Longitudinal impact of demographic and clinical variables on Health-Related Quality of Life in Cystic Fibrosis

Objectives: The insights that people with cystic fibrosis have concerning their health are important given that aspects of health-related quality of life (HRQoL) are independent predictors of survival and a decrease in lung function is associated with a decrease in HRQoL over time. Cross-sectional data suggest that key variables, other than lung function, are also associated with HRQoL - although study results are equivocal. This work evaluates the relationship between these key demographic and clinical variables and HRQoL longitudinally. Design: Longitudinal observational study. Observations were obtained at seven time points: approximately every two years over a twelve year period. Setting: Large Adult Cystic Fibrosis Centre in the UK. Participants: 234 participants aged 14-48 years at recruitment. Outcome measure: Nine domains of HRQoL (Cystic Fibrosis Quality of Life Questionnaire) in relation to demographic (age, gender) and clinical measures (FEV1% predicted, BMI, cystic fibrosis related diabetes, B. cepacia complex, totally implantable vascular access device, nutritional and transplant status). Results: A total of 770 patient assessments were obtained for 234 patients. The results of random coefficients modelling indicated that demographic and clinical variables were identified as being significant for HRQoL over time. In addition to lung function, transplant status, age, having a totally implantable vascular access device, cystic fibrosis related diabetes, BMI and B. cepacia complex impacted on many HRQoL domains longitudinally. Gender was important for the domain of Body image. Conclusion: Demographic and changes in clinical variables were independently associated with a change in health-related quality of life over time. Compared with these longitudinal data, cross-sectional data are inadequate when evaluating the relationships between HRQoL domains and key demographic and clinical variables, as they fail to recognise the full impact of the CF disease trajectory and its treatments on quality of life

Compassion in healthcare: a concept analysis

Background Compassion and compassionate care are central to radiographers’ professional policy and practice and are congruent with the core values of the National Health Service (NHS) Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term, compassion in healthcare. Method Walker and Avant’s Eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, Science Direct, Cochrane and DARE; dictionaries, social media, internet sources, books and doctoral theses. 296 resources were included in the review. Results The concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: Recognition, Connection, Altruistic desire, Humanistic response and Action. Conclusion The findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding; facilitating active engagement and implementation into practice

Stimulating the innovation potential of 'routine' workers through workplace learning

Governments worldwide seek to upgrade the ‘basic skills' of employees deemed to have low literacy and numeracy, in order to enable their greater productivity and participation in workplace practices. A longitudinal investigation of such interventions in the United Kingdom has examined the effects on employees and on organizations of engaging in basic skills programmes offered in and through the workplace. ‘Tracking’ of employees in selected organizational contexts has highlighted ways in which interplay between formal and informal workplace learning can help to create the environments for employees in lower grade jobs to use and expand their skills. This workplace learning is a precondition, a stimulus and an essential ingredient for participation in employee-driven innovation, as workers engage with others to vary, and eventually to change, work practices. © 2010, SAGE Publications. All rights reserved

Elliptic Curves over Real Quadratic Fields are Modular

We prove that all elliptic curves defined over real quadratic fields are modular.Comment: 38 pages. Magma scripts available as ancillary files with this arXiv versio

“It’s like my life but more, and better!” - Playing with the Cathaby Shark Girls: MMORPGs, young people and fantasy-based social play

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.Digital technology has opened up a range of new on-line leisure spaces for young people. Despite their popularity, on-line games and Massive Multiplayer Online Role Playing Games in particular are still a comparatively under-researched area in the fields of both Education and more broadly Youth Studies. Drawing on a Five year ethnographic study, this paper considers the ways that young people use the virtual spaces offered by MMORPGs. This paper suggests that MMORPGs represent significant arenas within which young people act out a range of social narratives through gaming. It argues that MMORPG have become important fantasy spaces which offer young people possibilities to engage in what were formally material practices. Although this form of play is grounded in the everyday it also extends material practices and offers new and unique forms of symbolic experimentation, thus I argue that game-play narratives cannot be divorced from the everyday lives of their participants

Radiation Reveal: Moving from research engagement to involvement.

Here, we report on the process of a highly impactful and successful creative, collaborative, and multi-partner public engagement project, Radiation Reveal. It brought together ten young adults aged 17-25-year-olds with experience of radiotherapy with researchers at Cancer Research UK RadNet City of London across three 2-hour online workshops. Our aims were to 1) initiate discussions between young adults and radiation researchers, and 2) identify what people wish they had known about radiotherapy before or during treatment. These aims were surpassed; other benefits included peer support, participants' continued involvement in subsequent engagement projects, lasting friendships, creation of support groups for others, and creation and national dissemination of top ten tips for medical professionals and social media resources. A key learning was that this project required a dedicated and (com)passionate person with connections to national cancer charities. When designing the project, constant feedback is also needed from charities and young adults with and without radiotherapy experience. Finally, visually capturing discussions and keeping the door open beyond workshops further enhanced impact. Here, we hope to inform and inspire people to help project the patient voice in all we do

The small-nucleolar RNAs commonly used for microRNA normalisation correlate with tumour pathology and prognosis

Background:To investigate small-nucleolar RNAs (snoRNAs) as reference genes when measuring miRNA expression in tumour samples, given emerging evidence for their role in cancer.Methods:Four snoRNAs, commonly used for normalisation, RNU44, RNU48, RNU43 and RNU6B, and miRNA known to be associated with pathological factors, were measured by real-time polymerase chain reaction in two patient series: 219 breast cancer and 46 head and neck squamous cell carcinoma (HNSCC). SnoRNA and miRNA were then correlated with clinicopathological features and prognosis.Results:Small-nucleolar RNA expression was as variable as miRNA expression (miR-21, miR-210, miR-10b). Normalising miRNA PCR expression data to these recommended snoRNAs introduced bias in associations between miRNA and pathology or outcome. Low snoRNA expression correlated with markers of aggressive pathology. Low levels of RNU44 were associated with a poor prognosis. RNU44 is an intronic gene in a cluster of highly conserved snoRNAs in the growth arrest specific 5 (GAS5) transcript, which is normally upregulated to arrest cell growth under stress. Low-tumour GAS5 expression was associated with a poor prognosis. RNU48 and RNU43 were also identified as intronic snoRNAs within genes that are dysregulated in cancer.Conclusion:Small-nucleolar RNAs are important in cancer prognosis, and their use as reference genes can introduce bias when determining miRNA expression. © 2011 Cancer Research UK All rights reserved

Hexamerization-enhanced CD20 antibody mediates complement-dependent cytotoxicity in serum genetically deficient in C9

We examined complement-dependent cytotoxicity (CDC) by hexamer formation-enhanced CD20 mAb Hx-7D8 of patient-derived chronic lymphocytic leukemia (CLL) cells that are relatively resistant to CDC. CDC was analyzed in normal human serum (NHS) and serum from an individual genetically deficient for C9. Hx-7D8 was able to kill up to 80% of CLL cells in complete absence of C9. We conclude that the narrow C5b-8 pores formed without C9 are sufficient for CDC due to efficient antibody-mediated hexamer formation. In the absence of C9, we observed transient intracellular increases of Ca2 + during CDC (as assessed with FLUO-4) that were extended in time. This suggests that small C5b-8 pores allow Ca2 + to enter the cell, while dissipation of the fluorescent signal accompanying cell disintegration is delayed. The Ca2 + signal is retained concomitantly with TOPRO-3 (viability dye) staining, thereby confirming that Ca2 + influx represents the most proximate mediator of cell death by CDC

Law and ethics: problematising the role of the foundation degree and paralegal education in English post-compulsory education

This article is based on research on a foundation degree programme in paralegal education in England. The content explores the pedagogical benefits of this academic programme with its work-related focus. The research has been completed with academic tutors and students who are associated with a foundation degree programme in paralegal education in the north of England. The researchers have adopted an ethnographic paradigm in their exploration of learning and teaching within this academic programme. The research is ‘field based’ as it is situated in a particular context and it has occurred over four years of investigation. The article advocates the development of a transformative learning ethos that is based on a sound philosophy of teaching and learning in order to support the development of understandings of ethics within a vocational foundation degree context. The originality of the article rests in the observation that paralegal education is ideally situated within a foundation degree structure due to its vocational emphasis and its philosophy of pedagogy. The combination of practical work experience on the foundation degree and a clear vision of pedagogy has led to the emergence of a vibrant curriculum within a post-compulsory educational context