ANNUAL REPORT CHILD HEALTH AND WELFARE RESEARCH GROUP 1st January 2001 to 30th June 2002 Principal Investigators
Prof J Stuart Elborn : Professor of Respiratory Medicine, Queen's University Belfast and)
Prof Madeleine Ennis : Professor of Immunopharmacology, Queen's University Belfast
Prof Henry L Halliday : Consultant Neonatologist, Royal Maternity Hospital and Honorary
Dr Liam G Heaney : Senior Lecturer in Respiratory Medicine, Queen's University Belfast and
Prof Peter G Hepper : Professor of Psychology, Queen's University Belfast (email: )
Prof D Iwaniec : Professor of Social Work and Director of Centre for Child Care Research,Queen's University Belfast (email:
Prof James C McElnay : Professor of Pharmacy and Dean of Science, Queen's University
Dr Michael D Shields : Senior Lecturer in Child Health, Queen's University Belfast andConsultant Paediatrician, Royal Belfast Hospital for Sick Children
Dr Moira C Stewart : Senior Lecturer in Child Health, Queen's University Belfast andConsultant Paediatrician, Royal Belfast Hospital for Sick Children)
Prof David I Thurnham : Howard Professor of Human Nutrition, Northern Ireland Centre forDiet and Health, School of Biomedical Sciences, University of Ulster
The Child Health and Welfare Research Group was created under the auspices of the Research& Development Office in June 2000. The R & D Strategy Group selected 4 RecognisedResearch Groups (RRGs) from the first wave of proposals: Cancer, Child Health and Welfare,Endocrinology and Diabetes, and Epidemiology. The aim of the Child Health and WelfareRRG is to achieve a greater understanding of the factors, and their interaction, that influence thedevelopment, both normal and abnormal, of the individual from fetal life through infancy andchildhood into adult life. The RRGs main objectives are to:
• Perform research to elucidate mechanisms of development and disease of human biological
systems from fetal life through infancy and childhood into adult life
• Design, evaluate and study prevention and treatment programmes to alleviate disease
originating from events in early development and later childhood
• Undertake research designed to optimise the delivery, safety and efficacy of drugs used to
• Develop and maintain research expertise and skills relevant to research in this area and to
• Promote collaborative research in the area of fetal, neonatal and paediatric health, welfare
The RRG draws together expertise from 5 closely inter-related areas:
Six specific research programmes are being supported by HPSS R & D Fund as first waveprojects (detailed below). In addition the RRG has one R & D funded Fellowship and oneStudentship. Two Special Nursing Fellows and 2 Health and Social Care Fellows funded by R& D are attached to the RRG for mentoring. The RRG has 10 Principal Investigators (PIs),nine of whom are named in the first wave programmes listed below. We also have 56 associate
Specific Research Programmes Nutrition, air pollution and lung disease
Principal Investigators: Professor Madeleine Ennis, Professor J Stuart Elborn, Dr Michael DShields
Staff: Ms Jean Finnegan (R&D funded via RGHT), Research Nurse and Ms Vanessa Brown,Research Technician (R&D funded via QUB)
Summary and progress to date: The air that we breathe contains both oxygen, which is vital forlife, and pollutants which may cause worsening of lung diseases. The aim of this project is toinvestigate whether glass fronted fires are associated with higher levels of pollutants and
whether these pollutants are associated with worsening of respiratory symptoms. There isconsiderable public concern relating specifically to respiratory ill health caused byfumes/pollution from these heating systems. Our study will focus on individuals with anidentified respiratory complaint (asthma) living in houses heated by glass fronted fires. Thestudy will establish whether the "perceived" risk to health from smokeless solid fuel centralheating (glass fronted fires) is "real" in terms of elevated pollution levels in the home.
This project is not fully underway. The pollution monitoring equipment was not funded and wehave failed to secure funding after 2 grant applications to outside bodies (National AsthmaCampaign and Ulster Garden Villages). In order that the project can proceed, the PIs associatedwith it have agreed to provide soft funding to purchase one set of all the necessary equipment. The requests for quotations have been submitted and orders were placed at the end of June2002.
Currently the Research Nurse has recruited over 100 potential patients to enrol. She hasreceived training in spirometry and in the measurement of exhaled nitric oxide ENO). She iscurrently studying factors associated with differing concentrations of ENO in subjects withoutairways disease or atopy. The research technician has been managing the sample database forProgramme 3.3, as well as performing assays associated with that programme of work. Pathophysiology of childhood asthma
Principal Investigators: Dr Michael D Shields, Professor J Stuart Elborn, Professor MadeleineEnnis and Dr Liam G Heaney
Staff: Dr G Doherty, Research Fellow (PhD, funded by R&D via RGHT), Ms Francine deCourcey, Research Technician (funded by R&D via QUB)
Summary and progress to date: This programme involves taking samples of bronchoalveolarlavage fluid (BALF) and epithelial cells (EC) from bronchial brushings in children. Toovercome the ethical difficulties in obtaining paediatric samples for research, the childrenstudied will be undergoing elective surgical procedures. The aims of the studies are todetermine : 1. Whether BALF and EC from children with atopic asthma exhibit epithelialstress, aberrant epithelial signalling and increased matrix turnover compared to control childrenand 2. whether the secretory potential (cytokines, chemokines, growth factors) of bronchial ECfrom infants and young children following exposure to aeroallergens and respiratory viruses(before development of wheezing) differs in those who subsequently develop wheezing andthose who do not. Infants and children will be categorised by detailed respiratory and allergyquestionnaire into one of 5 groups : 1. non-wheezing, non-atopic, 2. non-wheezing, atopic, 3. viral associated wheezing, non-atopic, 4. atopic asthma, and 5. children who have 'outgrowntheir asthma'. Each will have samples of BALF, epithelial brushing and serum obtained afterintubation and prior to the surgical procedure. BALF will be analysed for cellular content,protein and cell activation status, markers of increased matrix turnover and antioxidant status. EC will be studied for their secretory potential. In addition, we will develop primary ECcultures to study reaction to exposure to viruses and aeroallergens. We are especiallyinterested in subjects (atopic or non-atopic) who have never previously wheezed. As many ofthem will subsequently develop wheezing we aim to determine whether the EC are pre-programmed to release abnormal amounts of cytokines, chemokines and growth factors. Theywill be reviewed yearly and assessed by maternal respiratory questionnaire. In addition,
children who have outgrown their asthma will be studied and followed by questionnaire todetermine if residual airways inflammation or airways remodelling persists. Furthermore, wewill investigate how markers of airways remodelling measured in BALF relate to histology. We will establish normal ranges for soluble factors and investigate their concentrations inpatients with different forms of asthma. These will be related to lung function, disease severity,and degree of airway remodelling on biopsy. Since biopsies cannot be taken from childrenusing our protocol, this study must be performed in adults.
We have recruited 66 children who have undergone BAL and cytology brush sampling ofbronchial epithelium. Simple biochemical and cellular analysis of BALF has been performedwith aliquots frozen for future analysis of markers of inflammation, cell signalling and airwaysremodelling. We have developed the protocol for culture of primary human bronchial EC toreliably expand cultures from bronchial brushings. Other techniques developed includefluorescent immunocytochemistry and a fluorescent assay of cell viability which we are usingto assess the susceptibility of airway epithelial cells to oxidant injury. Long-term outcome in relation to steroid use after birth in a population of very preterm children randomised to receive early or later systemic inhaled steroids in the neonatal period
Principal Investigator: Professor Henry L Halliday
Staff: Mr Trevor Wilson, Research Psychologist, (PhD, part funded by R&D and Action
Research via RGHT), Mrs Samantha Jameson, part-time Administrator (funded by R&Dand Action Research via QUB)
Summary and progress to date: This study aims to examine the outcome of 419 survivingchildren from the OSECT study (Pediatrics 2001; 107: 232-240) to see if corticosteroidsadministered after birth to prevent or treat neonatal chronic lung disease cause adverseneurodevelopmental outcomes. The original study showed that both inhaled and systemiccorticosteroids reduce the risks of chronic lung disease but at the same time increase theincidence of hyperglycaemia, hypertension, gastrointestinal problems and growth delay inbabies of average gestational age 27 weeks and birth weight 1000 grams. The study had afactorial design allowing 2 questions to be answered with the same sample size: 1. Isdexamethasone better than inhaled budesonide? and 2. Is early treatment (< 3 days) better thandelayed treatment (> 15 days)?
The follow-up study which has been jointly funded by the R&D Office and Action Researchwill have 2 main components. Two hundred and sixty eight of the surviving children liveoutside the UK and Ireland and they will be assessed by questionnaires completed by their localpaediatrician. This allows assessment of growth, health, development, medical history andexamination, blood pressure and disabilities. Of the 151 children in the UK and Ireland, 91 arein England and Wales and 60 are in Scotland, Northern Ireland and Ireland. Two part-timeresearch Psychologists, one in Belfast (Trevor Wilson) and one in Nottingham (LorraineWatters) are currently tracing and assessing these children. In addition to the questionnairecompleted by the local paediatrician the children undergo a number of psychometric tests(NEPSY, BAS II and behavioural scales) over a 2 hour period.
After one year 59 children have been traced (1 is now living in the USA) and have beencontacted by the Belfast-based psychologist. Twenty eight have been assessed andappointments have been arranged for 15; the Nottingham-based psychologist has assessed 64children and has made appointments for 10 children. In Belfast a group of non-treated siblingcontrol children is being recruited for assessment which will enhance the ability of this follow-up study to determine a link between postnatal corticosteroid treatment and adverse neuro-developmental outcomes including cerebral palsy. It should also be possible to determinedifferences in outcome between dexamethasone and budesonide treated infants and decide iftiming of administration is important. Examination of homeobox gene expression in lung and blood cells of preterm babies
Principal Investigator: Professor Henry L Halliday, Principal Collaborator: Professor Terry RJLappin
Staff: Dr David G Grier, Research Fellow (PhD, funded by R&D via RGHT)
Summary and progress to date: Homeobox genes regulate growth and development in theembryo and aberrations can lead to a number of congenital anomalies, most notably thoseinvolving the limbs. Human cells have 39 major homeobox genes on 4 separate chromosomes. Twenty two of the 39 homeobox genes are found in immature blood cells and it is planned tostudy their expression at different gestational ages and in diabetic pregnancies. Homeoboxgenes are also found in the developing lung but not in the adult lung unless cancer is present. Itis believed that homeobox gene expression in the lung affects maturation of the lung from botha morphological and a biochemical standpoint. It is planned to study homeobox geneexpression from lung cells obtained by bronchoalveolar lavage from both term and preterminfants. Corticosteroids, particularly betamethasone, have been used to enhance fetal lungmaturation in the human and their mode of action is uncertain. Maturation of the surfactantsystem of the lung and morphological changes in lung architecture occur after treatment withbetamethasone. We believe that homeobox gene expression will be altered by betamethasoneand will test this hypothesis in both in vitro and in vivo systems.
During the past year Dr David Grier, the Research Fellow, has attempted to obtain DNA fromlung cells obtained by bronchoalveolar lavage but to date this has not been possible. As a resulthe has assessed homeobox gene expression in a type II pneumocyte cell line A549 (derivedfrom a lung carcinoma) and shown that dexamethasone downregulates HOX B5 transiently butupregulates HOX A5 (Biol Neonate 2002; 81 (suppl 1): 31-32, abstract 6). Subsequentlymycoplasma infection of this cell line was discovered which could affect the results of furtherstudies. Dr Grier has also developed a murine model to study homeobox gene expression infetal lung at different gestations. To date he has performed 6-8 studies at each gestational agegroup and will analyse these results before proceeding to study the effects of prenatalbetamethasone. Habituation in the normal and abnormal fetus
Principal Investigator: Professor Peter Hepper
Summary and progress to date: The aim of this project is to examine the relationship of prenatalhabituation to postnatal health and development. Previous studies have suggested thathabituation has the potential to provide important information on fetal health and subsequentwell-being through the assessment of central nervous system (CNS) functioning. Habituation isthe decrement in response following repeated stimulation with the same stimulus. Althoughsimple, habituation is regarded as one of the most widespread forms of learning. Habituationmay be of great value in assessing fetal well-being for two main reasons: habituation has beenargued to involve the cerebral cortices and hence habituation performance reflects CNSfunctioning and integrity; habituation assesses neural processes that have importance for futurefunctioning, thus antenatal fetal habituation performance may have a predictive value for futurefunctioning. Examination of the habituation performance of individuals after birth with CNSdisorders has found it to be different from individuals without these conditions. These studiesdemonstrate that habituation is affected by alterations in CNS functioning. This suggests thathabituation provides information on the functioning of the CNS and thus, when applied to thefetus, may enable the assessment of its CNS and hence its well-being. This project willexamine: habituation in the fetus of low risk pregnancy; habituation in the fetus of high riskpregnancy; habituation in the abnormal fetus: the effect of the environment on fetal habituationperformance. The outcome of individuals after birth will be related to their prenatal habituationperformance to assess the predictive value of fetal habituation for subsequent neurobehaviouraldevelopment.
The research will begin shortly following the purchase of new equipment essential to theproject. 3.11 Risk Factors and protective mechanisms in failure to thrive in young children
Principal Investigators: Professor Dorota Iwaniec, Dr Moira Stewart, Professor DavidThurnham
Staff: Dr Helga Sneddon, Co-ordinator (funded by R&D via QUB). Dr Sarah Allen, Dr. ZeinabAbdelrahim, Ms Jill Fleck , Ms Lorraine McErlean (these staff will take up their appointmentsafter August 2002)
Summary and progress to date: Children who show persistent growth failure during the firstyear of life may be described as failing to thrive and, compared to their peers, they aresignificantly smaller and can be expected to have poorer outcomes. This project will investigatethe roles played by physical problems (such as oral/motor difficulties, vitamin A deficiency,Helicobactor pylori) and non-organic causes of failure to thrive (such as parental stress, patternsof interaction, quality of parenting), and their relationship with nutritional intake. Investigationof the potential mechanisms for failure to thrive from a multidisciplinary perspective will assistfuture diagnoses and the treatment of this client group.
The official start date for this project is 1 August 2002. To date research staff have beenappointed (they will take up their positions after August), ethical approval has been obtained,
testing facilities and office space have been negotiated at the Cupar Street Community Clinicand design work has continued. R&D Fellowship: The interaction between viral infection and the epithelium and childhood wheezing disorders
Principal Investigators: Dr Michael D Shields and Dr Liam G Heaney
Staff: Dr Sharon Christie, Research Fellow (MD, funded by R&D via QUB)
Summary and progress to date: The major environmental trigger for wheezing episodes inchildren appears to be viral infection, though not all children with lower respiratory tract viralinfection will wheeze, suggesting “susceptibility factors” in some children. Part of this“susceptibility” may relate to the airway inflammatory response generated by viral infection andlikely mediated by the epithelium (being the principal host cell of viruses). Studies in primarybronchial epithelial cell (PBEC) cultures in adults have shown that viral infection will produceepithelial damage and production of pro-inflammatory chemokines / cytokines (IL-8, RANTESand IL-6) (6,7). We propose that in “susceptible” children with VAW, viral infection mayresult in increased epithelial expression of pro-inflammatory cytokines / chemokines comparedto children who do not wheeze with resultant increased neutrophil recruitment and airwaydamage. Similarly, in children with chronic persistent asthma, viral infections will induce a Th2cytokine / chemokine response in a polarised epithelium with eosinophil recruitment andepithelial damage. Thus, in all forms of childhood wheezing, epithelial cell derived cytokines /chemokines, induced by viral infection, will drive the airway inflammatory response and relateto the clinical phenotype.
This study is cross-sectional in nature with data collected on children attending for electivesurgical procedures. Samples of bronchoalveolar lavage fluid and epithelial cells are obtainedand a detailed respiratory/allergy history and examination performed. Thus far, 52 children havebeen sampled by both BAL and nasal swabs using nested multiplex PCR for 11 respiratoryviruses. We have started to inoculate these primary bronchial epithelial cultures (PBECs) withadenovirus 5 and to quantify the response in terms of end point titration PCR and real timePCR. We have begun innoculation experiments with RSV on the PBECs. We also are nowalmost complete with regard to method development for measuring gene expression of IL-8, IL-6, TNF-α, GM-CSF, RANTES, GRO-α, GAPDH and sample analysis is imminent. R&D Studentship: Delivery of asthmatic drugs in paediatrics
Principal Investigators: Professor James McElnay, Dr Jeff Millership, Dr Paul Collier and DrMichael Shields.
Staff: Jennifer Bell (PhD, funded by R&D via QUB)
Summary and progress to date: This project began in May 2002. The overall aim of theresearch project is to optimise the dosage and routes of administration of inhaled drugs used inpaediatric patients. At present many of these agents are used at doses above those licensed andit is unclear as to the amount of drug that actually reaches the site of action in the lungs. Objectives of the research include the development of an in vitro paediatric lung model to
assess 1. drug delivery via spacer devices and nebulisers in spontaneously breathing childrenand 2. the administration of drugs via metered dose inhalers to children on different types ofmechanical ventilators. The performance of the in vitro model will be assessed by comparisonwith concentrations of drug achieved in the plasma and urine of children who are receivingrespiratory medications within the hospital setting. To date the PhD candidate has reviewed allpublished literature in the field, has made a study of the different devices (including ventilators)and is currently developing high pressure liquid chromatography methodology for the analysisof respiratory drugs both in buffer solutions (to be used in the in vitro model) and biologicalmatrices (plasma and urine). The project forms an integral part of the ongoing researchprogramme on improving the safety and efficacy of drugs used outside their license inpaediatric patients. Fellows and students associated with RRG, with source of funding Position
Dr Julian Leggett MD Student R&DMr Trevor Wilson
Research Psychologist-PhD R&D/Action Research
Fellows attached to RRG for mentoring
Mr Garrett O'Brien PhD Student R&DMr Mark Livingston PhD Student NICHSADr Alison Watt Post-doc Research Fellow NS R&DDr Julia Courtney MD Student NS R&DDr Sanjeev Kamath MD Student Own FundsDr Fionnuala Crummy MD StudentDr Stephen Farrell MD Student RBHSCDr Terry McManus MD Student MaterDr Neil Patterson MD StudentMs Joanne Smyth PhD Student School of Pharmacy
3. Publications since start of RRG (January 2001) Peer Reviewed Publications
Bedford-Russell AR, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL,Holland B, Davies EG. A trial of recombinant human granulocyte treatment for thetreatment of very low birthweight infants with presumed sepsis and neutropenia. ArchDis Child 2001; 84: F172-F176.
Bevilacqua G, Goelz R, Halliday HL. Guidelines on surfactant treatment. Prenat NeonatMed 2001; 6 (Suppl 1): 84-88.
Bevilacqua G, Goelz R, Halliday HL. Guidelines on surfactant treatment. Prenat NeonatMed 2001; 6: 374-378.
Bradley J, McAlister O, Elborn S. Pulmonary function, inflammation, exercise capacityand quality of life in cystic fibrosis. Eur Resp J 2001; 17: 712-715.
Brown V, Ennis M. Flow-cytometric analysis of basophil activation: inhibition byhistamine at conventional and homeopathic concentrations. Inflamm Res 2001; 50 (Suppl2): S47-S48.
Chopra M, Fitzsimons PE, Hopkins M, Thurnham DI. Dialysis and gel filtration ofisolated low density lipoproteins do not cause a significant loss of low density lipoproteintocopherol and carotenoid concentration. Lipids 2001; 36: 205-209.
Cooper KA, Adelekan DA, Esimai AO, Northrop-Clewes CA, Thurnham DI. Lack ofinfluence of red palm oil on severity of malaria infection in pre-school Nigerian children. Trans R Soc Trop Med Hyg 2002; 96: 216-223.
Crockard AD, Ennis M. Laboratory-based allergy diagnosis; should we go with the flow?Clin Exp Allergy 2001; 31: 957-957.
Crockard AD, Ennis M. Basophil histamine release tests in the diagnosis of allergy andasthma. Clin Exp Allergy 2001; 31: 345-350.
10. Curley AE, Halliday HL. The present status of exogenous surfactant for the newborn.
11. Curley AE, Halliday HL. Evidence-based practice: does it have a role in paediatrics?
12. De Soyza A, McDowell A, Archer L, Dark JH, Elborn SJ, Mahenthiralingam E, Gould K,
Corris PA. Burkholderia cepacia complex genomovars and pulmonary transplantationoutcomes in patients with cystic fibrosis. Lancet 2001; 358: 1780-1781.
13. Dillenburger K, Keenan M, Gallagher S, McElhinney M. Autism: intervention and
parental empowerment. Multidisp J Child Care Pract 2002 (In press).
14. Dunlop KA, Carson DJ, Shields MD. Hypoglycaemia due to adrenal suppression
secondary to high-dose nebulised corticosteroid.Pediatr Pulmonol2002 (In press).
15. Dunlop KA, Woodman D, Carson DJ. Hypopituitarism following cerebral oedema in
diabetic ketoacidosis. Arch Dis Child 2002 (In press).
16. Flanagan N, Macleod C, Jenkins MG, Wylie R. The child protection register - a tool in
the accident and emergency department. Emerg Med J 2002; 19: 229-230.
17. Garske L, Moore JE, Crowe MJ, Elborn JS. Cystic fibrosis and guidelines to assess
significance of new colonisers ? Ir J Med Sci 2002; 171: 116-117.
18. Gawley S, Cupples ME. Smoking in pregnancy- the size of our challenge. Ulster Med J
19. Gibson M, Iwaniec D. An empirical study into the psychosocial reactions of staff working
as helpers to those affected in the aftermath of two traumatic incidents. The findings fromthe Kegworth Air Crash and the Shankill Road bombing incidents – The implications forpolicy and practice in relation to training for those who have to cope with trauma in theirworkplace. Brit J Social Work (In press).
20. Grier DG, Halliday HL. Postnatal steroids in preterm neonates. Ital J Pediatr 2002; 28:
21. Halliday HL. Guidelines on neonatal steroids. Prenat Neonat Med 2001; 6: 371-373.
22. Halliday HL. Early postnatal dexamethasone and cerebral palsy. Pediatrics 2002; 109:
23. Halliday HL. The effect of postnatal steroids on growth and development. J Perinat Med
24. Halliday HL Postnatal steroids: a dilemma for the neonatologist. Acta Paediatr 2001; 90:
25. Halliday HL. Adverse effects of early dexamethasone treatment in extremely-low-birth-
weight infants. J Pediatr 2001; 139: 163-164.
26. Halliday HL. Benefits and side-effects of steroids in neonatal medicine. Prenat Neonat
27. Halliday HL. Guidelines on neonatal steroids. Prenat Neonat Med 2001; 6 (Suppl 1): 81-83.
28. Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in
vigorous, meconium-stained infants born at term. (Updated Cochrane Review). In: TheCochrane Library, Issue 1, 2001. Oxford : Update Software.
29. HallidayHL, Ehrenkranz RA. Early postnatal (<96 hours) corticosteroids for preventing
chronic lung disease in preterm infants. (Updated Cochrane Review). In : The CochraneLibrary, Issue 1, 2001. Oxford: Update Software.
30. Halliday HL, Ehrenkranz RA. Moderately early postnatal corticosteroids for preventing
chronic lung disease in preterm infants. (Updated Cochrane Review). In: The CochraneLibrary, Issue 1, 2001. Oxford: Update Software.
31. Halliday HL, Patterson CC, Halahakoon CWNL on behalf of the European Multicenter Steroid
Study Group. A multicenter randomized open study of early corticosteroid treatment (OSECT)in preterm babies with respiratory illness: comparison of early and late treatment and ofdexamethasone and inhaled budesonide. Pediatrics 2001; 107: 232-240.
32. Hare LG, Millership JS, Collier PS, McElnay JC, Carson DJ, Shields MD. The use of
polymeric solid phase extraction and HPLC analysis for the determination ranitidine inroutine plasma samples obtained from paediatric patients. J Pharm Pharmacol2001, 53:1265-1272.
Hunt O, Hepper P, Johnston C, Stevenson M, Burden D. Profession perceptions of thebenefits of orthodontic treatment. Eur J Orthod 2001; 23: 315-323.
Hunt O, Hepper P, Johnston C, Stevenson M, Burden D. The aesthetic component of theindex of orthodontic treatment need validated against lay opinion. Eur J Orthod 2002; 24:53-55.
Hunt O, Johnston C, Hepper P, Burden D, Stevenson M. The influence of maxillarygingival exposure on dental attractiveness rating. Eur J Orthod 2002; 24: 199-204.
Hunt OT, Johnston CD, Hepper PG, Burden DJ. The psychosocial impact of orthognathicsurgery: a systematic review. Am J Orthod Dentofacial Orthop 2002; 120: 490-497.
Iwaniec D. The long term follow-up of children who failed to thrive: messages forprofessionals representing children. Representing Children 2001; 13: 48-60.
38. Iwaniec D, Finzi R, Cohen O, Sapir Y, Weizman A. The drug-user husband and his wife:
attachment styles and family cohesion and adaptability. Substance Use and Misuse 2002(In press).
39. Iwaniec D, Sneddon H. The quality of parenting of individuals who had failed-to-thrive as
children. Brit J Social Work 2002; 32: 283-298.
40. Iwaniec D, Sneddon H. Attachment style in adults who failed to thrive as children:
outcomes of a 20 year follow up study of factors influencing maintenance or change inattachment style. Brit J Social Work 2001; 31: 179-195.
41. Jewell VC, Northrop-Clewes CA, Tubman R, Thurnham DI. Nutritional factors and
visual function in premature infants. Proc Nutr Soc 2001; 60: 171-178.
42. Kelly MG, McGarvey LP, Lawson JT, Elborn JS. Pseudodextrocardia in bronchiectasis.
43. Kelly MG, Elborn JS. Admissions with chronic obstructive pulmonary disease after
publication of national guidelines. Ir J Med Sci 2002; 171: 16-19.
44. Kelly MG, Brown V, Ennis M, Elborn JS. Comparing flow cytometry of sputum,
bronchoalveolar lavage, and peripheral blood cells in healthy individuals. Clin Immunol2001; 99: 100-101.
45. Little JF, Hepper PG, Dornan JC. Maternal alcohol consumption during pregnancy and
fetal startle behaviour. Physiol Behav 2002 (In press).
46. Macleod C. Child abuse; denial and the implications for partnership. Child Care Pract
47. Macleod C. Evaluating cardiac murmurs; are diagnostic tests helpful? Ir Med J 2001; 94:
48. Macleod C, McElroy G, O'Loan D, Kennedy F, Kerr RM, Jenkins JG, Lim J. Ambulatory
paediatrics- does it work? Ir Med J 2002; 95: 41-44.
49. Mayes C, Yarr J, Spence D, Tubman R, Halliday HL. Neonatal seizures-
management and outcome in a regional unit. Ir Med J 2002 (In press).
50. McCloskey M, McCaughan J, Redmond AO, Elborn JS. Clinical outcome after
acquisition of Burkholderia cepacia in patients with cystic fibrosis. Ir J Med Sci 2001;170: 28-31.
51. McCloskey M, Redmond AO, Pyper S, McCabe C, Westertrep KR, Elborn JS. Total
energy expenditure in stable patients with cystic fibrosis. Clin Nutr 2001; 20: 235-241.
52. McCormick J, Tubman R. Readmission with respiratory syncytial virus (RSV) infection
among graduates from a neonatal intensive care unit. Pediatr Pulmonol 2002; 34: 262-266.
53. McDowell A, Mahenthiralingam E, Moore JE, Dunbar KE, Webb AK, Dodd ME, Martin
SL, Millar BC, Scott CJ, Crowe M, Elborn JS. PCR-based detection and identification ofBurkholderia cepacia complex pathogens in sputum from cystic fibrosis patients. J ClinMicrobiol 2001; 39: 4247-4255.
54. McGovern MC, Glasgow JFT, Stewart MC. Reye's syndrome and aspirin! Lest we
forget. Brit Med J 2001; 322: 1591-1592.
55. McGrath LT, McCall D, Hanratty CG, Brennan S, Devine A, McCauley DF, Silke B,
Elborn S. Individuals with cystic fibrosis do not display impaired endothelial function orevidence of oxidative damage in endothelial cells exposed to serum. Clin Sci 2001; 101:507-513.
56. Millership JS, Hare LG, Farry M, Collier PS, McElnay JC, Shields MD, Carson DJ. The
use of hydrophilic lipophilic balanced (HLB) copolymer SPE cartridges for the extractionof diclofenac from small volume paediatric plasma samples. J Pharm Biomed Anal2001;25: 871-879.
57. Moore JE, Millar BC, Xu J, Crowe M, Redmond AO, Elborn JS. Misidentification of a
genomovar of Burkholderia cepacia by recA restriction fragment length polymorphism. JClin Pathol 2002; 55: 309-311.
58. Moore JE, Xu J, Millar BC, Crowe M, Elborn JS. Improved molecular detection of
Burkholderia sepacia genomovar III and Burkholderia multivorans directly from sputumof patients with cystic fibrosis. J Microbiol Methods 2002; 49: 183-191.
59. Moore JE, Heaney N, Millar BC, Crowe M, Elborn JS. Incidence of Pseudomonas
aeruginosa in recreational and hydrotherapy pools. Commun Dis Public Health 2002; 5:23-26.
60. Moore JE, Thompson I, Crowe M, Xu J, Shaw A, Millar BC, Redmond AO, Reid AJ,
Clarke C, Elborn JS. Burkholderia cepacia from a sink drain. J Hosp Infect 2002; 50:235-237.
61. Moore JE, Crowe M, Shaw A, McCaughan J, Redmond AO, Elborn JS. Antibiotic
resistance in Burkholderia cepacia at two regional cystic fibrosis centres in NorthernIreland: is there a need for synergy testing? J Antimicrob Chemother 2001; 48: 319-321.
62. Moore JE, McIlhatton B, Shaw A, Murphy PG, Elborn JS. Occurrence of Burkholderia
cepacia in foods and waters: clinical implications for patients with cystic fibrosis. J FoodProt 2001; 64: 1076-1078.
Moore JE, Shaw AB, Stanley T, Crowe MJ, Elborn JS. Long-term preservation of strainsof Burkholderia cepacia, Pseudomonas spp. And Stenotrophomonas maltophilia isolatedfrom patients with cystic fibrosis. Lett Appl Microbiol 2001; 33: 82-83.
64. Moore JE, Elborn JS. Burkholderia cepacia and cystic fibrosis - 50 years on. Commun
65. Moore JE, Millar BC, Jiru X, McCappin J, Crowe M, Elborn JS. Rapid characterization
of the genomovars of the Burkholderia cepacia complex by PCR-single-strandedconformational polymorphism (PCR-SSCP) analysis. J Hosp Infect 2001; 48: 129-134.
66. Olmedilla B, Granado F, Southon S, Wright AJA, Blanco I, Gil-Martinez E, Van den
Berg H, Thurnham DI, Corridan B, Chopra M, Hininger I. A European multicentre,placebo-controlled supplementation study with a-tocopherol, carotene-rich palm oil,lutein or lycopene: analysis of serum responses. Clin Sci 2002; 102: 447-456.
67. Olmedilla B, Granado F, Southon S, Wright AJA, Blanco I, Gil-Martinez E, Van den
Berg H, Corridan B, Rousell A-M, Chopra M, Thurnham DI. Serum concentrations ofcarotenoids and vitamins A, E, and C in control subjects from five European countries. Brit J Nutr 2001; 85: 227-238.
68. O'Neill ME, Carroll Y, Olmedialla B, Granado F, Blanco I, Van den Berg H, Hininger I,
Rousell A-M, Chopra M, Southon S, Thurnham DI. A European carotenoid database toassess carotenoid intakes and its use in a five-country comparative study. Brit J Nutr2001; 85: 499-507.
69. Schock BC, Sweet DG, Ennis M, Warner JA,Young IS, Halliday HL. Oxidative stress and
increased type-IV collagenase levels in bronchoalveolar lavage fluid from newbornbabies. Pediatr Res 2001; 50: 29-33.
70. Schock BC, Sweet DG, Halliday HL,Young IS, Ennis M. Oxidative stress in lavage fluid
of preterm infants at risk of chronic lung disease. Am J Physiol Lung Cell Mol Physiol2001; 281: L1386-L1391.
71. Schock BC, Young IS, Brown V, Fitch PS, Taylor R, Shields MD, Ennis M.
Antioxidants and protein carbonyls in bronchoalveolar lavage fluid of children: normaldata. Pediatr Res 2001; 49: 155-161.
72. Schock BC, Young IS, Brown V, Fitch PS, Shields MD, Ennis M. Antioxidants and
oxidative stress in BAL fluid of atopic asthmatic children. Pediatr Res 2002 (In press).
73. Shields MD, O’Hare B, Nelson J, Stewart MC, Coyle P. Maternal CMV positivity and
gender determination. Brit Med J 2002 (In press).
74. Stewart C, Stewart C, Stewart F. Microgastria-limb reduction anomaly with total amelia.
75. Sweet DG, Halliday HL, Warner JA. Airway remodelling in chronic lung disease of
prematurity. Paediatr Respir Rev 2002 (In press).
76. Sweet DG, McMahon KJ, Curley AE, O'Connor CM, Halliday HL. Type-1 collagenases
in bronchoalveolar lavage fluid from preterm babies at risk of developing chronic lungdisease. Arch Dis Child 2001; 84: F168- F171.
77. Sweet DG, Savage GA, Tubman TRJ, Lappin TRJ, Halliday HL. Study of maternal
influences on fetal iron status at term using cord blood transferrin receptors. Arch DisChild 84: F40-F43, 2001.
78. Sweet DG, Savage GA, Tubman TRJ, Lappin TRJ, Halliday HL. Cord blood transferrin
receptors to assess fetal iron status. Arch Dis Child 2001; 85: F46-F48.
79. Thompson A, Reid A, Steen HJ, Shields MD. A pale child: pulmonary haemosiderosis
presenting as anaemia. Ann Allergy Immunol 2002 (In Press).
80. Thompson AJ, Shields MD, Patterson CC. Acute asthma exacerbations and air pollutants
in children living in Belfast.Arch Environ Health2001; 56: 234-241.
81. Truffert P, Breart G, Goelz R, Saugstad OD, Halliday HL, Bevilacqua G. Treatment
strategies in Europe for neonatal pulmonary morbidity using surfactant and postnatalcorticosteroids. Prenat Neonat Med 2001; 6 (Suppl 2): 8-14.
82. Warke TJ, Fitch PS, Brown V, Taylor R, Lyons JD, Ennis M, Shields MD. Exhaled nitric
oxide correlates with airway eosinophils in childhood asthma. Thorax 2002, 57: 383-387.
83. Warke TJ, Fitch PS, Brown V, Taylor R, Lyons JD, Ennis M, Shields MD. Outgrown
asthma does not mean no airways inflammation. Eur Respir J 2002; 19: 284-287.
84. Warke TJ, Kamath S, Fitch PS, Brown V, Shields MD, Ennis M. The repeatability of
nonbronchoscopic bronchoalveolar lavage differential cell counts. Eur Respir J2001;18:1009-1012.
85. Wright AJA, Southon S, Chopra M, Meyer-Wenget A, Moser U, Granado F, Olmedilla B,
Corridan B, Hininger I, Rousell A-M, Van den Berg H, Thurnham DI. Comparison ofLDL fatty acid and carotenoid concentrations and oxidative resistance of LDL involunteers from countries with different rates of cardiovascular disease. Brit J Nutr 2002;87: 21-29.
86. Wright RM, Moore JE, Shaw A, Dunbar K, Dodd M, Webb K, Redmond AO, Crowe M,
Murphy PG, Peacock S, Elborn JS. Improved cultural detection of Burkholderia cepaciafrom sputum in patients with cystic fibrosis. J Clin Pathol 2001; 54: 803-805.
87. Yarnell J, McCrum E, Patterson C, Shields MD, MacMahon J, Evans AE. The
prevalence of excess weight in 13 and 14 year old schoolchildren in Northern Ireland. Acta Paediatr 2001, 90: 1435-1439. 4. External Grants Awarded Since Start of RRG Principal Investigators Funding Body Amount Date of Award
DI Thurnham et al UNICEF $55,000 March 2002
HL Halliday et al Action Research £108,179 Feb 2001
MD Shields RBHSC Fellow £35,000 May 2002
JC McElnay et al Action Research £114,836 Nov 2000
M Ennis Linen Industry £17,928 2001 NATO Expert £2100 2001
Associate Members 5. Indicators of prestige awarded to members since start of RRG Principal Investigator Award/Honour Date
MD Shields Elected member of Assoc of Physicians of GB
President of European Histamine Research
Member Council Brit Soc Allergy Clin Immunol
Member of Editorial Boards: Inflammation Res,
Academician, Academy Learned Soc. Social Scienc. 2001-
Chair International Pediatr Research Foundation
Ext Examiner Paediatrics Chinese Univ, Hong Kong May 2001-2Section Editor, Paediatric Masterclass, RCPCH
Chair NI Forum for Health and Social Care Res
Editorial Board, J Mat-Fetal & Neonatal Medicine
Member European Inhaled NO Consensus Group
Chair Pharmaceutical Care Network in Europe 2001- Chair UK Health Services & Pharm Pract Res Com 2002- Member Brit Forum Use of Medicines in Children 2000- Chair Pract Res Com Royal Pharm Soc of GB 2002-
Member Board of Faculty Paediatrics, Ireland 2002-
6. Activities supported by the Cohesion Fund since start of RRG
The following activities have been supported from the Cohesion fund:1. Workshops, 2. Invited speakers, 3. Seminars for Research Fellows, 4. Administration,5. Research Fellows examination fees, 6. Website, and 7. Travel and conference fees
Workshops W/Shops Title Speakers
Topics covered: Clinical trials, Qualitative research, Using surveys in research
Attended by about 45 members and associate members
Topics covered: An ethics committee application, research governance, fraud in
medical research and obtaining "informed consent" in difficult situations"
Attended by about 30 members and associate members
Professor Ian Young also gave a talk entitled "Now you have the results - but what do they mean?"
Attended by about 35 members and associate members
Attended by about 55 members and associate members
Monthly Seminars for Research Fellows
These were arranged by one of our Special Nursing Fellows, Miss Dale Spence and each washeld in the Perinatal Room, Royal Maternity Hospital. They were open to all Research Fellowsand attendance varied between 5 - 10. Each seminar had a Tutor and a Research Fellowallocated as follows:
Tutor/Research Fellow Administration
The Cohesion fund supports 1 session of administration and office expenditure. FromSeptember 2002 the administrator's time will be increased to 2 sessions per week. Research Fellows Examination Fees
R&D funded Research Fellows have their MD / PhD fees paid but Research Fellows working inthe RRGs on funded projects are not supported centrally. The RRG has agreed in the meantime to support MD / PhD fees for 4 Research Fellows.
This has been set up with the help of Geoff Caves from the Department of Psychology, QUBwho is acting as the Webmaster. Travel and Conference Fees
The Cohesion fund supports travel and conference fees for PIs, Research Fellows and ResearchAssistants when funding is not available from other sources.
Roadmap to Seclusion and Restraint Free Mental Health Services Children’s Mental Health Poster Contest – 2000Minnesota Association for Children’s Mental Health Roadmap to Seclusion and Restraint Free Mental Health Services U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov R
fairvesta désormais également numéro 1 des entreprises spécialisées en fonds fermésEn début d'année, fairvesta occupait déjà la place de numéro 1 lors de la publication des chiffres dusecteur par l'Association al emande des fonds fermés (VGF). Aucune maison d'émission indépendantedes banques n'a pu, l'année dernière, investir autant de capitaux propres dans le secteur des fondsfer