An examination of the evidence for the existence of leprosy and Hansen's Disease in medieval Ireland

Much concerning the disease termed leprosy is accepted as received knowledge, without thought to time and place, but there were many differences in how leprosy sufferers were treated across regions and eras, and so diversity should be regarded as normal. This thesis will examine what was meant by the term leprosy during primarily the medieval period between the sixth and fifteenth centuries in Ireland in order to see if this equates with the disease called Hansen’s Disease in the twenty-first century. The focus will fall around the twelfth century, but as the majority of the extant documentary evidence is mainly from the early modern period, this will, out of necessity, also be discussed. There has been much written on what exactly leprosy was in the past and this thesis will not attempt to answer that question directly, instead its aim will be to contextualise the situation in medieval Ireland by examining the presence of leprosy in comparative terms in the Middle Ages. Leprosy in medieval Ireland is a much neglected area of research due to the perception that there is a lack of evidence. Although extant documentary sources may be less than elsewhere in medieval Europe, this thesis will show that there are plenty of other forms of proof available. Ciara Crawford’s unpublished thesis of 2010, which examined general illness, including leprosy in the Irish annals, is the only other research undertaken this millennium regarding leprosy in medieval Ireland, as all of the other limited research in connection with this subject was undertaken during the nineteenth and early twentieth centuries. This thesis employs all forms of extant evidence including, annals, documentary, hagiography, archaeology, paleopathology and place-names and using this multi-disciplinary approach provides confirmation of the presence of the disease, which was then termed leprosy, in medieval Ireland. This approach resulted in multiple methodological and terminology issues and this thesis will also attempt to address these in order to understand the extent and nature of leprosy in Ireland and its prevalence throughout the period under scrutiny. Employment of this multi-disciplinary approach has resulted in a surprising amount of Irish evidence concerning leprosy being gathered together for the first time. This approach enabled an image to emerge of how leprosy and its sufferers were treated and together with elsewhere, Ireland shows diverse outcomes. It must be taken into consideration however that the extant evidence is inconsistent and some geographical areas and time periods are better represented than others, resulting in an incomplete and uneven portrayal

Pressure Sores: An Investigation Into the Clinical Nursing Management of the Prevention and Management of Pressure Sores Within an Acute Hospital Trust

Pressure sores are a common problem throughout all health care settings. A number of risk assessment scales have been developed in an endeavour to help carers recognise the individuals most at risk of developing pressure sores, and to identify the factors which contribute to that risk in order to guide appropriate and individualised plans of care. Waterlow (1991) suggests that a care plan relating specifically to the prevention and management of pressure sores may be beneficial. However, no study has investigated if the results of risk assessment are used to plan patient care or if a pressure sore care plan is advantageous. This two-phase correlational study was conducted to identify whether there was an association between risk assessment, as defined by the Waterlow Risk Assessment Scale, severity of sore, as defined by the Stirling Pressure Sore Severity scale, and management of care. In addition, two care plan systems were compared to determine if a care plan specifically for the prevention and treatment of pressure sores facilitated the systematic management of patient care. The study was conducted in an acute hospital trust. Thirty Registered Nurses were interviewed using a structured interview schedule and 327 patient records were reviewed. A comparison was made between two different care plan systems in use. Data were analysed using chi-squared, Spearman's correlation co-efficient, and McNemar's test. Level of significance was set at p<0.05 The relationship between Waterlow score and mobilisation (chi2=3.2,df=4,p=0.530) was not significant. Significant relationships were detected between Waterlow score and pressure relief (chi2 =32.92,df=2,p<0.001), Waterlow score and education (chi2=6.04, df =2,p<0.05), Waterlow score and severity of sore (rs=0.46, p<0.001). Also between care plan type and pressure relief (chi2=38.3,df=2,p<0.01), care plan type and mobilisation (chi2=12.1,df=2,p<0.016) and between care plan type and education (chi2 40.8, df=2,p<0.01). The clinical significance of the results suggest that Waterlow Risk Assessment Scale is invalid when used in routine practice and that regardless of care plan type, individual risk factors are not being taken into account when planning patient care

Simulation–Optimization Modeling: A Survey and Potential Application in Reservoir Systems Operation

This paper presents a survey of simulation and optimization modeling approaches used in reservoir systems operation problems. Optimization methods have been proved of much importance when used with simulation modeling and the two approaches when combined give the best results. The main objective of this review article is to discuss simulation, optimization and combined simulation– optimization modeling approach and to provide an overview of their applications reported in literature. In addition to classical optimization techniques, application and scope of computational intelligence techniques, such as, evolutionary computa- tions, fuzzy set theory and artificial neural networks, in reservoir system operation studies are reviewed. Conclusions and suggestive remarks based on this survey are outlined, which could be helpful for future research and for system managers to decide appropriate methodology for application to their systems

Shiga Toxin–producing Escherichia coli Strains Negative for Locus of Enterocyte Effacement

The ehx plasmids of these strains are highly related, which suggests acquisition of the large plasmid was central to the strains’ emergence

Outcomes Associated With Early vs Late Initiation of Exclusive Enteral Feeding Regimens Following Laparoscopic Gastrostomy Tube Placement in the Pediatric Patient

ObjectivesDespite frequent placement of pediatric laparoscopic gastrostomy tubes (GTs), no rigorous evaluation of initial feeding and advancement regimens exists. Therefore, the aim of this study was to determine whether early enteral feeding after GT placement is associated with increased symptoms, procedural complications, or length of stay (LOS).MethodsIn this retrospective cohort study, the records of all patients at a tertiary care pediatric hospital who had gastrostomy placement were reviewed. Only patients fed exclusively via gastrostomy were included. Feeding was monitored starting with the first postoperative feed and subsequently in 24- hour increments. Adverse events were recorded based on clinical documentation.ResultsA total of 480 patients met inclusion criteria. Patients who started feeds between 24 and 36 hours had a shorter LOS compared with those who started at 36- 48 hours (P = .0072) or >48 hours (P < .0001). Patients requiring - ¥60 hours to reach goal feeds had significantly longer LOS than the other groups. There was no difference in the distribution of the LOS based on percentage of goal feeds initiated. Patients who required - ¥60 hours to attain goal feeds had the most feeding complications.ConclusionsMore aggressive feeding advancement and earlier initiation of feeds were associated with decreased LOS without an associated increase in adverse clinical events.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162797/2/ncp10503.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162797/1/ncp10503_am.pd

Chapter Plant Name Resources

Plant names are the key to communicating and managing information about plants. This paper considers how providers of high quality technical plant name information can better meet the requirements non-botanical audiences who also rely on plant names for elements of their work. The International Plant Name Index, World Checklist of Selected Plant Families and The Plant List are used as examples to illustrate the strengths and weaknesses of plant name resources from a non-expert user’s perspective. The above resources can be thought of as botanists pushing data at audiences. Without closer engagement with users, however, there is a limit to their relevance and impact. The need to cover common names is a frequent criticism of existing resources. The Medicinal Plant Names Services (MPNS, www.kew.org/mpns) is an example of how plant name resources can be adapted to better address the needs of a non-botanical audience. Some of the major challenges are outlined and solutions suggested

Cerebrovascular Variants and the Role of the Selfish Brain in Young-Onset Hypertension

Background: Variants in the posterior anatomy of the cerebral circulation are associated with hypertension and lower cerebral blood flow in midlife (age ≈55 years); however, whether these variants are a result of aging or long-term exposure to high blood pressure is unclear. Additionally, the role these variants play in early onset of hypertension (<40 years) and poor cerebral perfusion in this population is unknown. Methods: We retrospectively examined whether specific cerebrovascular variants (vertebral artery hypoplasia and absent/hypoplastic posterior communicating arteries (an incomplete posterior circle of Willis) measured via magnetic resonance angiography) were associated with a diagnosis of hypertension in 220 young adults (<40 years; n=164 primary hypertensive [mean age±SD, 32±6 years] and n=56 [30±6 years] normotensive adults). Whether cerebrovascular variants were associated with lower cerebral blood flow (phase-contrast angiography) was measured in the hypertensive group only (n=146). Results: Binary logistic regression (adjusted for age, sex, and body mass index) showed that vertebral artery hypoplasia with an incomplete posterior circle of Willis was associated with hypertension diagnosis (P<0.001, odds ratio; 11.79 [95% CI, 3.34–41.58]). Vertebral artery hypoplasia plus an incomplete circle of Willis was associated with lower cerebral blood flow in young adults with hypertension (P=0.0172). Conclusions: Vertebral artery hypoplasia plus an incomplete posterior circle of Willis independently predicts hypertension in young adults suggesting that this variant is not acquired with aging into midlife. Importantly this variant combination was associated with lower cerebral perfusion, which may have long-term consequences on cerebrovascular health in young adults with hypertension

Genetic Diversity and Virulence Potential of Shiga Toxin-Producing Escherichia coli O113:H21 Strains Isolated from Clinical, Environmental, and Food Sources

Shiga toxin-producing Escherichia coli strains of serotype O113:H21 have caused severe human diseases, but they are unusual in that they do not produce adherence factors coded by the locus of enterocyte effacement. Here, a PCR microarray was used to characterize 65 O113:H21 strains isolated from the environment, food, and clinical infections from various countries. in comparison to the pathogenic strains that were implicated in hemolytic-uremic syndrome in Australia, there were no clear differences between the pathogens and the environmental strains with respect to the 41 genetic markers tested. Furthermore, all of the strains carried only Shiga toxin subtypes associated with human infections, suggesting that the environmental strains have the potential to cause disease. Most of the O113:H21 strains were closely related and belonged in the same clonal group (ST-223), but CRISPR analysis showed a great degree of genetic diversity among the O113:H21 strains.French Joint Ministerial Program of R&D against CBRNE RisksFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Food & Drug Adm, Div Microbiol, College Pk, MD 20740 USAFrench Agcy Food Environm & Occupat Hlth & Safety, Lab Food Safety, Maisons Alfort, FranceFood & Drug Adm, Div Mol Biol, Laurel, MD USAUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, São Paulo, BrazilFed Inst Risk Assessment, Natl Reference Lab Escherichia coli, Berlin, GermanyInst Nacl Enfermedades Infecciosas ANLIS Dr Carlo, Serv Fisiopatogenia, Buenos Aires, DF, ArgentinaUniv Melbourne, Peter Doherty Inst Infect & Immun, Dept Microbiol & Immunol, Melbourne, Vic, AustraliaUniv Adelaide, Res Ctr Infect Dis, Sch Mol & Biomed Sci, Adelaide, SA, AustraliaUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, São Paulo, BrazilFrench Joint Ministerial Program of R&D against CBRNE Risks: C17609-2Web of Scienc