Studies in the Sugar Alcohol, Steroid and Heterocyclic Series

Abstract Not Provided

Linking demand, gender and poverty for sustainability

NEWAH began a gender mainstreaming process in January 1999 in its organisation and programme. At the programme level this involved establishing a Gender and Poverty (GAP) Unit comprising 6 operational teams of both technical and social staff, which successfully piloted a GAP approach in 5 communities in 5 regions of Nepal (three gravity flow and two groundwater projects). Some initial results of the GAP pilot projects suggest that actions taken to target women and poorest community members have been effective in leading to greater inclusion of often excluded groups in making decisions throughout the service planning and implementation process of projects. Also that giving voice and choice to more community people – the poor, better off, women and men, boys and girls – and letting them influence (or control) the process of the service establishment is empowering them to potentially manage and sustain their services more effectively

Effect of impact damage on fatigue performance of structures reinforced with GLARE bonded crack retarders

Fibre-Metal Laminates (FML) such as GLARE are of interest as bonded crack retarders (BCR) to improve the fatigue performance of aircraft structures. The degradation of the performance of the crack retarder in service if subjected to damage is a critical factor in designing with this concept. Bonded assemblies of an aluminium alloy substrate reinforced with a GLARE strap were prepared, and were subjected to low velocity impact damage onto the GLARE, with impact energies ranging from 10 to 60J. The thermal residual stresses developed during the bonding process of the GLARE to the aluminium were determined using neutron diffraction, and the change in the thermal residual stresses owing to impact damage onto the GLARE was evaluated. Pre- and post-impact fatigue performance of the BCR assemblies has been investigated. The results show that the BCR provides an improvement in fatigue life, but the reduction is impaired following impact damage. The results show that monitoring of impact damage will be critical in the damage tolerance assurance for aerospace structures containing bonded crack retarders

A Second Order Godunov Method for Multidimensional Relativistic Magnetohydrodynamics

We describe a new Godunov algorithm for relativistic magnetohydrodynamics (RMHD) that combines a simple, unsplit second order accurate integrator with the constrained transport (CT) method for enforcing the solenoidal constraint on the magnetic field. A variety of approximate Riemann solvers are implemented to compute the fluxes of the conserved variables. The methods are tested with a comprehensive suite of multidimensional problems. These tests have helped us develop a hierarchy of correction steps that are applied when the integration algorithm predicts unphysical states due to errors in the fluxes, or errors in the inversion between conserved and primitive variables. Although used exceedingly rarely, these corrections dramatically improve the stability of the algorithm. We present preliminary results from the application of these algorithms to two problems in RMHD: the propagation of supersonic magnetized jets, and the amplification of magnetic field by turbulence driven by the relativistic Kelvin-Helmholtz instability (KHI). Both of these applications reveal important differences between the results computed with Riemann solvers that adopt different approximations for the fluxes. For example, we show that use of Riemann solvers which include both contact and rotational discontinuities can increase the strength of the magnetic field within the cocoon by a factor of ten in simulations of RMHD jets, and can increase the spectral resolution of three-dimensional RMHD turbulence driven by the KHI by a factor of 2. This increase in accuracy far outweighs the associated increase in computational cost. Our RMHD scheme is publicly available as part of the Athena code.Comment: 75 pages, 28 figures, accepted for publication in ApJS. Version with high resolution figures available from http://jila.colorado.edu/~krb3u/Athena_SR/rmhd_method_paper.pd

Old English Violin Music

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Should exercises be painful in the management of chronic musculoskeletal pain?: a systematic review and meta-analysis

Background: Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged, compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. Methods: Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool and the GRADE system was used to evaluate the quality of evidence. Results: The literature search identified 9,081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain at medium and long term; and function and disability at short, medium and long term there was no significant difference. Conclusion: Protocols using painful exercises offer a small, but significant benefit over pain-free exercises at short term, with moderate quality of the evidence. At medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO Registration: CRD4201603888

Comparison of the airway microbiota in children with chronic suppurative lung disease

Rationale: The airway microbiota is important in chronic suppurative lung diseases (CSLD), such as primary ciliary dyskinesia (PCD) and cystic fibrosis (CF). This comparison has not previously been described but is important because difference between the two diseases may relate to the differing prognoses and lead to pathological insights and potentially, new treatments. Objectives: To compare the longitudinal development of the airway microbiota in children with PCD to that of CF and relate this to age and clinical status. Methods: Sixty-two age-matched children (age range 0.5–17 years) with PCD or CF (n=31 in each group) were recruited prospectively and followed for 1.1 years. Throat swabs or sputum as well as clinical information were collected at routine clinical appointments. 16S rRNA gene sequencing was performed. Measurements and Main Results: The microbiota was highly individual and more diverse in PCD and differed in community composition when compared with CF. Whilst Streptococcus was the most abundant genus in both conditions, Pseudomonas was more abundant in CF with Haemophilus more abundant in PCD (Padj=0.0005). In PCD only, an inverse relationship was seen in the relative abundance of Streptococcus and Haemophilus with age. Conclusions: Bacterial community composition differs between children with PCD and those with CF. Pseudomonas is more prevalent in CF and Haemophilus in PCD, at least until infection with Pseudomonas supervenes. Interactions between organisms, particularly members of Haemophilus, Streptococcus, and Pseudomonas genera appear important. Study of the interactions between these organisms may lead to new therapies or risk stratification

The experience of living with patellofemoral pain: loss, confusion and fear-avoidance: a UK qualitative study

Objectives: To investigate the experience of living with patellofemoral pain. Design: Qualitative study design using semi-structured interviews, and analysed thematically using the guidelines set out by Braun and Clarke. Setting: A National Health Service (NHS) physiotherapy clinic within a large UK teaching hospital. Participants: A convenience sample of ten participants, aged between 18 and 40, with a diagnosis of patellofemoral pain and on a physiotherapy waiting list, prior to starting physiotherapy. Results: Participants offered rich and detailed accounts of the impact and lived experience of patellofemoral pain, including: loss of physical and functional ability; loss of self - identity; pain related confusion and difficulty making sense of their pain ; pain related fear, including fear -avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. Conclusions: These findings offer an insight into the lived experience of individuals with patellofemoral pain. Previous literature ha s focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain related fear for people with patellofemoral pain. The current consensus that best - evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients

Hepatitis B Vaccination for Patients with Chronic Renal Failure

Background Chronic renal failure patients are at particular risk of hepatitis B virus infection. Early studies have demonstrated that renal failure patients benefit from vaccination; however, not all studies have consistently shown benefit. Objectives To determine the beneficial and harmful effects of hepatitis B vaccine and of a reinforced vaccination series in chronic renal failure patients. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Renal Group Controlled Trials Register, The Cochrane Controlled Trials Register on The Cochrane Library (Issue 1, 2002), PubMed/MEDLINE (1966 to July 2003), EMBASE (1985 toNovember 2003), Current Clinical Practice Guidelines (Canadian Immunization Guide and Vaccine Preventable Diseases Surveillance Manual), and Science Citation Index as well as journals, published abstracts, and reference lists of articles. Selection criteria Randomised clinical trials comparing plasma vaccine with placebo, recombinant vaccine with placebo, recombinant vaccine with plasma vaccine, and a reinforced vaccination series (ie, more than three inoculations) with three inoculations of vaccine in chronic renal failure patients. Data collection and analysis Primary outcome measures included incidence of patients developing hepatitis B virus antibodies and infections while secondary outcomes included adverse events, liver-related morbidity, and mortality. Random effects models were used and reported relative risks and 95% confidence intervals (RR and 95% CI). Main results We included seven randomised clinical trials. None of them had high quality. Plasma vaccine was significantly more effective than placebo in achieving hepatitis B antibodies (RR 23.0, 95% CI 14.39 to 36.76, 3 trials). We found no statistically significant difference between plasma vaccine or placebo regarding hepatitis B virus infections (RR 0.50, 95% CI 0.20 to 1.24). We found no statistically significant differences between recombinant vaccine and plasma vaccine in achieving hepatitis B antibodies (RR 0.65, 95% CI 0.28 to 1.53, 2 trials). Heterogeneity was significant and appeared to be attributable to the dose of vaccine. Two trials examined a reinforced recombinant vaccine strategy, which was not statistically more effective than three inoculations of recombinant vaccine regarding development of hepatitis B antibodies (RR 1.36, 95% CI 0.85 to 2.16). Authors’ conclusions Plasma derived vaccines are more effective than placebo in achieving hepatitis B antibodies, while no statistically significant difference was found between recombinant and plasma vaccines. No statistically significant difference of effectiveness was observed between a reinforced vaccination series versus routine vaccinations of three inoculations of recombinant vaccine