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Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop feeding information to better support parents.
Materials and methods:
A search for existing material on six electronic databases and an internet search for unpublished (grey) literature on feeding information for infants with CHD were carried out. Following the development of feeding information, semi-structured interview(s) with parents/health-care professionals were completed, focusing on whether the information was easy to understand, relevant, provided sufficient information around feeding/feeding difficulties, and whether there were any information gaps. Iterative changes were made to the information following each interview. The process was completed until thematic saturation was achieved.
A total of 23 unique articles were identified of which 5 studies were included. From the grey literature, four web pages were reviewed. A total of 22 parents and 25 health-care professionals were interviewed. All parents/health-care professionals felt that the feeding information developed provided sufficient information; however, many wanted information on how to introduce complementary food, particularly if weaning was delayed.
This study describes the development of feeding information for infants with CHD. From parent interviews, gaps identified focused on the introduction of complementary foods and uncertainty regarding the feeding journey beyond surgery.
Filarial nematodes possess glutathione transferases (GSTs), ubiquitous enzymes with the potential to detoxify xenobiotic and endogenous substrates, and modulate the host immune system, which may aid worm infection establishment, maintenance and survival in the host. Here we have identified and characterized a σ class glycosylated GST (OoGST1), from the cattle-infective filarial nematode Onchocerca ochengi, which is homologous (99% amino acid identity) with an immunodominant GST and potential vaccine candidate from the human parasite, O. volvulus, (OvGST1b). Onchocerca ochengi native GSTs were purified using a two-step affinity chromatography approach, resolved by 2D and 1D SDS-PAGE and subjected to enzymic deglycosylation revealing the existence of at least four glycoforms. A combination of lectin-blotting and mass spectrometry (MS) analyses of the released N-glycans indicated that OoGST1 contained mainly oligomannose Man5GlcNAc2 structure, but also hybrid- and larger oligommanose-type glycans in a lower proportion. Furthermore, purified OoGST1 showed prostaglandin synthase activity as confirmed by Liquid Chromatography (LC)/MS following a coupled-enzyme assay. This is only the second reported and characterized glycosylated GST and our study highlights its potential role in host-parasite interactions and use in the study of human onchocerciasis.
Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
The northern New England region includes the states of Vermont, New Hampshire, and Maine and encompasses a large degree of climate and edaphic variation across a relatively small spatial area, making it ideal for studying climate change impacts on agricultural weed communities. We sampled weed seedbanks and measured soil physical and chemical characteristics on 77 organic farms across the region and analyzed the relationships between weed community parameters and select geographic, climatic, and edaphic variables using multivariate procedures. Temperature-related variables (latitude, longitude, mean maximum and minimum temperature) were the strongest and most consistent correlates with weed seedbank composition. Edaphic variables were, for the most part, relatively weaker and inconsistent correlates with weed seedbanks. Our analyses also indicate that a number of agriculturally important weed species are associated with specific U.S. Department of Agriculture plant hardiness zones, implying that future changes in climate factors that result in geographic shifts in these zones will likely be accompanied by changes in the composition of weed communities and therefore new management challenges for farmers.
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the Pooh
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
This study links two models, one that simulates changes in snow microstructure and one that recovers microstructure properties from measurements of snow reflectance. An energy and mass transfer model, SNTHERM.89, was used to calculate snow grain growth. Grain-sizes from the model and measurements of grain bond areas provided estimates of the surface-to-volume ratio of the bulk snow, which were transformed to geometrically-equivalent sphere sizes. An inversion technique based on a discrete-ordinate model of the directional reflectance recovered optically-equivalent sphere sizes from reflectance measurements at 1.075 μm. The predictions of equivalent sphere sizes from the snow model and the recovered optical sphere sizes from the inversion method were compared with stereological measurements from snow sections. The geometrically-equivalent and optically-equivalent grain-sizes showed good agreement with each other and with stereological measurements from snow a few days old. The predictions of the reflectance inversion method also compared favorably with geometrically-equivalent grain-sizes measured from a melt-freeze surface crust. This investigation showed the potential for fully coupling snow property simulations with models to predict the spectral reflectance of snow.
The haunted house is a common motif of Gothic texts. As Kim Newman observes, ‘The old dark house was the focus of the Gothic imagination well before the invention of the cinema’ (Newman 2013, 96). Anthony Vidler observes of the nineteenth-century Gothic that
The house provides an especially favored site for uncanny disturbances: its apparent domesticity, its residue of family history and nostalgia, its role as the last and most intimate shelter of private comfort sharpened by contrast the terror of invasion by alien spirits. (Vidler, 1992, 17)
Jack Morgan remarks: ‘In the gothic context, there tends to be much ado about […] real-estate matters, a reflection of the genre's notorious spatialization of fear’ (Morgan 2002, 179). Peter Hutchings refers to the horror genre more widely but notes the importance of the house for figuring issues to do with the past: ‘a recurrent feature of the horror genre is the house that contains secrets from the past, with the characters in these films often discovering that a familiar domestic setting is not so familiar after all’ (Hutchings 2004, 74). This chapter studies the use of haunted houses in contemporary Spanish films to consider the varied uses made of houses and the ghosts that haunt them. Following on from the discussion of the role of the past in the Gothic novel of the previous chapter, this chapter starts by considering the valuable conceptualisation of Spanish historical memory of the Civil War and Francoism in terms of hauntology (as hypothesised in Labanyi 2001). It also considers the problems and contradictions that nonetheless arise from it, not least the fact that Gothic horror tales deliberately evoke ghosts and other monsters so that the repressed anxieties which are called forth by ghosts may arise as much from the demands of genre as of history. The chapter concludes by considering the house as part of an unstable cultural flow of Gothic, underscoring the ironic lack of fixity of the house that prefigures parallel arguments for the lack of fixity of the Gothic body in Chapter 6.
Somewhat belatedly, Spanish cultural critique is beginning to catch up with the Gothic. Certainly there have been Gothic texts produced in Spain for at least the last two centuries while arguably earlier productions, such as the tale of Don Juan and its ghostly statue, prefigure the start of what we consider to be the Gothic in the eighteenth century. It is just that recognition of such texts as Gothic has occurred only recently. This state of affairs is not only the result of a process of catch-up as Hispanic Studies follows the paths of disciplines such as cultural studies, paths already well trodden by others. Abigail Lee Six, herself one of the few scholars writing on Spanish Gothic, observes that ‘Hispanic Studies has tended to be excessively isolationist in its approach to certain literary trends’ (Lee Six 2010, 11), and I fully concur with this. I would extend this criticism still further to argue that such isolationism can apply to wider cultural trends. This perhaps follows from Spain's history over the past two centuries, somewhat semi-detached from events elsewhere in Europe, such as the two World Wars, in conjunction with a tendency to read texts only in terms of national history. Genre, as a mode that crosses national borders or indeed takes no notice of them, is often neglected even though genre can prove a ready vehicle for bringing ideas into a national culture while also allowing that culture to contribute to the sum of the genre.
Nonetheless, in terms of the Gothic, such neglect in Hispanic Studies also arises from Gothic's overwhelming focus on British Gothic texts, with some space allowed for American texts as well. There are good reasons for this: the Gothic as we know it today is generally thought to have begun with Horace Walpole's The Castle of Otranto (1764), followed fairly swiftly by the works of Ann Radcliffe and then Matthew Lewis. Yet a consolidated scholarly interest in Gothic production from other nations and cultures and in other languages has recently come to fruition in the last decade or so, as has interest in Gothic cultural flow, defined as globalgothic by Glennis Byron (2013a) and Justin D. Edwards and Fred Botting (2013).
Examines Spain's contribution to international interest in Gothic culture, film and literature.With the success of novels such as The Shadow of the Wind and films like The Others, contemporary Spanish culture has contributed a great deal to the imagery and experience of the Gothic, although such contributions are not always recognised as being specifically Spanish in origin. Contemporary Spanish Gothic is the first book to study how the Gothic mode intersects with cultural production in Spain today, considering some of the ways in which such production feeds off and simultaneously feeds into Gothic production more widely. Examining the works of writers and filmmakers like Carlos Ruiz Zafón, Arturo Pérez-Reverte, Pedro Almodóvar and Alejandro Amenábar, as well as the further reaches of Spanish Gothic influence in the Twilight film series, the book considers images and themes like the mad surgeon and the vulnerable body, the role of the haunted house, and the heritage biopics of Francisco de Goya.
This chapter looks at the Gothic work of renowned Spanish cameraman Javier Aguirresarobe. Aguirresarobe is one of the leading directors of photography in Spanish cinema's contemporary era, having had a long career in Spain arising from the vanguard of Basque film-making in the 1980s. This included working with Imanol Uribe, the leading Basque director throughout the 1980s. In the 1990s he worked regularly with Pilar Miró, Spain's leading female director of the era, while, over the years, he has also worked with prominent Spanish directors such as Julio Medem, Pedro Almodóvar, Alejandro Amenábar, Víctor Erice and Fernando Trueba. From the turn of the century, he has also established an international reputation through working with Woody Allen, Miloš Forman, and James Ivory. Much of his current output emanates from Hollywood, and this includes involvement in Hollywood's highly successful and perhaps most notorious recent franchise, the Twilight series, based on the books by Stephenie Meyer. The cameraman's resumé demonstrates work across a wide variety of genres and is not by any means confined to horror and Gothic film-making; some of the most successful films he has worked on, however, come from this genre.
In the discussion here, I shall first focus on two examples of Aguirresarobe's explicitly Gothic landscapes that he created on Spanish soil: La madre muerta (The Dead Mother, Juanma Bajo Ulloa 1993) and The Others (Alejandro Amenábar 2001). I shall then discuss his more recent work in the United States and, specifically, his work on The Twilight Saga: New Moon (Chris Weitz 2009), the second instalment in the Twilight film saga, to look at the ways in which Aguirresarobe's work contributes to an idea of Gothic cultural exchange. The notion of a specifically Spanish contribution is from the outset undermined by Aguirresarobe's roots in the Basque Country and his contribution to the establishment of a specifically Basque cinema. This has occurred primarily through his work with Uribe, particularly on key films, such as El proceso de Burgos (The Burgos Trial, 1979), La fuga de Segovia (The Flight from Segovia, 1981) and La muerte de Mikel (The Death of Mikel, 1984), which remain landmarks in the development of a specifically Basque cinema after the end of the Franco dictatorship.