Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

BackgroundBEIT CURE International Hospital (BCIH) opened in 2002 providingorthopaedic surgical services to children in Malawi. This study reviews thehospital’s progress 10 years after establishment of operational services. Inaddition we assess the impact of the hospital’s Malawi national clubfootprogramme (MNCP) and influence on orthopaedic training.MethodsAll operative paediatric procedures performed by BCIH services in the10th operative year were included. Data on clubfoot clinic locations andnumber of patients treated were obtained from the MNCP. BCIH recordswere reviewed to identify the number of healthcare professionals whohave received training at the BCIH.Results609 new patients were operated on in the 10th year of hospital service.Patients were treated from all regions; however 60% came fromSouthern regions compared with the 48% in the 5th year. Clubfoot,burn contracture and angular lower limb deformities were the three mostcommon pathologies treated surgically. In total BCIH managed 9,842patients surgically over a 10-year period. BCIH helped to establish andco-ordinate the MNCP since 2007. At present the program has a totalof 29 clinics, which have treated 5748 patients. Furthermore, BCIH hasoverseen the full or partial training of 5 orthopaedic surgeons and 82orthopaedic clinical officers in Malawi.ConclusionThe BCIH has improved the care of paediatric patients in a country thatprior to its establishment had no dedicated paediatric orthopaedic service,treating almost 10,000 patients surgically and 6,000 patients in the MNCP.This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training  commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation

Genetic therapies for cystic fibrosis lung disease

Gene therapy for cystic fibrosis (CF) has been the subject ofintense research over the last twenty-five years or more, usingboth viral and liposomal delivery methods, but so far withoutthe emergence of a clinical therapy. New approaches to CFgene therapy involving recent improvements to vector systems,both viral and non-viral, as well as new nucleic acidtechnologies have led to renewed interest in the field. The fieldof therapeutic gene editing is rapidly developing with theemergence of CRISPR/Cas9 as well as chemically modifiedmRNA therapeutics. These new types of nucleic acid therapiesare also a good fit with delivery by non-viral deliveryapproaches which has led to a renewed interest in lipid-basedand other nanoformulation

Classical and quantum: a conflict of interest

We highlight three conflicts between quantum theory and classical general relativity, which make it implausible that a quantum theory of gravity can be arrived at by quantising classical gravity. These conflicts are: quantum nonlocality and space-time structure; the problem of time in quantum theory; and the quantum measurement problem. We explain how these three aspects bear on each other, and how they point towards an underlying noncommutative geometry of space-time.Comment: 15 pages. Published in `Gravity and the quantum' [Essays in honour of Thanu Padmanabhan on the occasion of his sixtieth birthday] Eds. Jasjeet Singh Bagla and Sunu Engineer (Springer, 2017

The Filter Detection Task for measurement of breathing-related interoception and metacognition

The study of the brain’s processing of sensory inputs from within the body (‘interoception’) has been gaining rapid popularity in neuroscience, where interoceptive disturbances are thought to exist across a wide range of chronic physiological and psychological conditions. Here we present a task and analysis procedure to quantify specific dimensions of breathing-related interoception, including interoceptive sensitivity, decision bias, metacognitive bias, and metacognitive performance. Two major developments address some of the challenges presented by low trial numbers in interoceptive experiments: (i) a novel adaptive algorithm to maintain task performance at 70–75% accuracy; (ii) an extended hierarchical metacognitive model to estimate regression parameters linking metacognitive performance to relevant (e.g. clinical) variables. We demonstrate the utility of the task and analysis developments, using both simulated data and three empirical datasets. This methodology represents an important step towards accurately quantifying interoceptive dimensions from a simple experimental procedure that is compatible with clinical settings

The Golden Ratio Prediction for the Solar Angle from a Natural Model with A5 Flavour Symmetry

We formulate a consistent model predicting, in the leading order approximation, maximal atmospheric mixing angle, vanishing reactor angle and tan {\theta}_12 = 1/{\phi} where {\phi} is the Golden Ratio. The model is based on the flavour symmetry A5 \times Z5 \times Z3, spontaneously broken by a set of flavon fields. By minimizing the scalar potential of the theory up to the next-to-leading order in the symmetry breaking parameter, we demonstrate that this mixing pattern is naturally achieved in a finite portion of the parameter space, through the vacuum alignment of the flavon fields. The leading order approximation is stable against higher-order corrections. We also compare our construction to other models based on discrete symmetry groups.Comment: 28 pages, 2 figures. Minor changes, references added. Corrected typos in Appendix A. Version appeared on JHE

Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

BACKGROUND: The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis. METHODS: A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4–6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made. RESULTS: After 4–6 weeks of treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention. CONCLUSIONS: The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol

Organising care, practice and participative research : Papers from the cognitive decline partnership centre

Non peer reviewe

Physical activity and fitness in women with metastatic breast cancer.

PURPOSE: This study aimed to explore differences in physical activity and fitness between women with metastatic breast cancer compared to healthy controls and factors associated with their physical activity levels. METHODS: Seventy-one women with metastatic breast cancer, aged (mean (SD)) 57.7 (9.5) and 2.9 (3.1) years after the onset of metastatic disease, and 71 healthy controls aged 55.0 (9.4) years participated. Of those with metastatic disease, 27% had bone-only metastases, 35% visceral-only metastases and 38% bone and visceral metastases. Patient-reported outcomes and physical measures of muscle strength and aerobic fitness assessments were obtained. Participants wore a SenseWear® physical activity monitor over 7 days, and the average steps/day and the time spent in moderate-to-vigorous intensity physical activity were determined. RESULTS: Women with metastases were significantly (i) less aerobically fit than the control group (25.3 (5.4) vs. 31.9 (6.1) mL • kg(-1) • min(-1); P < 0.001); (ii) weaker (e.g. lower limb strength for the metastatic and control groups was 53.5 (23.7) vs. 76.0 (27.4) kg, respectively; P < 0.001); (iii) less active, with the metastatic group attaining only 56% of the mean daily step counts of the healthy women; and (iv) more symptomatic, reporting higher levels of fatigue and dyspnoea (P < 0.001). CONCLUSION: Women living in the community with metastatic breast cancer possessed lower aerobic fitness, reduced muscular strength and less daily physical activity compared to healthy counterparts. They also experienced poorer functioning and higher symptom burden. IMPLICATIONS FOR CANCER SURVIVORS: Women living with metastatic breast cancer may benefit from a physical activity programme to address their physical impairments

Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research

The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines: (1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders; (2) language and framing of transgender health research should be non-stigmatizing; (3) research should be disseminated back to the community; (4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected; (5) informed consent must be meaningful, without coercion or undue influence; (6) the protection of participant confidentiality should be paramount; (7) alternative consent procedures should be considered for TGGD minors; (8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and (9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject