Governing the constructs of life: what constitutes ‘good’ governance?

This thesis explores contrasting perspectives on what constitutes 'good governance' for human embryonic stem cell (hESC) research. It asks whether there are systematic differences between perspectives of UK and US policy actors and what kinds of patterns are discernible. Biomedical technologies like hESCs generate complex interactions between public values, institutional interests, societal expectations and technological uncertainties. These pose serious governance challenges. Under such conditions, diverse aspects and implications of risk, ambiguity and uncertainty come into focus. We need appraisal processes that address these issues by combining quantitative and qualitative dimensions to 'open up' divergent governance framings. The research framework employed here uses and further develops one such elicitation and analysis process called Multicriteria Mapping (MCM). MCM combines qualitative sensitivity with quantitative precision, while also aiding transparency and reflexivity in documenting and understanding diverse stakeholder perspectives. We therefore address 'good' governance both as an analytical subject and as a rationale for testing a novel form of appraisal. The analysis discerns systematic patterns in perspectives on good governance across national contexts and between stakeholders, identifying several points of convergence and divergence. We examine underlying rationales behind individual perspectives, obtaining empirical support for recent theoretical arguments concerning technology appraisal and democratic deliberation. We find national policy literatures make greater use of moral and ethical language to frame governance challenges, by comparison with stakeholders' emphasis on institutional and socio-political factors. This suggests a more critical and cautious stance is needed towards the legitimatory language of 'bioethics' in policy making. Finally, we explore some of the normative implications for governance of culturally sensitive and scientifically uncertain issues. By providing reflexive explanations of factors influencing perspectives of policy actors, this thesis makes a number of interlinked theoretical, methodological, empirical and normative contributions to understanding of how good governance of biomedical technologies is and should be conducted

Let’s Get That Bread Clip: Mechanical or Malignant Large Bowel Obstruction?

A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course

Comparative performance of adult social care research, 1996-2011: a bibliometric assessment

Decision-makers in adult social care are increasingly interested in using evidence from research to support or shape their decisions. The scope and nature of the current landscape of adult social care research (ASCR) needs to be better understood. This paper provides a bibliometric assessment of ASCR outputs from 1996 to 2011. ASCR papers were retrieved using three strategies: from key journals; using keywords and noun phrases; and from additional papers preferentially citing or being cited by other ASCR papers. Overall 195,829 ASCR papers were identified in the bibliographic database Scopus, of which 16% involved at least one author from the UK. The UK output increased 2.45-fold between 1996 and 2011. Among selected countries, those with greater research intensity in ASCR generally had higher citation impact, such as the US, UK, Canada and the Netherlands. The top-5 UK institutions in terms of volume of papers in the UK accounted for 26% of total output. We conclude by noting the limitations to bibliometric analysis of ASCR and examine how such analysis can support the strategic development of the field

7 Essays on Impact

Edited by Dr Andrew Dean, Dr Michael Wykes & Hilary Stevens, University of ExeterThrough the Jisc-funded DESCRIBE Project we have sought to undertake a rigorous assessment of current standards relating to the evidence of impacts arising from Higher Education research. This document contains seven valuable essays each exploring the topic of Impact. Each essay is distinct and we have sought to enable selected thought-leaders and Impact experts to both review the status quo, and to look to the future, making suggestions and recommendations for the development of Impact in the sector. DESCRIBE has been managed by the University of Exeter’s Research and Knowledge Transfer team in partnership with the Marchmont Observatory. We have sought to combine the latest thinking on research Impact with examples and recommendations which are practical and rooted in the art of the possible.JISC DIINN1

Concert recording 2016-02-04

[Track 01]. Der Schmetterling / Franz Schubert -- [Track 02]. Moonshine lullaby from Annie get your gun / Irving Berlin -- [Track 03]. Voi, che sapete from Le Nozze di Figaro / Wolfgang Amadeus Mozart -- [Track 04]. Barcarolle from Les contes d\u27Hoffman / Jacques Offenbach -- [Track 05]. A maiden fair to see from H.M.S. Pinafore / Gilbert and Sullivan -- [Track 06]. Im wunderschönen Monat Mai from Dichterliebe / Robert Schumann -- [Track 07]. L\u27heure exquise / Reynaldo Hahn -- [Track 08]. And this is my beloved from Kismet / Wright ; Forest -- [Track 09]. Wenn mein Schatz Hochzeit macht from Lieder eines fahrenden Gesellen / Gustav Mahler -- [Track 10]. Va! Laisse couler mes larmes from Werther / Jules Massenet -- [Track 11]. Give me Jesus / traditional ; arranged by Moses Hogan -- [Track 12]. Il lacerato spirito from Simon Boccanegra / Giuseppe Verdi -- [Track 13]. Giunse alfin il momento...Deh viene, non tardar from Le nozze di Figaro / Wolfgang Amadeus Mozart -- [Track 14]. St. Ita\u27s vision from Hermit songs / Samuel Barber -- [Track 15]. Adele\u27s audition aria from Die Fledermaus / Johann Strauss -- [Track 16]. A part of that from The last five years / Jason Robert Brown -- [Track 17]. Two for the road / Henry Mancini -- [Track 18]. Nel cor piu non mi sento / Giovanni Paisiello -- [Track 19]. Love\u27s minstrels from The house of life / Ralph Vaughan-Williams -- [Track 20]. Der stürmische Morgen / Franz Schubert -- [Track 21]. Die Lotosblume / Robert Schumann -- [Track 22]. Nothing from A chorus line / Hammlisch ; Kleban -- [Track 23]. Spiel auf deiner Geige / Robert Stolz

Learning from the UK’s research impact assessment exercise: a case study of a retrospective impact assessment exercise and questions for the future

National governments spend significant amounts of money supporting public research. However, in an era where the international economic climate has led to budget cuts, policymakers increasingly are looking to justify the returns from public investments, including in science and innovation. The so-called ‘impact agenda’ which has emerged in many countries around the world is part of this response; an attempt to understand and articulate for the public what benefits arise from the research that is funded. The United Kingdom is the most progressed in implementing this agenda and in 2014 the national research assessment exercise, the Research Excellence Framework, for the first time included the assessment of research impact as a component. For the first time within a dual funding system, funding would be awarded not only on the basis of the academic quality of research, but also on the wider impacts of that research. In this paper we outline the context and approach taken by the UK government, along with some of the core challenges that exist in implementing such an exercise. We then synthesise, together for the first time, the results of the only two national evaluations of the exercise and offer reflections for future exercises both in the UK and internationally

Sepsis prevalence and outcome on the general wards and emergency departments in Wales: Results of a multi-centre, observational, point prevalence study

Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality

Evaluation of functional dynamics during osseointegration and regeneration associated with oral implants

The aim of this paper is to review current investigations on functional assessments of osseointegration and assess correlations to the peri-implant structure.The literature was electronically searched for studies of promoting dental implant osseointegration, functional assessments of implant stability, and finite element (FE) analyses in the field of implant dentistry, and any references regarding biological events during osseointegration were also cited as background information.Osseointegration involves a cascade of protein and cell apposition, vascular invasion, de novo bone formation and maturation to achieve the primary and secondary dental implant stability. This process may be accelerated by alteration of the implant surface roughness, developing a biomimetric interface, or local delivery of growth-promoting factors. The current available pre-clinical and clinical biomechanical assessments demonstrated a variety of correlations to the peri-implant structural parameters, and functionally integrated peri-implant structure through FE optimization can offer strong correlation to the interfacial biomechanics.The progression of osseointegration may be accelerated by alteration of the implant interface as well as growth factor applications, and functional integration of peri-implant structure may be feasible to predict the implant function during osseointegration. More research in this field is still needed. To cite this article: Chang P-C, Lang NP, Giannobile WV. Evaluation of functional dynamics during osseointegration and regeneration associated with oral implants. Clin. Oral Impl. Res . 21 , 2010; 1–12.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78668/1/j.1600-0501.2009.01826.x.pd

Comparative Genomic Analysis of Drosophila melanogaster and Vector Mosquito Developmental Genes

Genome sequencing projects have presented the opportunity for analysis of developmental genes in three vector mosquito species: Aedes aegypti, Culex quinquefasciatus, and Anopheles gambiae. A comparative genomic analysis of developmental genes in Drosophila melanogaster and these three important vectors of human disease was performed in this investigation. While the study was comprehensive, special emphasis centered on genes that 1) are components of developmental signaling pathways, 2) regulate fundamental developmental processes, 3) are critical for the development of tissues of vector importance, 4) function in developmental processes known to have diverged within insects, and 5) encode microRNAs (miRNAs) that regulate developmental transcripts in Drosophila. While most fruit fly developmental genes are conserved in the three vector mosquito species, several genes known to be critical for Drosophila development were not identified in one or more mosquito genomes. In other cases, mosquito lineage-specific gene gains with respect to D. melanogaster were noted. Sequence analyses also revealed that numerous repetitive sequences are a common structural feature of Drosophila and mosquito developmental genes. Finally, analysis of predicted miRNA binding sites in fruit fly and mosquito developmental genes suggests that the repertoire of developmental genes targeted by miRNAs is species-specific. The results of this study provide insight into the evolution of developmental genes and processes in dipterans and other arthropods, serve as a resource for those pursuing analysis of mosquito development, and will promote the design and refinement of functional analysis experiments