The measurement of response shift in patients with advanced prostate cancer and their partners

BACKGROUND: There is increasing evidence to support the phenomenon of response shift (RS) in quality of life (QoL) studies, with many current QoL measures failing to allow for this. If significant response shift occurs amongst prostate cancer patients, it will be necessary to allow for this in the design of future clinical research and to reassess the conclusions of previous studies that have not allowed for this source of bias. This study therefore aimed to assess the presence of RS and psychosocial morbidity in patients with advanced prostate cancer and their partners. METHODS: 55 consecutive advanced prostate cancer patients and their partners completed the Prostate Cancer Patient & Partner questionnaire (PPP), shortly after diagnosis and again at 3 months and 6 months. At the follow-up visits, both patients and partners also completed a then-test in order to assess RS. RESULTS: Partners consistently showed greater psychological morbidity than patients in relation to the prostate cancer. This was most marked on the General Cancer Distress (GCD) subscale (p < 0.001, paired t-test), and regarding worries about treatment (p = 0.01). Significant RS was identified in partners and patients by the use of the then-test technique, particularly on the GCD subscale, the concerns about treatment and the concerns about urinary symptoms items. CONCLUSION: These results suggest the presence of RS in patients with advanced prostate cancer and their partners, with higher levels of psychosocial morbidity noted amongst partners. This is the first study to identify RS in partners and calls into question the interpretation of all studies assessing changes in QoL that fail to allow for this phenomenon

Sentry bioconvertible inferior vena cava filter: Study of stages of incorporation in an experimental ovine model

The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection from pulmonary embolism (PE) and then bioconvert to become incorporated in the vessel wall, leaving a patent IVC lumen. Objective. To evaluate the performance and stages of incorporation of the Sentry IVC filter in an ovine model. Methods. Twenty-four bioconvertible devices and 1 control retrievable filter were implanted in the infrarenal IVC of 25 sheep, with extensive daily monitoring and intensive imaging. Vessels and devices were analyzed at early (≤98 days, n = 10) and late (180 ± 30 days, n = 14 study devices, 1 control) termination and necropsy time-points. Results. Deployment success was 100% with all devices confirmed in filtering configuration, there were no filter-related complications, and bioconversion was 100% at termination with vessels widely patent. By 98 days for all early-incorporation analysis animals, the stabilizing cylindrical part of the Sentry frame was incorporated in the vessel wall, and the filter arms were retracted. By 180 days for all late-incorporation analysis animals, the filter arms as well as frames were stably incorporated. Conclusions. Through 180 days, there were no filter-related complications, and the study devices were all bioconverted and stably incorporated, leaving all IVCs patent

Climate Change Adaptation Planning for Cultural Heritage, a National Scale Methodology

Ireland’s Climate Action and Low Carbon Development Act 2015 established the requirement for a National Adaptation Framework (NAF) composed of 9 sectoral plans, of which Built and Archaeological Heritage is one. All the plans were written according to the six step process outlined in Sectoral Planning Guidelines for Climate Change Adaptation produced by the Department of Communications, Climate Action and Environment (DCCAE, 2018) which is also the government department charged with coordinating the NAF. This article summarises the application of the methodology to heritage resources in Ireland, the issues encountered and the results achieved. The plan was informed by existing research and incorporated expert, stakeholder and public consultation throughout the process. It also closely considered published plans from other sectors in order to aid consistency within the NAF and to ensure cross-cutting issues were highlighted. Of the many potential impacts of climate change, those identified as priorities for adaptation planning in Ireland were flooding (inland & coastal), storm damage, coastal erosion, soil movement (landslip or erosion), changing burial preservation conditions, pests and mould, wildfires, and maladaptation. Goals, objectives and an action plan were developed commensurate with the five-year term of the plan, but also initiating a long-term strategic vision. A monitoring strategy was developed to monitor progress, identify problems and inform improvements to the adaptation plan as part of an iterative process. Much work is being done on the topic of climate change and cultural heritage but it is believed that when Ireland adopted its national adaptation plan for cultural heritage in October 2019 it was the first government to do so

Simvastatin improves the sexual health-related quality of life in men aged 40 years and over with erectile dysfunction : Additional data from the Erectile Dysfunction and Statin trial

© 2014 Trivedi et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background: Erectile dysfunction is prevalent in men over 40 years, affecting their quality of life and that of their partners. The aims of this study were:a)To evaluate the internal reliability of the male erectile dysfunction specific quality of life (MED-QoL) scale and explore its factor structure.b)To evaluate the effect of simvastatin on subscales of the MED-QoL in men over forty years with erectile dysfunction. Methods: This is a double blind randomised controlled trial of 40 mg simvastatin or placebo given once daily for six months to men over forty years with untreated erectile dysfunction, who were not at high cardiovascular risk and were not on anti-hypertensive or lipid-lowering medication. 173 eligible men were recruited from 10 general practices in East of England. Data were collected at two points over 30 weeks. We report on the factor structure of MED-QoL, the internal reliability of the scale and the derived subscales, and the effect of simvastatin on MED-QoL subscales. Results: An initial analysis of the MED-QoL items suggested that a number of items should be removed (MED-QoL-R). Exploratory factor analysis identified three subscales within the MED-QoL-R which accounted for 96% of the variance, related to feelings of Control, initiating Intimacy, and Emotional response to erectile dysfunction. The alpha value for the revised scale (MED-Qol-R) was >0.95 and exceeded .82 for each subscale. Regression analysis showed that patients in the placebo group experienced a significantly reduced feeling of Control over erectile dysfunction than those in the statin group. Those in the placebo group had significantly lower Emotional response than those in the statin group at the close of trial, but there was no significant treatment effect on Intimacy. Conclusions: Our revised MED-QoL-R identified three subscales. Secondary analysis showed a significant improvement in sexual health related quality of life, specifically in relation to perception of control and emotional health in men with untreated erectile dysfunction given 40 mg simvastatin for six months. Trial registration: Current Controlled Trials ISRCTN66772971.Peer reviewe

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism

Discussing life expectancy with surgical patients: Do patients want to know and how should this information be delivered?

<p>Abstract</p> <p>Background</p> <p>Predicted patient life expectancy (LE) and survival probability (SP), based on a patient's medical history, are important components of surgical decision-making and informed consent. The objective of this study was to assess patients' interpretation of and desire to know information relating to LE, in addition to establishing the most effective format for discussion.</p> <p>Methods</p> <p>A cross sectional survey of 120 patients (mean age = 68.7 years, range 50–90 years), recruited from general urological and surgical outpatient clinics in one District General and one Teaching hospital in Southwest England (UK) was conducted. Patients were included irrespective of their current diagnosis or associated comorbidity. Hypothetical patient case scenarios were used to assess patients' desire to know LE and SP, in addition to their preferred presentation format.</p> <p>Results</p> <p>58% of patients expressed a desire to know their LE and SP, if it were possible to calculate, with 36% not wishing to know either. Patients preferred a combination of numerical and pictorial formats in discussing LE and SP, with numerical, verbal and pictorial formats alone least preferred. 71% patients ranked the survival curve as either their first or second most preferred graph, with 76% rating facial figures their least preferred. No statistically significant difference was noted between sexes or educational backgrounds.</p> <p>Conclusion</p> <p>A proportion of patients seem unwilling to discuss their LE and SP. This may relate to their current diagnosis, level of associated comorbidity or degree of understanding. However it is feasible that by providing this information in a range of presentation formats, greater engagement in the shared decision-making process can be encouraged.</p

Technological Revolutions and Debt Hangovers: Is There a Link?

Abstract The Great Recession, the Great Depression, and the Japanese slump of the 1990s were all preceded by periods of major technological innovation. In an attempt to understand these facts, we estimate a model with noisy news about the future. We find that beliefs about long run income adjust with an important delay to shifts in trend productivity. This delay, together with estimated shifts in the trend of productivity in the three cases, are able to tell a common and simple story for the observed dynamics of productivity and consumption on a 20 to 25 year window. Our analysis highlights the advantages of a look at this data from the point of view of the medium run

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Finding new uses for Irish demesnes: authenticity and integrity issues

The demesnes of Ireland occupy a central place within the evolution of the modern Irish landscape. They were constructed by a confident and self-assured landed gentry who enjoyed absolute economic, political and social power on the island. For them, gardens were a very visible means of proclaiming newly found status and wealth, as well as authority on the island. The recreation of space in accordance with practical and fashionable aesthetic norms had the dual role of asserting the landlord’s status as members of the elite, while at the same time emphasising the social distance, which separated them from the remainder of society. Progressively, the demesne form was raised to the level of art by the eighteenth and nineteenth centuries, where demesnes became masterpieces of architecture and landscape design. They frequently comprised of unique areas of outstanding architectural, archaeological, botanical and landscape importance. In the decades up to World War I, the landownership system began to change radically. With these changes, the animating and unifying forces behind demesne construction crumbled and disappeared. In the newly established Irish Free State, few people saw demesnes as part of a shared heritage worth preserving. As a result, country houses and demesnes, the very symbol of British power in Ireland, came under direct attack. Demesnes were acquired compulsorily by the Land Commission and the newly formed Forest Service for use in agriculture, forestry or congestion relief. They paid little if any regard to their historic designed landscapes and, for a great many demesnes, their original context was frequently lost. This attitude continued up to the early 1980s, with the burning of a number of country houses in response to the republican hunger-strikes in Northern Ireland. As passionate memory faded and later generations began to objectively examine the cultural heritage surrounding them, a new appreciation of these eighteenth and nineteenth century xvi landscapes began to emerge. However, the survival of demesnes remains under threat as development pressures, especially during the “Celtic Tiger” era, have resulted in a significant number of demesnes undergoing radical changes of use. These threats range from holiday home developments, road building exercises carried-out under the National Development Plans (NDPs) 2000-2006 and 2007-2012, urban and suburban expansion and, above all, golf and spa hotel resorts. Such developments impact upon the continued authenticity and integrity of such important cultural landscapes and, as a result, many have been needlessly destroyed. However, conservation policy in Ireland is still dominated by conservation tools used to protect architectural structures, rather than cultural landscapes. Cultural landscapes cannot be conserved in the same manner as structures, as they are inevitably in a continual state of change through the seasons; their component plants grow and die, and they require significantly higher levels of maintenance to preserve their integrity. Such landscapes create a unique set of conservation challenges that can only be addressed though appropriate conservation legislation and policy guidance. In order to effectively conserve remaining demesnes, a new understanding of their complex composition and design interdependencies needs to be initially acknowledged before appropriate conservation tools are used to conserve them. In addition, if a demesne is to be adequately conserved in the longer-term, the potential consequences of fragmentation of land ownership and, resultant, uncoordinated development must also be addressed. Such an approach would allow for an appropriate new use to be found for a demesne, replicating the original animating and unifying forces. Only then would it be possible to maintain a demesne’s authenticity and integrity. This is an essential prerequisite and the chief role for conservation policy in Ireland. This dissertation aims to uncover a greater understanding of the original functions that they served xvii and their intricate design interdependencies before making conservation policy recommendations aimed at safeguarding their continued authenticity and integrity. To address these issues in a chronological manner, this dissertation is separated into distinct chapters, as follows: Chapter One: Introduction This chapter introduces this dissertation’s main research question and methodology. Chapter Two: Irish Demesnes This chapter sets the scene with an examination of the existing definitions for demesnes. Chapter Three: Historical Context: The Development of Demesnes in Ireland This chapter traces the historical development of demesnes in Ireland from the twelfth to the twentieth century uncovering their historical form, function and layout. Chapter Four: Demesne Structure in the Irish Landscape This chapter summarises the significance and common characteristics of demesnes. Chapter Five: The Abolition of Landlordism in Ireland This chapter examines the decline of the system of landownership that brought demesnes into existence and their subsequent reappraisal in the 1980s. Chapter Six: Current Threats to the Integrity of Irish Demesnes This chapter outlines the vulnerable design elements and current development threats to the continued integrity and authenticity of demesnes. xviii Chapter Seven: Conservation Legislation in Ireland This chapter undertakes a detailed examination of current conservation legislation in operation in Ireland. It will uncover how well Irish conservation legislation copes with the intricate design complexities of demesnes since it was overhauled a decade ago. Chapter Eight: Case-study Analyses This chapter examines the ability of current conservation legislation to protect the integrity of demesnes from the threat of erroneous development using three case-study examples. Chapter Nine: Conclusion The final chapter will make recommendations for future legislative and policy amendments with the aim of further solidifying legislative reform begun in 2000

The Irish on the Somme; being the second series of "The Irish at the front,"

"The Irish troops dealt with are all of the new armies--the Ulster division, the Irish division and the Tyneside Irish brigade."--Introd.Mode of access: Internet