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This paper sets out the rationale and design for a more physiologically representative bladder / urethral model than the current rigid funnel industry standard.We suggest this flexible model can better serve as a basis for evaluating new catheters. We investigated the parameters and the validation tests required to construct and test with more flexible materials. The protocol includes static and impact force tests, while measuring internal retention balloon pressure. We have designed a flexible elastomer bladder floor and urethral model and tested it with a Foley balloon catheter. The tests showed that the model could hold the catheter with static loads up to 0.7 kg, but that the catheter was pulled out by impact forces from dropped weights.The Foley catheter design and its associated standards make no provision to mitigate urethral injury in the surprisingly common event of removal with a filled balloon. Our design is a more realistic model for testing retention and extraction characteristics of a urethral catheter. Validation tests have confirmed the feasibility of measuring urethral dilation and balloon pressure, both under traction and during progressive deflation. We suggest this model improves upon the current standard tests and will enable the design of safer catheters.

In Gate Theatre studies, the venue’s original artistic directors, Hilton Edwards and Micheál mac Liammóir, are commonly described as ‘Englishmen’. This chapter breaks new ground by exploring the Irish roots of Edwards and mac Liammóir, and the rumours that mac Liammóir had Spanish and Jewish ancestry. ‘The Boys’ were not the only figures associated with the early Gate to have transnational backgrounds. Coralie Carmichael, the theatre’s biggest female star in its early years, was of mixed Moroccan and Scottish ancestry, and Nancy Beckh, who worked as an actor, costume designer and milliner at the Gate between 1932 and 1956, was a Dubliner of half-German descent. Using critical theories around new interculturalism, the chapter suggests that the mixed backgrounds of these artists helped them to create intercultural performances. It further demonstrates that these performances cannot be simply dismissed as those of people condescendingly engaging in cultural imperialism or shallow cosmopolitanism.

BackgroundPeople carrying out clean intermittent self-catheterisation (CISC) to empty their bladder often suffer repeated urinary tract infections (UTIs). Continuous once-daily, low-dose antibiotic treatment (antibiotic prophylaxis) is commonly advised but knowledge of its effectiveness is lacking.ObjectiveTo assess the benefit, harms and cost-effectiveness of antibiotic prophylaxis to prevent UTIs in people who perform CISC.DesignParallel-group, open-label, patient-randomised 12-month trial of allocated intervention with 3-monthly follow-up. Outcome assessors were blind to allocation.SettingUK NHS, with recruitment of patients from 51 sites.ParticipantsFour hundred and four adults performing CISC and predicted to continue for ≥ 12 months who had suffered at least two UTIs in the previous year or had been hospitalised for a UTI in the previous year.InterventionsA central randomisation system using random block allocation set by an independent statistician allocated participants to the experimental group [once-daily oral antibiotic prophylaxis using either 50 mg of nitrofurantoin, 100 mg of trimethoprim (Kent Pharmaceuticals, Ashford, UK) or 250 mg of cefalexin (Sandoz Ltd, Holzkirchen, Germany);n = 203] or the control group of no prophylaxis (n = 201), both for 12 months.Main outcome measuresThe primary clinical outcome was relative frequency of symptomatic, antibiotic-treated UTI. Cost-effectiveness was assessed by cost per UTI avoided. The secondary measures were microbiologically proven UTI, antimicrobial resistance, health status and participants’ attitudes to antibiotic use.ResultsThe frequency of symptomatic antibiotic-treated UTI was reduced by 48% using prophylaxis [incidence rate ratio (IRR) 0.52, 95% confidence interval (CI) 0.44 to 0.61;n = 361]. Reduction in microbiologically proven UTI was similar (IRR 0.49, 95% CI 0.39 to 0.60;n = 361). Absolute reduction in UTI episodes over 12 months was from a median (interquartile range) of 2 (1–4) in the no-prophylaxis group (n = 180) to 1 (0–2) in the prophylaxis group (n = 181). The results were unchanged by adjustment for days at risk of UTI and the presence of factors giving higher risk of UTI. Development of antimicrobial resistance was seen more frequently in pathogens isolated from urine andEscherichia colifrom perianal swabs in participants allocated to antibiotic prophylaxis. The use of prophylaxis incurred an extra cost of £99 to prevent one UTI (not including costs related to increased antimicrobial resistance). The emotional and practical burden of CISC and UTI influenced well-being, but health status measured over 12 months was similar between groups and did not deteriorate significantly during UTI. Participants were generally unconcerned about using antibiotics, including the possible development of antimicrobial resistance.LimitationsLack of blinding may have led participants in each group to use different thresholds to trigger reporting and treatment-seeking for UTI.ConclusionsThe results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC. Antibiotic prophylaxis use appears safe for individuals over 12 months, but the emergence of resistant urinary pathogens may prejudice longer-term management of recurrent UTI and is a public health concern. Future work includes longer-term studies of antimicrobial resistance and studies of non-antibiotic preventative strategies.Trial registrationCurrent Controlled Trials ISRCTN67145101 and EudraCT 2013-002556-32.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology AssessmentVol. 22, No. 24. See the NIHR Journals Library website for further project information.

Aims: The microbiome is the term used for the symbiotic microbial colonisation of healthy organs. Studies have found bacterial identifiers within voided urine which is apparently sterile on conventional laboratory culture, and accordingly there may be health and disease implications. Methods: The International Consultation on Incontinence Research Society (ICI-RS) established a literature review and expert consensus discussion focussed on the increasing awareness of the urinary microbiome, and potential research priorities. Results: The consensus considered the discrepancy between findings of conventional clinical microbiology methods, which generally rely on culture parameters predisposed towards certain ‘‘expected’’ organisms. Discrepancy between selective culture and RNA sequencing to study speciesspecific 16S ribosomal RNA is increasingly clear, and highlights the possibility that protective or harmful bacteria may be overlooked where microbiological methods are selective. There are now strong signals of the existence of a ‘‘core’’ urinary microbiome for the human urinary tract, particularly emerging with ageing. The consensus reviewed the potential relationship between a patient’s microbiome and lower urinary tract dysfunction, whether low-count bacteriuria may be clinically significant and mechanisms which could associate micro-organisms with lower urinary tract symptoms. Conclusions: Key research priorities identified include the need to establish the scope of microbiome across the range of normality and clinical presentations, and gain consensus on testing protocols. Proteomics to study enzymatic and other functions may be necessary, since different bacteria may have overlapping phenotype. Longitudinal studies into risk factors for exposure, cumulative risk, and emergence of disease need to undertaken. Neurourol. Urodynam. 36:850–853, 2017.

This chapter shows that literacy in English could be utilized by the Methodist community in Ireland to create a countervailing religious and political discourse to that of their English brethren, allowing them to intervene in both political and religious issues. This discussion of literacy, denominational identity, and Irish Methodism provides a vivid example of the deep connections between religion and literacy outlined earlier in the volume. With the emergence of the ‘nonconformist conscience’ into British public life in the 1880s, Irish Methodists responded by developing their own denominational newspaper that articulated a peculiarly Irish Methodist view, distinct from that being promoted in England. The establishment of the weekly Christian Advocate in Belfast in 1884 marked the transfer of denominational influence from the wealth of Dublin to the popular heartlands in Ulster. Thus the establishment and distribution of an indigenous Irish Methodist journal drew together a geographically dispersed denomination and developed a distinctly Irish Methodist response to current affairs.

This paper reports an investigation into the educational experiences of six academically gifted pupils and their parents within one local authority. Phenomenological interviews and interpretative phenomenological analysis was used to gather and analyse the data. The literature review explores some of the debate regarding the definition and conceptualisation of giftedness. It also identifies some of the approaches being used both nationally and internationally in the education of gifted pupils. The findings indicated that most of the pupil participants perceived themselves to be strongly self-motivated and hard working. Although some schools were successfully meeting their needs, many of the pupil participants felt under-challenged and undervalued at school. Particular concerns were raised with regard to the first two years of secondary. The role of parents in providing early educational opportunities and stimulation was also highlighted. Many parents expressed concern that their children’s needs had not been adequately met. The paper highlights approaches which could be used. Suggested roles for educational psychologists are also highlighted. These include teacher training and supporting the transition of gifted pupils from primary to secondary.

Background Clean intermittent self-catheterisation is an important management option for people who cannot empty their bladder effectively. Recurrent urinary tract infections are common in these patients. Data from recent studies suggest that antibiotic prophylaxis may be beneficial in reducing infection risk, but the effectiveness of this intervention remains uncertain. Methods/design This is a 52-site, patient randomised superiority trial set in routine care comparing an experimental strategy of once daily antibiotic prophylaxis for 12 months against a control strategy of no prophylaxis in people who carry out self-catheterisation and suffer recurrent urinary tract infections. The primary outcome is number of urinary tract infections during a 12-month treatment period. Both groups will otherwise receive usual care including on demand treatment courses of antibiotics for urinary tract infection. Participants and their clinicians will not be blinded to the allocated intervention, but central trial staff managing and analysing trial data will, as far as possible, be unaware of participant allocation. The analysis will follow intention-to-treat principles. Discussion This trial was commissioned and funded by the United Kingdom National Health Service following prioritisation of the research question by the National Institute for Health and Care Excellence. Trial registration ISRCTN67145101 EUDRACT2013-002556-32. Registered on 25 October 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1389-y) contains supplementary material, which is available to authorized users.

The microbiome is the term used for the symbiotic microbial colonisation of healthy organs. Studies have found bacterial identifiers within voided urine which is apparently sterile on conventional laboratory culture, and accordingly there may be health and disease implications.The International Consultation on Incontinence Research Society (ICI-RS) established a literature review and expert consensus discussion focussed on the increasing awareness of the urinary microbiome, and potential research priorities.The consensus considered the discrepancy between findings of conventional clinical microbiology methods, which generally rely on culture parameters predisposed towards certain "expected" organisms. Discrepancy between selective culture and RNA sequencing to study species-specific 16S ribosomal RNA is increasingly clear, and highlights the possibility that protective or harmful bacteria may be overlooked where microbiological methods are selective. There are now strong signals of the existence of a "core" urinary microbiome for the human urinary tract, particularly emerging with ageing. The consensus reviewed the potential relationship between a patient's microbiome and lower urinary tract dysfunction, whether low-count bacteriuria may be clinically significant and mechanisms which could associate micro-organisms with lower urinary tract symptoms.Key research priorities identified include the need to establish the scope of microbiome across the range of normality and clinical presentations, and gain consensus on testing protocols. Proteomics to study enzymatic and other functions may be necessary, since different bacteria may have overlapping phenotype. Longitudinal studies into risk factors for exposure, cumulative risk, and emergence of disease need to undertaken. Neurourol. Urodynam. 36:850-853, 2017. © 2017 Wiley Periodicals, Inc.

Summary Objective To assess the quality of clinical care at first clinic attendance in children with suspected epilepsy from a defined geographical population. Method All hospital- and community-based consultant paediatricians in Nottingham City region, UK, were asked to collaborate with a retrospective clinical audit identifying children seen between January 2001 and March 2002. The British Paediatric Neurology Association (BPNA) audit tool (Appleton R, Besag F, Kennedy C, et al. An audit of children referred with suspected epilepsy. Seizure 1998; 7 (6):489–95) was used to analyse the initial outpatient assessment. Results All consultants agreed to participate. A total of 147 children were identified as meeting the inclusion criteria. The sequence of events during the episodes was well recorded (91%). Other aspects of the history were less well recorded. Twelve percent were given a diagnosis of epilepsy, 26% non-epileptic and 62% uncertain. Documentation of early development and school performance was low (41%). Twenty-four percent of the children had no written documentation confirming physical and neurological examination. Documentation describing referral to an epilepsy nurse or support group was seen in 11%. Drug treatment and doses and follow-up plans were recorded in nearly all cases where applicable. Discussion A managed clinical network for children with epilepsy in Nottingham and the surrounding Trent region is currently being discussed which will consider alternative models of care for children with epilepsy. A revision of the BPNA audit tool has been produced with the BPNA Audit group and is available for other centres via the BPNA website's ‘clinical toolbox' (http://www.bpna.org.uk/audit).

The return of Irish Home Rule to the realm of practical politics in 1912 after the passing of the Parliament Act the previous year stimulated a massive popular response across Ireland. In Ulster, the determination of Unionists to resist the imposition of Home Rule was epitomized by the signing of the Ulster Solemn League and Covenant on 28 September 1912. The images that flooded the press of Unionist leaders signing the covenant at Belfast City Hall and the huge crowds of Ulstermen queuing to pledge their support for the Unionist cause were, and have remained, some of the most iconic representations of Unionist resistance and have been consciously mimicked in more recent times, notably for the marking of the centenary.1 Alvin Jackson argues that the images taken from the dome of Belfast City Hall in 1985 of Unionists demonstrating against the Anglo-Irish Agreement consciously mimicked those of 1912. Political leaders were shown to be invoking the men of 1912 and that ‘Ian Paisley plays Carson to James Molyneaux’s Craig’.2 Similarly, the official images of the centenary commemorations were deliberately staged by the Loyal Orders to invoke the past, and indicate the unanimity of the Protestant people in support of the Union.3

Objectives To investigate the effect of a hydrogel coating on the dynamics of bacterial growth in laboratory models of the catheterized bladder. Infection of the urinary tract by Proteus mirabilis can result in catheter blockage by crystalline biofilm, a common complication in patients undergoing long-term bladder catheterization. Methods Two series of catheters were tested in the infected bladder models: test series 1, silicone catheters impregnated with triclosan (0.5%, 1%, 4%), or silicone catheters with 0% triclosan impregnated with pure solvents and hydrogel coated (based on polyvinylpyrrolidone); and test series 2, silicone catheters, hydrogel-coated with hydrogel plus iodine (polyvinylpyrrolidone plus iodine) or hydrogel plus polyhexamethylene biguanide. Test series 1 was used to detect the influence of triclosan, solvents, impregnation time, and the presence of hydrogel coating on the interval to catheter blockage by P. mirabilis biofilm. The experiments with test series 2 focused on the dynamic interaction of the hydrogel coating and biofilm formation. The division of the catheterized bladder model into 3 sampling zones brought more information about the spatial segregation of the bacterial population. Results The bacteriostatic efficiency of the water-soluble polyhexamethylene biguanide and polyvinylpyrrolidone iodine complex was limited to the first hours after catheterization. Only catheters containing triclosan resisted encrustation for significantly longer (up to >7 days). In contrast, the uncoated and hydrogel-coated catheters were occluded by day 2. Conclusions The hydrogel layer can increase aggregation of the planktonic cells and newly nucleated crystals, leading to even faster catheter blockage than in the case of uncoated silicone. However, the addition of active agents were able to suppress this negative effect.