Considering Vietnam

The Vietnam War is evolving from contemporary memory into history. Fifty years on, it still serves as a benchmark in the history of war reporting and in the representation of conflict in popular culture and historical memory. This conference seeks to explore the legacy of the US involvement in South East Asia and the resonances it still has for the coverage of contemporary warfare. In particular, the conference will reassess the role of the media in covering the war and the implications this has had for the coverage of subsequent conflicts, the impact of the war on popular culture, the ways that wars and their aftermaths are experienced on the ‘home front,’ and issues around memorialisation and memory, particularly in museum culture. The conference will bring together practitioners, academics and curators in an interdisciplinary engagement with this complex but important issue

A commentary on recent water safety initiatives in the context of water utility risk management.

Over the last decade, suppliers of drinking water have recognised the limitations of relying solely on end-product monitoring to ensure safe water quality and have sought to reinforce their approach by adopting preventative strategies where risks are proactively identified, assessed and managed. This is leading to the development of water safety plans; structured ‘route maps’ for managing risks to water supply, from catchment to consumer taps. This paper reviews the Hazard Analysis and Critical Control Point (HACCP) procedure on which many water safety plans are based and considers its appropriateness in the context of drinking water risk management. We examine water safety plans in a broad context, looking at a variety of monitoring, optimisation and risk management initiatives that can be taken to improve drinking water safety. These are cross-compared using a simple framework that facilitates an integrated approach to water safety. Finally, we look at how risk management practices are being integrated across water companies and how this is likely to affect the future development of water safety p

The impact of regulation, ownership and business culture on managing corporate risk within the water industry

Although the specifics of water utility ownership, regulation and management culture have been explored in terms of their impact on economic and customer value, there has been little meaningful engagement with their influence on the risk environment and risk management. Using a literature review as the primary source of information, this paper maps the existing knowledge base onto two critical questions: what are the particular features of regulation, ownership and management culture which influence the risk dynamic, and what are the implications of these relationships in the context of ambitions for resilient organizations? In addressing these queries, the paper considers the mindful choices and adjustments a utility must make to its risk management strategy to manage strategic tensions between efficiency, risk and resilience. The conclusions note a gap in understanding of the drivers required for a paradigm shift within the water sector from a re-active to a pro-active risk management culture. A proposed model of the tensions between reactive risk management and pro-active, adaptive risk management provides a compelling case for measured risk management approaches which are informed by an appreciation of regulation, ownership and business culture. Such approaches will support water authorities in meeting corporate aspirations to become "high reliability" services while retaining the capacity to out-perform financial and service level targets

MOBILE and the provision of total joint replacement

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research

Biochemical and clinical response after umbilical cord blood transplant in a boy with early childhood-onset beta-mannosidosis.

BACKGROUND: Deficiency in the enzyme β-mannosidase was described over three decades ago. Although rare in occurrence, the presentation of childhood-onset β-mannosidase deficiency consists of hypotonia in the newborn period followed by global development delay, behavior problems, and intellectual disability. No effective pharmacologic treatments have been available. METHODS: We report 2-year outcomes following the first umbilical cord blood transplant in a 4-year-old boy with early childhood-onset disease. RESULTS: We show restoration of leukocyte β-mannosidase activity which remained normal at 2 years posttransplant, and a simultaneous increase in plasma β-mannosidase activity and dramatic decrease in urine-free oligosaccharides were also observed. MRI of the brain remained stable. Neurocognitive evaluation revealed test point gains, although the magnitude of improvement was less than expected for age, causing lower IQ scores that represent a wider developmental gap between the patient and unaffected peers. CONCLUSION: Our findings suggest that hematopoietic cell transplant can correct the biochemical defect in β-mannosidosis, although preservation of the neurocognitive trajectory may be a challenge

Digital transcriptome profiling of normal and glioblastoma-derived neural stem cells identifies genes associated with patient survival.

BACKGROUND: Glioblastoma multiforme, the most common type of primary brain tumor in adults, is driven by cells with neural stem (NS) cell characteristics. Using derivation methods developed for NS cells, it is possible to expand tumorigenic stem cells continuously in vitro. Although these glioblastoma-derived neural stem (GNS) cells are highly similar to normal NS cells, they harbor mutations typical of gliomas and initiate authentic tumors following orthotopic xenotransplantation. Here, we analyzed GNS and NS cell transcriptomes to identify gene expression alterations underlying the disease phenotype. METHODS: Sensitive measurements of gene expression were obtained by high-throughput sequencing of transcript tags (Tag-seq) on adherent GNS cell lines from three glioblastoma cases and two normal NS cell lines. Validation by quantitative real-time PCR was performed on 82 differentially expressed genes across a panel of 16 GNS and 6 NS cell lines. The molecular basis and prognostic relevance of expression differences were investigated by genetic characterization of GNS cells and comparison with public data for 867 glioma biopsies. RESULTS: Transcriptome analysis revealed major differences correlated with glioma histological grade, and identified misregulated genes of known significance in glioblastoma as well as novel candidates, including genes associated with other malignancies or glioma-related pathways. This analysis further detected several long non-coding RNAs with expression profiles similar to neighboring genes implicated in cancer. Quantitative PCR validation showed excellent agreement with Tag-seq data (median Pearson r = 0.91) and discerned a gene set robustly distinguishing GNS from NS cells across the 22 lines. These expression alterations include oncogene and tumor suppressor changes not detected by microarray profiling of tumor tissue samples, and facilitated the identification of a GNS expression signature strongly associated with patient survival (P = 1e-6, Cox model). CONCLUSIONS: These results support the utility of GNS cell cultures as a model system for studying the molecular processes driving glioblastoma and the use of NS cells as reference controls. The association between a GNS expression signature and survival is consistent with the hypothesis that a cancer stem cell component drives tumor growth. We anticipate that analysis of normal and malignant stem cells will be an important complement to large-scale profiling of primary tumors.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Banking on exclusion:Data disclosure and geographies of UK personal lending markets

In 2013, the UK Government announced that seven of the nation’s largest banks had agreed to publish their lending data at the local level across Great Britain. The release of such area based lending data has been welcomed by advocacy groups and policy makers keen to better understand and remedy geographies of financial exclusion. This paper makes three contributions to debates about financial exclusion. First, it provides the first exploratory spatial analysis of the personal lending data made available; it scrutinises the parameters and robustness of the dataset and evaluates the extent to which the data increase transparency in UK personal lending markets. Second, it uses the data to provide a geographical overview of patterns of personal lending across Great Britain. Third, it uses this analysis to revisit the analytical and political limitations of ‘open data’ in addressing the relationship between access to finance and economic marginalisation. Although a binary policy imaginary of ‘inclusion-exclusion’ has historically driven advocacy for data disclosure, recent literatures on financial exclusion generate the need for more complex and variegated understandings of economic marginalisation. The paper questions the relationship between transparency and data disclosure, the policy push for financial inclusion, and patterns of indebtedness and economic marginalisation in a world where ‘fringe finance’ has become mainstream. Drawing on these literatures, this analysis suggests that data disclosure, and the transparency it affords, is a necessary but not sufficient tool in understanding the distributional implications of variegated access to credit

The asteroseismic ground-based observational counterpart of CoRoT

We present different aspects of the ground-based observational counterpart of the CoRoT satellite mission. We give an overview of the selected asteroseismic targets, the numerous instruments and observatories involved, and the first scientific results.Comment: 3 pages, 2 tables, 1 figure, to be published in the conference proceedings 'Stellar Pulsation: Challenges for Theory and Observation' (31 May - 5 June, Santa Fe, New Mexico, US), publishers: American Institute of Physic

The impact of patient participation direct enhanced service on patient reference groups in primary care: a qualitative study.

NHS policy documents continue to make a wide-ranging commitment to patient involvement. The Patient Participation Direct Enhanced Service (PP-DES), launched in 2011, aimed to ensure patients are involved in decisions about the range and quality of services provided and commissioned by their practice through patient reference groups (PRGs). The aim of this exploratory study is to review the impact of the PP-DES (2011-13) on a sample of PRGs and assess how far it has facilitated their involvement in decisions about the services of their general practices.The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR)

Is childhood obesity a child protection concern?

Background The question as to whether childhood obesity should be considered a child protection issue has divided commentators, with many questioning whether a child should be removed from parents who do not seek to reduce their child's weight, where significant obesity is identified. This divide is reflected in the social work profession where there is resistance to a role focused on bodily surveillance, whilst also acknowledging the need to investigate neglect where evidence exists of a clear parental failure to manage a child’s diet, health and fitness. Similar divisions exist in the medical profession and debates are taking place in Australia and the US but with little research to inform policy and practice. In the UK, practice varies with a consideration of obesity being incorporated in some multi-agency child protection procedures but with no mention in others and little research to explain variations. In the absence of evidence the most influential guidance remains a paper by Viner et al (2010), which concludes: • Childhood obesity alone is not a child protection issue • Failure to reduce overweight alone is not a child protection concern • Consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children • Obesity may be part of wider concerns about neglect or emotional abuse • Assessment should include systemic (family and environmental) factors It is this framework which is both widely quoted and incorporated into the child protection procedures of some local authorities but there appears to be no research which has tested its usefulness or applicability in practice. This research project was funded by NIHR CLAHRC YH and was conducted by staff from The Department of Social Work, Social Care and Community Studies and Centre for Health and Social Care Research at Sheffield Hallam University, Doncaster MBC, Rotherham MBC and School of Human and Health Sciences Huddersfield University. Ethical approval was provided by Sheffield Hallam University and research governance from Doncaster MBC. A project advisory group was set up from health and social care professionals which met virtually at the outset of the project, to guide the direction of the research, interviewing content and protocol, and to inform sampling. Aims and Objectives The research aimed to understand whether childhood obesity is a child protection concern and had three objectives: • To explore the current and past practice of staff working within child protection and obesity services regarding child protection and obesity • To explore staff perceptions of childhood obesity as a child protection issue using interview and focus group methods • To explore the use of the Viner et al (2010) framework for action to understand child protection concerns for children who are obese. Design and Methods The research project conducted semi-structured interviews (N23) and facilitated focus groups (N3, N24) involving key stake holders from social care, health and education services. The professional roles of participants ranged from professionals involved in early help and family support, through to investigation and middle and senior management. Doncaster Council (DC) supported the recruitment of participants, through dissemination of information leaflets, email contact and the provision of interview facilities. All of the interviews and focus groups were undertaken in Doncaster in South Yorkshire, however the research was by no means an evaluation of current or past practice within the authority and participants were able to reflect on their experiences across geographic areas and professional roles and responsibilities. Framework Analysis methods were used to generate categories, codes and themes that capture the experiences, views and perceptions of the participants. The research team took a collective approach to the analytical process in order to develop the thematic framework. Findings The framework comprised of seven key themes: Obesity: The short and long term impacts that obesity may have on a young person's physical and psychosocial health were acknowledged. Social factors relating to culture and poverty were also seen as contributing factors. Parental attitudes and perceptions were seen as playing a key role in recognising and responding to childhood obesity. The clinical nature of assessing and identifying obesity is complicated for non-health professionals. Thresholds: For child protection services to undertake work, requests need to meet a severity threshold for interventions to occur. Thresholds were nuanced and complex and could act as inhibitors to providing services. The threshold operated not only as a line that had to be crossed in order for a referral to be accepted by social services but also in respect of individual practitioner thresholds regarding personal views and values regarding obesity, different agency thresholds, referrals for different services within an agency and also between agencies. Child Protection: Respondents were divided as to whether child obesity was a child protection concern. For some the impact of obesity on long and short term outcomes for children made obesity unequivocally a child protection concern, yet for others excess weight itself was not sufficient. Where there was more common ground was in respect of the links between obesity and parental neglect. This could be in the form of associated factors such as failure to attend school or mental health issues but also for many respondents a failure on the part of families to engage with support plans and services offered. Those services were seen as a continuum of intervention levels from universal to statutory with child protection and legal interventions part of that continuum rather than a separate entity. A child protection approach could act as a catalyst for families to take up support as well as a gateway to more financially expensive and intensive support offers. Viner Framework: The Viner framework was developed as a means of understanding and working with child obesity as a child protection issue. Almost all participants had no awareness of the Viner framework. Overall the framework was welcomed as a useful tool, with the caveat that over reliance on a framework can lead to over simple assessment. The framework was not seen as overcoming problems inherent in measuring and identifying obesity, and not identifying the association of obesity with sexual abuse. Good Practice: Good practice was seen as beginning with a holistic understanding of obesity and its impact followed by a multi-agency approach including health, school and social care. Direct work with the whole family is given prominence in achieving change, both within and without a child protection context. Family involvement in the development and implementation of that work in a way that empowers but does not stigmatise was identified as a goal. Parental education was seen as important as part of a preventative approach and in sustaining change. Challenges for Practice: Challenges to practice included structural issues such as a lack of funding for preventative services and a scarcity of targeted services for disadvantaged groups. Psycho-social barriers to families accepting support were identified such as poverty impacting upon individual behaviour. Multi–agency working was a source of frustration with a lack of clarity regarding roles and responsibilities. Direct work with families was central but could be contentious. Challenges included the potential reinforcement of unhealthy eating patterns and the need to balance risk management with building trust and relationships in order to bring about change. Suggestions for Future: Suggestions included training on obesity and service availability, and providing a framework and procedures to guide practice. Evidence on short and long-term outcome measurements was identified as a deficit. More research and dissemination of findings on outcomes and what works regarding interventions is required. Conclusions This research has offered a unique insight into current multi-agency practice in respect of child obesity and child protection. Whether obesity alone can be a child protection concern is contested. Families who fail to recognise that child obesity is harmful to children and the failure of families to engage in support services was thought to potentially constitute neglect. When making judgements about child obesity and levels of harm, personal views about obesity and value judgements regarding parenting and children were as important, if not more so, than factual knowledge. These views come to the fore explicitly in threshold judgements and subsequent referral behaviour regarding identifying and acting on potential and actual significant harm. The services offered to and accepted by service users in respect of child obesity are both influenced by and a consequence of those threshold judgements. Training regarding the identification, assessment and implications of child obesity was required. Given an acknowledgement of a multidisciplinary approach to child obesity assessment and service delivery being most effective, multidisciplinary training could also be most useful. Many would welcome a framework and procedures to guide, but not dictate, practice where child obesity may constitute significant harm and become a child protection concern. Direct obesity focussed work with children and families is seen as key to bringing about change whether through universal services, family support or child protection statutory interventions. More research is required on the short and long-term effectiveness, outcomes and financial viability of those interventions to guide strategic and front line service delivery