Biography and vulnerability: Loss, dying and death in the Romantic paintings of JMW Turner (1775-1851)

Copyright@ 2005 Edward Arnold (Publishers) Ltd.Narratives of suffering and vulnerability are an important theme in western art, the humanities and the social sciences. It is argued here that J.M.W. Turner's pictures, like those of many artists, are biographical tales. The central tenet of Turner's romantic art is the arousal of sensation and Turner's pictures include wonderfully evocative `visual poems' on the human experiences of loss, decline, `the fallacies of hope', grief and death. This paper first explores the connections between Turner's biography and his art through a discussion of several of Turner's key paintings. It then moves on to a more in-depth discussion of two pictures painted by Turner in 1842, when he was 67 years old: Peace — Burial at Sea, and War — The Exile and the Rock Limpet. These paintings can be seen as insightful biographical narratives on the embodiment of vulnerability. In conclusion, it is suggested that Turner's paintings of loss and death are valuable exemplars of the capacity of art to meld together biography, narrative, vulnerability, suffering and embodiment

Neuroscientists’ everyday experiences of ethics: The interplay of regulatory, professional, personal and tangible ethical spheres

Copyright @ 2013 The Authors. This article has been published using OnlineOpen. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonline library.com/onlineopen#OnlineOpen_Terms.The ethical issues neuroscience raises are subject to increasing attention, exemplified in the emergence of the discipline neuroethics. While the moral implications of neurotechnological developments are often discussed, less is known about how ethics intersects with everyday work in neuroscience and how scientists themselves perceive the ethics of their research. Drawing on observation and interviews with members of one UK group conducting neuroscience research at both the laboratory bench and in the clinic, this article examines what ethics meant to these researchers and delineates four specific types of ethics that shaped their day-to-day work: regulatory, professional, personal and tangible. While the first three categories are similar to those identified elsewhere in sociological work on scientific and clinical ethics, the notion of ‘tangible ethics’ emerged by attending to everyday practice, in which these scientists’ discursive distinctions between right and wrong were sometimes challenged. The findings shed light on how ethical positions produce and are, in turn, produced by scientific practice. Informing sociological understandings of neuroscience, they also throw the category of neuroscience and its ethical specificity into question, given that members of this group did not experience their work as raising issues that were distinctly neuro-ethical.Wellcome Trus

Pharmacokinetics and efficacy of oral versus intravenous mixed-micellar phylloquinone (vitamin K-1) in severe acute liver disease

Background/Aims: In patients with severe acute liver dysfunction, i.v. phylloquinone (vitamin K-1) may be given to exclude vitamin K deficiency, rather than impaired hepatic synthesis of coagulation factors alone, as the cause of the coagulopathy. However, there have been no studies of the pharmacokinetics or efficacy of i.v. or oral K-1 in such patients.Methods: 49 adults with severe acute liver disease were randomised double-blind to a single 10 mg dose of i.v. or oral mixed-micellar K-1, or placebo. Serum levels of phylloquinone and undercarboxylated prothrombin (PIVKA-II) were assessed before and after treatment.Results: At admission, 13 patients (27 %) had either low serum K-1 levels or elevated PIVKA-II concentrations, indicative of subclinical vitamin K deficiency. In the 16 patients who received i.v. K-1, there was one (6 %) treatment failure (K-1 rise < 10 ng/ml above baseline), compared with 12 of the 15 (80 %) who received oral K, (P < 0.0001). One patient in the placebo group developed overt vitamin K deficiency.Conclusions: A minority of patients with severe acute liver dysfunction have subclinical vitamin K deficiency at the time of presentation, which is corrected by a single dose of i.v. K-1. The intestinal absorption of mixed-micellar K, is unreliable in adults with severe acute liver dysfunction. (c) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

Using card sorting technique to classify requirements change

Requirements Volatility is considered to be a major source of risk to the management of large and complex software projects. The ability to characterise the nature and origins of requirements change during software development is important and can lead organisations towards more effective management of changing requirements. This paper focuses on a study to establish how practitioners classify requirements change requests. We used the Card Sorting method to identify categories of change requests that software developers use in practice. Card sorting is a knowledge elicitation method that is commonly used for capturing information about different ways of representing domain knowledge. This study has allowed us to get valuable insights into the way practitioners classify change requests and to understand their perspectives on classification. This classification is a valuable source of information in prioritizing change requests and assessing their impact. Our findings from the card sorting exercise further reveal that the criteria used for categorization are related to the role the practitioner plays in the software development team and the nature and extent of their responsibilities. © 2004 IEEE

Development and validation of an instrument to assess and improve clinical consultation skills

Context: Development of medical students’ consultation skills with patients is at the core of the UK General Medical Council’s 'Tomorrow’s Doctors' guide (2009). Teaching and assessment of these skills must therefore be a core component of the medical undergraduate curriculum. The Calgary Cambridge guide to the medical interview and the Leicester Assessment Package (LAP) provide a foundation for teaching and assessment, but both have different strengths. Objective: To develop and validate a comprehensive set of generic consultation competencies. Design: The Calgary Cambridge guide to the medical interview was revised to include ‘clinical reasoning’, ‘management’, ‘record keeping’ and ‘case presentation’. Each section was populated with competencies generated from Tomorrow’s Doctors (2009), the LAP and the Calgary Cambridge guide to the medical interview. A Delphi validation study was conducted with a panel drawn from hospital and general practice clinical tutors from eight UK medical schools. Main outcome measures: A priori consensus standards for inclusion (or exclusion) of an element were: at Stage 1 =70% agreement (or disagreement) that the item should be included; at Stage 2 =50% agreement (or disagreement) that the item should be included. If more than 10% of respondents suggested a thematically similar new item (or rewording of an existing item) in Stage 1, it was included in Stage 2. Results: The design stage resulted in a set of 9 categories of consultation skills with 58 component competencies. In the Delphi study all the competencies reached 70% agreement for inclusion, with 24 suggested amendments, all of which achieved consensus for inclusion at Stage 2. Conclusion: We have developed a Generic Consultation Skills assessment framework (GeCoS) through a rigorous initial development and piloting process and a multi-institutional and multi-speciality Delphi process. GeCoS is now ready for use as a tool for teaching, formative and summative assessment in any simulated or workplace environment in the hospital or community clinical setting

Self-reported throat symptoms in Ehlers–Danlos syndromes and hypermobility spectrum disorders: A cross-sectional survey study

Objectives: This study identified the frequency and severity of dysphagia, dysphonia, and laryngopharyngeal reflux symptoms in people with Ehlers–Danlos syndromes (EDS) or hypermobility spectrum disorders (HSD) and explored differences between diagnostic groups. Methods: Participants were recruited via non-probability convenience sampling. Information was gathered via online survey, including the Reflux Symptom Index (RSI; Belafsky et al., J Voice. 2002;16:274–277), the Eating and Drinking Assessment Tool (EAT-10; Belafsky et al., Ann Otol Rhinol Laryngol. 2008;117:919–924), and the Voice Handicap Index (VHI; Jacobson et al., Am J Speech Lang Pathol. 1997;6(3):66–70). These were analyzed using ANOVAs. Results: There were 1620 participants (96.6% female, 2.8% male) that met the inclusion criteria. The mean age was 38.09 (SD 12.22). 75.51% had hypermobile EDS (hEDS), 17.83% had HSD and 3.33% had classic EDS (cED). The cohort's mean scores were RSI = 22.95 (SD 9.01), EAT-10 = 11.91 (SD 9.66), and VHI score = 31.99 (SD 24.36). The hEDS group had significantly higher mean scores than the HSD group on RSI score and on some RSI items, on EAT-10 score and on all EAT-10 items, and on one VHI item. Conclusion: People with EDS/HSD experience symptoms of acid reflux, dysphagia, and dysphonia to varying degrees with significant differences between hEDS than HSD. Awareness of the impact of EDS/HSD on throat symptoms will enable health care professionals to anticipate throat symptoms more readily in this population, providing individualized and effective management plans. Level of Evidence: IV

Invariant, super and quasi-martingale functions of a Markov process

We identify the linear space spanned by the real-valued excessive functions of a Markov process with the set of those functions which are quasimartingales when we compose them with the process. Applications to semi-Dirichlet forms are given. We provide a unifying result which clarifies the relations between harmonic, co-harmonic, invariant, co-invariant, martingale and co-martingale functions, showing that in the conservative case they are all the same. Finally, using the co-excessive functions, we present a two-step approach to the existence of invariant probability measures

A preliminary audit of medical and aid provision in English Rugby union clubs:compliance with Regulation 9

BackgroundGoverning bodies are largely responsible for the monitoring and management of risks associated with a safe playing environment, yet adherence to regulations is currently unknown. The aim of this study was to investigate and evaluate the current status of medical personnel, facilities, and equipment in Rugby Union clubs at regional level in England.MethodsA nationwide cross-sectional survey of 242 registered clubs was undertaken, where clubs were surveyed online on their current medical personnel, facilities, and equipment provision, according to regulation 9 of the Rugby Football Union (RFU).ResultsOverall, 91 (45. 04%) surveys were returned from the successfully contacted recipients. Of the completed responses, only 23.61% (n = 17) were found to be compliant with regulations. Furthermore, 30.56% (n = 22) of clubs were unsure if their medical personnel had required qualifications; thus, compliance could not be determined. There was a significant correlation (p = −0.029, r = 0.295) between club level and numbers of practitioners. There was no significant correlation indicated between the number of practitioners/number of teams and number of practitioners/number of players. There were significant correlations found between club level and equipment score (p = 0.003, r = −0.410), club level and automated external defibrillator (AED) access (p = 0.002, r = −0.352) and practitioner level and AED access (p = 0.0001, r = 0.404). Follow-up, thematic analysis highlighted widespread club concern around funding/cost, awareness, availability of practitioners and AED training.ConclusionThe proportion of clubs not adhering overall compliance with Regulation 9 of the RFU is concerning for player welfare, and an overhaul, nationally, is required

Cdc7 is a potent anti-cancer target in pancreatic cancer due to abrogation of the DNA origin activation checkpoint.

PURPOSE: Cdc7 is a serine/threonine kinase which is responsible for the 'firing' of replication origins leading to initiation of DNA replication. Inhibition or depletion of Cdc7 in normal cells triggers a DNA origin activation checkpoint causing a reversible G1 arrest. Here we investigate Cdc7 as a novel therapeutic target in pancreatic cancer. EXPERIMENTAL DESIGN: Cdc7 target validation was performed by immunoexpression profiling in a cohort of 73 patients with pancreatic adenocarcinoma including 24 controls. Secondly Cdc7 kinase was targeted in Capan-1 and PANC-1 pancreatic cancer cell line models using either an siRNA against Cdc7 or alternatively a small molecule inhibitor (SMI) of Cdc7 (PHA-767491). RESULTS: Cdc7 was significantly overexpressed in pancreatic adenocarcinoma compared to benign pancreatic tissue (median LI 34.3% vs. 1.3%; P<0.0001). Cdc7 knockdown using siRNA in Capan-1 and PANC-1 cells resulted in marked apoptotic cell death when compared with control cells. A prominent sub-G1 peak was seen on flow cytometry (sub-G1 51% vs. 3% and 45% vs. 0.7% in Capan-1 and PANC-1 cells, respectively). Annexin V labelling confirmed apoptosis in 64% vs. 11% and 75% vs. 8%, respectively. Western blotting showed cleavage of PARP-1 and caspase-3 and presence of γH2A.X. TUNEL assay showed strong staining in treated cells. These results were mirrored following Cdc7 kinase inhibition with PHA-767491. CONCLUSIONS: Our findings show that Cdc7 is a potent anti-cancer target in pancreatic adenocarcinoma and that Cdc7 immunoexpression levels might be used as a companion diagnostic to predict response to therapeutic siRNAs or SMIs directed against this kinase

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT) -based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n=7) or to the SDT-based intervention (n=6). Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833