Beyond Risk Profiling: Achieving better investment outcomes for consumers and industry

In the wake of the Retail Distribution Review, there remain fundamental questions about how best to support consumers to make sound investment decisions, particularly those with modest amounts of money to invest, for whom a poor investment decision may have a disproportionate adverse impact. The advent of new pension freedoms from April 2015, which give people more choice and flexibility about how they use their retirement savings, adds further impetus to the issue. To help inform policy and practice on this important subject, in June 2015 we brought together consumer and industry experts to explore possible new approaches to improve risk profiling and investment decision-making

A grounded theory approach to physical activity and advanced cancer:a qualitative study protocol

Background: Physical activity has demonstrated benefits in cancer-related fatigue and physical functioning in early-stage cancer patients; however, the role of physical activity at the end stage of cancer has not been established. To challenge positivist–empiricist assumptions, I am seeking to develop a new theoretical framework that is grounded in the advanced cancer patient’s experience of activity. Aim: To gain an in-depth understanding of the experience of activity and quality of life in advanced cancer patients. Objectives: (1) To explore the meaning of activity for advanced cancer patients in the context of their day-to-day life, (2) to elicit advanced cancer patients’ perceptions of activity with respect to their quality of life, and (3) to elicit advanced cancer patients’ views of barriers and facilitators to activity in the context of their day-to-day life. Study Design: A two-phase, crosssectional, qualitative study will be conducted through the postpositivist lens of subtle realism and informed by the principles of grounded theory methods. Study Methods: Advanced cancer patients will be recruited through the outpatient department of a tertiary cancer center. For Phase 1, participants will wear an activPAL™ activity monitor and fill out a daily record sheet for 7-day duration. For Phase 2, the activity monitor output and daily record sheets will be used as qualitative probes for face-to-face, semistructured interviews. Concurrent coding, constant comparative analysis, and theoretical sampling will continue with the aim of achieving as close as possible to theoretical saturation. Ethics and Discussion: Ethical and scientific approval will be obtained by all local institutional review boards prior to study commencement. The findings will generate new mid-level theory about the experience of activity and quality of life in advanced cancer patients and aid in the development of a new theoretical framework for designing interventions for this population

Metastatic Testicular Choriocarcinoma:A Rare Cause of Upper GI Bleeding

We present a case of upper gastrointestinal bleeding in an otherwise healthy 18-year-old man who presented with melena. Endoscopy revealed an ulcerated mass in the stomach and pathology confirmed this to be a malignant, poorly differentiated choriocarcinoma. Further imaging showed a left testicular mass with evidence of pulmonary, gastric, and brain metastases, and blood tests revealed an hCG level of 32,219 U/L. He was diagnosed with advanced metastatic testicular choriocarcinoma and underwent intensive induction chemotherapy and an orchidectomy. Metastatic testicular choriocarcinoma is a rare cause of gastrointestinal bleeding.</p

Increasing International Collaboration and Networking Among High-level Isolation Units and Programs

Peer Reviewe

Anxiety and cognitive bias in children and young people who stutter

Psychologists recognise various forms of anxiety, such as generalized anxiety disorder, separation anxiety and social phobia. People who stutter are at risk of elevated levels of anxiety, especially social phobia. Recent research has suggested that anxiety may be caused and maintained by cognitive biases such as preferentially allocating attention towards threat stimuli. These biases can be re-trained using cognitive bias modification with resulting improvements in levels of anxiety. In the present study, we measured different forms of anxiety and attentional bias for faces among 8-18 year olds attending the Michael Palin Centre for treatment for stuttering. The clients and their parent(s) completed the child and parent versions, respectively, of the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), which provides an overall anxiety score and sub-scores, with clinical cut-offs, for generalized anxiety disorder, separation anxiety, social phobia, school avoidance and panic. The clients also performed a computerised measure of attentional bias for faces, using schematic stimuli. Levels of anxiety were higher than in the general population, and prevalence increased with age. There was a significant correlation between SCARED scores produced by clients and their parents. Socially anxious participants showed a bias towards sad faces

Exile Vol. XXVI No. 1

Photo: Untitled by Jamie Bailey 3 Poem: Hi, My Name Is by Kathy Andrews 4 Poem: Untitled by Willi Haworth 5 Photo: Stratified Snow by Jim Lundy 6 Poem: Untitled by A. Pence 7 Poem: Akua\u27ba by Tona Dickerson 8 Photo: Untitled by Jim Lundy 9 Story: The Dogcatchers of Portimao by Debora Papierski 10-13 Photo: Untitled by Holly Hall 14 Poem: Tocopold Bloom: A Working Class Hero by Mary Ladky 15 Photo: Untitled by Cory Easter 16 Poem: A Mortal Wound by Peter Fish 17 Poem: Let Me Sleep by R. G. Trub 18-19 Photo: Modified Cube by Jim Lundy 20 Story: Untitled by Kathy Desmond 21-23 Photo: Untitled by Holly Hall 24 Poem: Untitled by Sharon McCartney 25 Photo: Untitled by Him Lundy 26 Poem: Every Morning I Wake by Peter Fish 27 Photo: Untitled by Rof Smith 28 Poem: For Mark Some Words by Bonny Lowe 29 Photo: Untitled by Jim Lundy 30 Poem: A Flash of Crooked Light by Lisa Minacci 31 Photo: Untitled by Jim Lundy 32 Poem: Paper Hearts by W. Dulles 33 Drawing: Untitled by Roger Weisman 34 Story: Untitled by Dane Lavin 35-42 Photo: Untitled by Jim Lundy 43 Special Thanks To Laurie Howard -

Medicalization and beyond: the social construction of insomnia and snoring in the news

What role do the media play in the medicalization of sleep problems? This article, based on a British Academy funded project, uses qualitative textual analysis to examine representations of insomnia and snoring in a large representative sample of newspaper articles taken from the UK national press from the mid-1980s to the present day. Constructed as `common problems' in the population at large, insomnia and snoring we show are differentially located in terms of medicalizing—healthicizing discourses and debates. Our findings also suggest important differences in the gendered construction of these problems and in terms of tabloid and `broadsheet' newspaper coverage of these issues. Newspaper constructions of sleep, it is concluded, are complex, depending on both the `problem' and the paper in question

Excavations in the Acheulean Levels at the Earlier Stone Age site of Canteen Koppie, Northern Province, South Africa

The fluvial gravels of the river Vaal in South Africa have long been known as a source for Earlier Stone Age (ESA) artefacts. Most were discovered through the open cast mining for diamonds that has left very little in situ fluvial sediment remaining today. The site of Canteen Koppie is an internationally famous location with a reputation for prolific Acheulean artefacts, especially handaxes and the enigmatic prepared core and Levallois-like technology known as Victoria West. Our understanding of this site, and most other Vaal locations, is almost solely based on highly selected artefact collections. Here, we report on the first controlled excavations ever to be conducted at Canteen Koppie. The deposits are likely to date to the Early and Middle Pleistocene, and our excavations sample the full depth of the stratigraphic sequence. The lower units, first identified in these excavations, add a considerable time depth to the Acheulean occupation of the site, making this the longest chrono-stratigraphic sequence in South Africa to our knowledge. Given the current international interest in the origins of Levallois/prepared core technology (PCT), its occurrence in Unit 2b Upper, and its presence alongside Victoria West technology in Unit 2a has significant implications for debates on the role of Victoria West in the origins of PCT. From the Canteen Koppie evidence, Levallois and Victoria West are clearly rooted in the Acheulean.RésuméOn sait depuis longtemps que les graviers fluviaux de la rivière Vaal en Afrique du Sud sont une source d'artefacts de l'âge de pierre ancien (ESA). Ils ont été découverts pour la plupart au cours de l'extraction de diamants dans des mines à ciel ouvert, ce qui fait qu'il ne reste que très peu de sédiments fluviaux in situ aujourd'hui. Le site de Canteen Koppie est un lieu célèbre dans le monde entier, réputé pour l'abondance de ses artefacts acheuléens, en particulier les bifaces et la technologie enigmatique des nucléus préparés semblable au Levallois connue sous le nom de Victoria West. Notre compréhension de ce site, et de la plupart des autres lieux du Vaal, repose presque uniquement sur des collections d'artefacts extrèmement sélectionnés. Ici, nous faisons le compte rendu des premières fouilles contrôlées jamais menées à Canteen Koppie. Les dépôts datent probablement du début et du milieu du pléistocène et nos excavations prennent des échantillons de l'ensemble de la profondeur de la séquence stratigraphique. Les unités les plus basses, identifiées pour la première fois au cours de ces fouilles, ajoutent une profondeur temporelle considérable à l'occupation acheuléenne du site, elles en font la plus longue séquence chronostratigraphique d'Afrique du Sud à notre connaissance. Etant donné l'actuel intérêt international pour les origines de la technologie Levallois/nucléus préparé (PCT), sa rencontre dans l'Unité 2b Supérieure, et sa présence à côté de la technologie Victoria West dans l'Unité 2a ont d'importantes implications pour les débats sur le rôle de Victoria West dans les origines de PCT. D'après les témoignages de Canteen Koppie,il est clair que Levallois et Victoria West ont leurs racines dans l'acheuléen.ZusammenfassungDie Schwemmkiese des Flusses Vaal in Südafrika sind seit langem als Fundort altsteinzeitlicher Artefakte bekannt. Meist wurden sie während des Diamanttagebaus gefunden, durch den heute sehr wenige Sedimente noch in situ erhalten sind. Der Fundplatz Canteen Koppie ist ein international weithin bekannter Ort, der berühmt ist für reiche Artefakte des Acheuléen, insbesondere Faustkeile und die rätselhafte, an Levallois erinnernde Kerntechnologie, die als Victoria West bekannt ist. Unser Verständnis dieses Fundplatzes, wie auch der meisten anderen Orte entlang des Vaal, basiert fast ausschließlich auf einer eng begrenzten Auswahl von Artefaktensembles. Hier berichten wir über die erste systematische Ausgrabung, die je in Canteen Koppie durchgeführt wurde. Die Schichten datieren wahrscheinlich ins Früh- und Mittelpleistozän; unsere Grabungen erfassten die gesamte Ausdehnung der stratigraphischen Abfolge. Die unteren Einheiten, die zuerst in den Grabungen identifiziert werden konnten, vergrößern die zeitliche Tiefe der Acheuléen-zeitlichen Nutzung des Ortes erheblich, wodurch dies nach unserem Wissen die längste chrono-stratigraphische Sequenz in Südafrika ist. Aufgrund des gegenwärtigen Interesses an den Ursprüngen der Levallois-Technik bzw. Technik der vorbereiteten Kerne (prepared core technology, PCT) ist ihr Auftreten in Unit 2b Upper und das Vorhandensein in Unit 2a, gemeinsam mit Victoria West-Technologie, von besonderer Bedeutung für die Diskussionen über die Rolle, die Victoria West bei der Entstehung von PCT spielt. Anhand der Beobachtungen in Canteen Koppie können wir festhalten, dass Levallois und Victoria West sicher im Acheuléen wurzeln.RésuménLas gravas fluviales del Rio Vaal en Sudáfrica han sido conocidas desde antiguo como una fuente de artefactos de la Primera Edad de Piedra (ESA en su acrónimo inglés). La mayoría han sido descubiertos al buscar diamantes al aire libre que ha dejado muy pocos sedientos fluviales in situ hoy en día. El yacimiento de Canteen Koppie es un emplazamiento internacionalmente famoso con una reputación de ser especialmente prolijo en artefactos del Achelense, especialmente hachas de mano y los enigmáticos núcleos preparados y la tecnología de estilo Levallois conocida como ‘Victoria West’. Nuestra comprensión de este yacimiento, y de la mayoría de los otros yacimientos en el Vaal, se basa casi exclusivamente en una serie de colecciones de artefactos altamente seleccionados. Este trabajo informa sobre las primeras excavaciones controladas jamás realizadas en Canteen Koppie. Los depósitos datan más probablemente al Pleistoceno Alto y Medio, y nuestra excavación cató toda la profundidad de la secuencia estratigráfica. Las capas más bajas, identificadas por primera vez en esta excavación, añaden una considerable profundidad temporal a la ocupación Achelense del yacimiento, y lo convierten, que sepamos, en la secuencia crono-estratigráfica más larga de Sudáfrica. Dado el interés internacional actual en los orígenes de la tecnología Levallois/núcleos preparados (PCT en su acrónimo inglés), su aparición en el Nivel 2b Superior, y su presencia junto con la tecnología Victoria West en el Nivel 2a tiene significativas consecuencias para los debates sobre el papel de Victoria West en los orígenes del PCT. Por lo que indica la evidencia de Canteen Koppie, las tecnologías Levallois y Victoria West están ambas claramente enraizadas en el Achelense

PANTHER: AZD8931, inhibitor of EGFR, ERBB2 and ERBB3 signalling, combined with FOLFIRI: a Phase I/II study to determine the importance of schedule and activity in colorectal cancer

BACKGROUND: Epidermal growth factor receptor (EGFR) is a therapeutic target to which HER2/HER3 activation may contribute resistance. This Phase I/II study examined the toxicity and efficacy of high-dose pulsed AZD8931, an EGFR/HER2/HER3 inhibitor, combined with chemotherapy, in metastatic colorectal cancer (CRC). METHODS: Treatment-naive patients received 4-day pulses of AZD8931 with irinotecan/5-FU (FOLFIRI) in a Phase I/II single-arm trial. Primary endpoint for Phase I was dose limiting toxicity (DLT); for Phase II best overall response. Samples were analysed for pharmacokinetics, EGFR dimers in circulating exosomes and Comet assay quantitating DNA damage. RESULTS: Eighteen patients received FOLFIRI and AZD8931. At 160 mg bd, 1 patient experienced G3 DLT; 160 mg bd was used for cohort expansion. No grade 5 adverse events (AE) reported. Seven (39%) and 1 (6%) patients experienced grade 3 and grade 4 AEs, respectively. Of 12 patients receiving 160 mg bd, best overall response rate was 25%, median PFS and OS were 8.7 and 21.2 months, respectively. A reduction in circulating HER2/3 dimer in the two responding patients after 12 weeks treatment was observed. CONCLUSIONS: The combination of pulsed high-dose AZD8931 with FOLFIRI has acceptable toxicity. Further studies of TKI sequencing may establish a role for pulsed use of such agents rather than continuous exposure. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number: NCT01862003

The pancreatic zymogen granule membrane protein, GP2, binds Escherichia coli type 1 Fimbriae

<p>Abstract</p> <p>Background</p> <p>GP2 is the major membrane protein present in the pancreatic zymogen granule, and is cleaved and released into the pancreatic duct along with exocrine secretions. The function of GP2 is unknown. GP2's amino acid sequence is most similar to that of uromodulin, which is secreted by the kidney. Recent studies have demonstrated uromodulin binding to bacterial Type 1 fimbria. The fimbriae serve as adhesins to host receptors. The present study examines whether GP2 also shares similar binding properties to bacteria with Type 1 fimbria. Commensal and pathogenic bacteria, including E. coli and Salmonella, express type 1 fimbria.</p> <p>Methods</p> <p>An <it>in vitro </it>binding assay was used to assay the binding of recombinant GP2 to defined strains of <it>E. coli </it>that differ in their expression of Type 1 fimbria or its subunit protein, FimH. Studies were also performed to determine whether GP2 binding is dependent on the presence of mannose residues, which is a known determinant for FimH binding.</p> <p>Results</p> <p>GP2 binds <it>E. coli </it>that express Type 1 fimbria. Binding is dependent on GP2 glycosylation, and specifically the presence of mannose residues.</p> <p>Conclusion</p> <p>GP2 binds to Type 1 fimbria, a bacterial adhesin that is commonly expressed by members of the <it>Enterobacteriacae </it>family.</p