transfer through national systems of innovation: climate relevant innovation-system builders (CRIBs)

The Technology Executive Committee (TEC) of the United Nations Framework Convention on Climate Change (UNFCCC) recently convened a workshop seeking to understand how strengthening national systems of innovation (NSIs) might help to foster the transfer of climate technologies to developing countries. This article reviews insights from the literatures on Innovation Studies and Socio-Technical Transitions to demonstrate why this focus on fostering innovation systems has potential to be more transformative as an international policy mechanism for climate technology transfer than anything the UNFCCC has considered to date. Based on insights from empirical research, the article also articulates how the existing architecture of the UNFCCC Technology Mechanism could be usefully extended by supporting the establishment of CRIBs (climate relevant innovation-system builders) in developing countries – key institutions focused on nurturing the climate-relevant innovation systems and building technological capabilities that form the bedrock of transformative, climate-compatible technological change and development

On the Equivalence of Quadratic APN Functions

Establishing the CCZ-equivalence of a pair of APN functions is generally quite difficult. In some cases, when seeking to show that a putative new infinite family of APN functions is CCZ inequivalent to an already known family, we rely on computer calculation for small values of n. In this paper we present a method to prove the inequivalence of quadratic APN functions with the Gold functions. Our main result is that a quadratic function is CCZ-equivalent to an APN Gold function if and only if it is EA-equivalent to that Gold function. As an application of this result, we prove that a trinomial family of APN functions that exist on finite fields of order 2^n where n = 2 mod 4 are CCZ inequivalent to the Gold functions. The proof relies on some knowledge of the automorphism group of a code associated with such a function.Comment: 13 p

Parenting Programmes for preventing tobacco, alcohol or drugs misuse in children under 18 : a systematic review

This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Health Education Research following peer review. The definitive publisher-authenticated version [Petrie, J. ,Bunn, F. and Byrne, G. (2007) 'Parenting Programmes for preventing tobacco, alcohol or drug abuse in children under 18:a systematic review'. Health Education Research 22 (2) pp.177-191] is available online at: http://her.oxfordjournals.org/archive/index.dtl --Copyright Oxford University PressWe conducted a systematic review of controlled studies of parenting programmes to prevent tobacco, alcohol or drug abuse in children under 18. We searched Cochrane Central Register of Controlled Trials, specialised Register of Cochrane Drugs and Alcohol Group, Pub Med, psych INFO, CINALH, and SIGLE. Two reviewers independently screened studies, extracted data and assessed study quality. Data were collected on actual or intended use of tobacco, alcohol or drugs by child, and associated risk or antecedent behaviours. Due to heterogeneity we did not pool studies in a meta-analysis and instead present a narrative summary of the findings. Twenty studies met our inclusion criteria. Statistically significant self-reported reductions of alcohol use were found in six of 14 studies, of drugs in five of nine studies and tobacco in nine out of 13 studies. Three interventions reported increases of tobacco, drug and alcohol use. We concluded that parenting programmes can be effective in reducing or preventing substance use. The most effective appeared to be those that shared an emphasis on active parental involvement and on developing skills in social competence, self-regulation and parenting. However, more work is needed to investigate further the change processes involved in such interventions and their long-term effectivenessPeer reviewe

Physiotherapists’ perceptions of problematic musculoskeletal soft tissue disorders

Original article can be found at: http://www.ijtr.co.uk/ Copyright MA Healthcare Limited.Aims: Many common musculoskeletal disorders are resistant to existing management strategies,causing long-term pain and disability. While arthritic and spinal problems have been prioritized for research, several soft tissue disorders may be equally burdensome for individuals and difficult to treat successfully. dentifying those that are least responsive to reatment may help focus the limited resources available for research and treatment provision. This study aimed to rank the most problematic disorders, and identify contributory factors, to inform the debate on research and service priorities in the management of musculoskeletal disorders. Methods: The views of practising physiotherapists on the most problematic soft tissue disorders were sought using a postal questionnaire survey and telephone interviews. The questionnaire was sent to 193 experienced musculoskeletal physiotherapists working in National Health Service and private clinics in south-east England. Findings: The response rate was 48%. The top three problematic disorders were identifi ed as frozen shoulder, plantar fasciitis and tennis elbow. Subsequent interviews with 20 respondents indicated that inadequate differential diagnosis, triaging and differences in therapeutic practice may account for some of the observed variation in outcomes. Conclusions: A greater focus on these particular disorders and issues by both clinicians and the research community is warranted.Peer reviewe

Law Reform in Estonia: The Role of Georgetown University Law Center

On June 19, 1992, we and seven other members of the Georgetown University Law Center community landed in Tallinn, the capital of Estonia, to help the Estonian government draft laws to support a market economy. Our group consisted of six students, two professors, and an alumnus. The country to which we had come had declared its independence from the Soviet Union less than one year before. After fifty years of imposed communism, the Estonian leaders wanted to understand and adopt the basic foundations for a Western legal system that would support democratic and market institutions

Calculus from the past: multiple delay systems arising in cancer cell modelling

Non-local calculus is often overlooked in the mathematics curriculum. In this paper we present an interesting new class of non-local problems that arise from modelling the growth and division of cells, especially cancer cells, as they progress through the cell cycle. The cellular biomass is assumed to be unstructured in size or position, and its evolution governed by a time-dependent system of ordinary differential equations with multiple time delays. The system is linear and taken to be autonomous. As a result, it is possible to reduce its solution to that of a nonlinear matrix eigenvalue problem. This method is illustrated by considering case studies, including the model of the cell cycle developed in Simms K, Bean N, & Koeber A. [10]. The paper concludes by explaining how asymptotic expressions for the distribution of cells across the compartments can be determined and used to assess the impact of different chemotherapeutic agents

A theoretical investigation of the effect of proliferation & adhesion on monoclonal conversion in the colonic crypt

The surface epithelium lining the intestinal tract renews itself rapidly by a coordinated programme of cell proliferation, migration and differentiation events that is initiated in the crypts of Lieberkühn. It is generally believed that colorectal cancer arises due to mutations that disrupt the normal cellular dynamics of the crypts. Using a spatially structured cell-based model of a colonic crypt, we investigate the likelihood that the progeny of a mutated cell will dominate, or be sloughed out of, a crypt. Our approach is to perform multiple simulations, varying the spatial location of the initial mutation, and the proliferative and adhesive properties of the mutant cells, to obtain statistical distributions for the probability of their domination. Our simulations lead us to make a number of predictions. The process of monoclonal conversion always occurs, and does not require that the cell which initially gave rise to the population remains in the crypt. Mutations occurring more than one to two cells from the base of the crypt are unlikely to become the dominant clone. The probability of a mutant clone persisting in the crypt is sensitive to dysregulation of adhesion. By comparing simulation results with those from a simple one-dimensional stochastic model of population dynamics at the base of the crypt, we infer that this sensitivity is due to direct competition between wild-type and mutant cells at the base of the crypt. We also predict that increases in the extent of the spatial domain in which the mutant cells proliferate can give rise to counter-intuitive, non-linear changes to the probability of their fixation, due to effects that cannot be captured in simpler models

A theoretical investigation of the effect of proliferation and\ud adhesion on monoclonal conversion in the colonic crypt

Colorectal cancers are initiated by the accumulation of mutations in the colonic epithelium. Using a spatially structured cell-based model of a colonic crypt, we investigate the likelihood that the progeny of a mutated cell will dominate, or be sloughed out of, a crypt. Our approach is to perform multiple simulations, varying the spatial location of the initial mutation, and its proliferative and adhesive properties, to obtain statistical distributions for the probability of domination. Our simulations lead us to make a number of predictions. The process of monoclonal conversion always occurs, and does not require that the cell which initially gave rise to the population remains in the crypt. Mutations occurring more than one to two cells from the base of the crypt are unlikely to become the dominant clone. The probability of a mutant clone persisting in the crypt is sensitive to dysregulation of adhesion, and comparison with a one-dimensional model suggests that this is caused by competition directly at the base of the crypt.\ud We also predict that increases in the extent of the spatial domain in which the mutant cells proliferate cause counter-intuitive non-linear changes to the probability of its fixation, due to effects that cannot be captured in simpler models