Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

Psychological influence of the media on patients commencing oral anticoagulation in atrial fibrillation:a qualitative analysis

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF); however it is still underutilized and sometimes refused by patients. Two inter-related studies were undertaken to understand the experiences and what influences this un- derutilisation of warfarin treatment in AF patients. These studies explored physician and patient experiences of AF and OAC treatment. The paper focuses on specific sub-themes from the study that explored patients’ experiences will be discussed. Aim: The study in question aimed to explore the experiences which influence patients’ decisions to accept, decline or discontinue OAC. Methods: Semi-structured individual interviews with patients were con- ducted. Three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued war- farin. Interpretative phenomenological analysis (IPA) was used to examine the data. IPA is a qualitative method that focuses on how participants make sense of an experiences phenomenon Results: Three over-arching themes comprised patients’ experiences: (i)the initial consultation, (ii) life after the consultation, and (iii) patients’reflections. In the last theme, patients reflected on their perceptions ofaspirin and warfarin. Aspirin was perceived as a natural wonder-drugwhile warfarin was perceived as a dangerous drug usually given to peo-ple at the end of their life. Interestingly they perceive both drugs as‘old’. However, for aspirin it had a positive association, old meaningtried and tested. While for warfarin, old meant ‘has been around fortoo long’.Conclusion: Media had an important role in how patients’ perceptionsof these two drugs were influenced. Literature shows that framingtechniques, i.e. using certain words or phrases such as ‘rat poison’, areprocesses adopted by media to alter medical knowledge into lay per-son’s language. Patients in turn form negative cognitive schemas,between the word ‘poison’ and warfarin, leading to the negative per-ception of warfarin which could influence non-adherence to treatment.This qualitative research highlighted the potential influences of themedia on AF patient perceptions commencing OAC treatment. Theassociation between media stimuli and patient perceptions on OACshould be further explored. The influential power of lay-media couldalso be instrumental in disseminating appropriate educational materialto the public

Researching language teacher cognition and practice:international case studies

This book presents a novel approach to discussing how to research language teacher cognition and practice. An introductory chapter by theeditors and an overview of the research field by Simon Borg precede eigh case studies written by new researchers, each of which focuses on one approach to collecting data. These approaches range from questionnaires and focus groups to think aloud, stimulated recall, and oral reflective journals. Each case study is commented on by a leading expert in the field - JD Brown, Martin Bygate, Donald Freeman, Alan Maley, Jerry Gebhard, Thoma Farrell, Susan Gass, and Jill Burton. Readers are encouraged to enter th conversation by reflecting on a set of questions and tasks in each chapter.

Developing a complex educational–behavioural intervention:the TREAT intervention for patients with atrial fibrillation

This article describes the theoretical and pragmatic development of a patient-centred intervention for patients with atrial fibrillation (AF). Theoretical models (Common Sense Model, Necessity-Concerns Framework), clinical frameworks, and AF patient feedback contributed to the design of a one-off hour-long behaviour-change intervention package. Intervention materials consisted of a DVD, educational booklet, diary and worksheet, which were patient-centred and easy to administer. The intervention was evaluated within a randomised controlled trial. Several “active theoretical ingredients” were identified (for e.g., where patients believed their medication was less harmful they spent more time within the therapeutic range (TTR), with general harm scores predicting TTR at 6 months). Allowing for social comparison and adopting behaviour change techniques enabled accurate patient understanding of their condition and medication. The process of developing the intervention using theory-derived content and evaluation tools allowed a greater understanding of the mechanisms by which this intervention was successful. Alleviating concerns about treatment medication by educating patients can help to improve adherence. This process of intervention development could be adopted for a range of chronic illnesses and treatments. Critical elements should include the use of: (1) clinical guidelines; (2) appropriate theoretical models; (3) patient input; and (4) appropriate evaluation tools.

An investigation of the effects of mothers' participation in adult literacy classes on interactive literacy activities (ILAs) at home

The National Center for Family Literacy (2003a) and the National Even Start Association (2005) have stated that the single most effective and influential factor in increasing student academic achievement is parental involvement. The purpose of this qualitative study was to determine how participation in adult literacy courses influences parent-child interaction in various educationally related activities known as Interactive Literacy Activities (ILAs). This study investigated ILAs from the mothers? perspective, and examines the changes that occur in parental involvement or ILAs when immigrant parents of a limited educational background participate in an adult education program. The principal method of data collection was key informant interviews (Gall, Borg, & Gall, 1996). Other methods of data collection included observations of parent-child interactions and field observations. Data analysis methods included Memo-ing (Miles & Huberman, 1994), within case analysis and cross-case analysis. ^ Findings demonstrate that changes occurred in the parent-child relationship when mothers of a limited educational background participated in an adult literacy course. When participating in ILAs or English literacy activities related to second language acquisition (including reading and speaking for comprehension and pronunciation), the children of these mothers took on the role of the adult. Participation in literacy activities was often initiated by the child and the children were frequently concerned with their mother's literacy acquisition. Mothers reported that their children were more confident, worked harder on school related activities and were more open to communication. ^ It can be concluded from this study that, in the case of these immigrant families, a mother's participation in adult literacy classes is influential in the relationship between mother and child. These children participated in ILAs for the benefit of their mothers and initiated literacy activities more frequently. The children responded better to their parents during literacy activities because there was a positive change in the relationship between mother and child. The relationship between mother and child appeared to be strengthened by greater trust, a sense of pride and more communication. ^

Efeitos do treino resistido na capacidade funcional e na reatividade pressórica em pacientes intradialíticos

Pacientes com doença renal crônica (DRC) submetidos ao treinamento resistido durante a hemodiálise apresentam benefícios substanciais dos sistemas muscular e cardiovascular, da capacidade funcional e da sua qualidade de vida. Entretanto, as melhorias na reatividade pressórica ainda não estão bem esclarecidas. O objetivo foi analisar o efeito do treino resistido na melhora da capacidade funcional e da reatividade pressórica em pacientes hemodialisados, em Natal/RN no ano de 2014. Trata-se de um ensaio clínico controlado e randomizado, com amostra de 64 pacientes, com média de idade de 42,28 (±11,48) anos, distribuídos em grupo experimental (GE) e controle (GC). Para mensurar os ganhos de força de membros inferiores foram utilizados os testes de sentar e levantar e de levantar e caminhar, já para a reatividade pressórica o teste cold pressor, em ambos os grupos antes e após a intervenção. Além disso, apenas o GE participou do treinamento resistido durante a hemodiálise em 16 semanas, composto por 3 sessões semanais, 3 séries de 10 repetições máximas (RM) estimadas (para extensores de joelho e flexores de quadril e joelho), entre 50 a 70% de 10 RM. Para a intensidade do treinamento foi utilizada a escala de Borg entre 11 a 14 durante as seções. Os dados foram analisados utilizando o Teste t para amostras independentes (inter-grupos) bem como para comparar a diferença das médias nos grupos pré e pós-intervenção (intra-grupos) a partir do Teste t para amostras repetidas. Para todas as variáveis foi considerada a significância estatística de 5% executados no software SPSS® 20.0. O estudo foi aprovado pelo comitê de ética do Hospital Universitário Onofre Lopes (HUOL - UFRN) número 37992214.2.0000.5292. Após a intervenção, verificou-se que os pacientes do GE tiveram um desempenho melhor nos testes de força (p<0,001) em comparação ao GC. Resultado também observado na pressão arterial sistólica e diastólica (PAS e PAD) ambas de repouso que apresentaram redução dos níveis pressóricos apenas no GE (p<0,001). Na reatividade pressórica tanto nos períodos pré bem como após 2 minutos também demonstraram reduções estatisticamente significativas do GE (p<0,001 e p=0,012) respectivamente quando comparado ao GC. Conclui-se que o treinamento resistido melhorou desempenho nos testes de força de membros inferiores beneficiando a capacidade funcional dos pacientes em hemodiálise, como também a pressão arterial de repouso e os níveis de reatividade pressórica obtiveram reduções significativas de seus valores após a intervenção. Além disso, este tipo de treinamento também pode ser utilizado como uma estratégia de proteção aos fatores de risco cardiovascular em pacientes renais crônicos.

Rugby : Epidemiologia lesional. Estudio de caso único en la readaptación y reentrenamiento tras fractura-luxación de maissoneuve

El rugby es un deporte ampliamente estudiado en el área física y técnico-táctica con una tasa lesional elevada, que presenta una relación entre los datos antropométricos y el rol de juego.
En este deporte, la incidencia lesional varía en función del rol de juego, siendo mayor en la posición de delantero, además estas lesiones se caracterizan por ser, predominantemente musculares, siendo más comunes en el miembro inferior. Por consiguiente, los objetivos del trabajo han sido sintetizar toda la información acerca del deporte y su epidemiología lesional, para poder realizar una intervención tras Fractura-Luxación Maissoneuve -caso único-, en la que se procuró recuperar una lesión atípica.
Los resultados obtenidos mostraron una mejora de las variables medidas, tanto objetivas (recorrido articular, fuerza y perímetro), como subjetivas (escala de Borg) conforme avanzó la intervención, lo que verificó la importancia del seguimiento y cuantificación de la recuperación, para su reajuste y optimización.

Rugby : Epidemiologia lesional. Estudio de caso único en la readaptación y reentrenamiento tras fractura-luxación de maissoneuve

El rugby es un deporte ampliamente estudiado en el área física y técnico-táctica con una tasa lesional elevada, que presenta una relación entre los datos antropométricos y el rol de juego.
En este deporte, la incidencia lesional varía en función del rol de juego, siendo mayor en la posición de delantero, además estas lesiones se caracterizan por ser, predominantemente musculares, siendo más comunes en el miembro inferior. Por consiguiente, los objetivos del trabajo han sido sintetizar toda la información acerca del deporte y su epidemiología lesional, para poder realizar una intervención tras Fractura-Luxación Maissoneuve -caso único-, en la que se procuró recuperar una lesión atípica.
Los resultados obtenidos mostraron una mejora de las variables medidas, tanto objetivas (recorrido articular, fuerza y perímetro), como subjetivas (escala de Borg) conforme avanzó la intervención, lo que verificó la importancia del seguimiento y cuantificación de la recuperación, para su reajuste y optimización.

Stable isotopes, PCBs and pesticide concentrations in zooplankton, seawater and POM from Kongsfjorden and Liefdefjorden, Svalbard

Differences in bioaccumulation of persistent organic pollutants (POPs) between fjords characterized by different water masses were investigated by comparing POP concentrations, patterns and bioaccumulation factors (BAFs) in seven species of zooplankton from Liefdefjorden (Arctic water mass) and Kongsfjorden (Atlantic water mass), Svalbard, Norway. No difference in concentrations and patterns of POPs was observed in seawater and POM; however higher concentrations and BAFs for certain POPs were found in species of zooplankton from Kongsfjorden. The same species were sampled in both fjords and the differences in concentrations of POPs and BAFs were most likely due to fjord specific characteristics, such as ice cover and timing of snow/glacier melt. These confounding factors make it difficult to conclude on water mass (Arctic vs. Atlantic) specific differences and further to extrapolate these results to possible climate change effects on accumulation of POPs in zooplankton. The present study suggests that zooplankton do biomagnify POPs, which is important for understanding contaminant uptake and flux in zooplankton, though consciousness regarding the method of evaluation is important.

(Table 1) Age determination of sediment core BC5, Golf of Lion

Hitherto unknown abundance peaks of left coiling (l.c.) Neogloboquadrina pachyderma from a Gulf of Lions piston core indicate that abrupt cold spells associated with Atlantic Heinrich events affected the Mediterranean. N. pachyderma (l.c.) is typical of (sub) polar waters in the open ocean. The southern edge of its glacial North Atlantic bioprovince reached south Portugal. Only trace abundances of N. pachyderma (l.c.) are known from Quaternary Mediterranean sediments, suggesting that no significant "invasions" occured via the Strait of Gibraltar. The Gulf of Lions abundance peaks therefore seem to reflect area-specific thriving of a normally rare but indigenous taxon in the western Mediterranean through local favorable habitat development. The general planktonic foraminiferal record suggests that the basic hydrographic regime in the Gulf of Lions, with wintertime deep convective overturn, was relatively stable over the past 60 kyr. Under these conditions, high abundances of N. pachyderma (l.c.) would essentially imply temperature reductions of the order of 5°-8° relative to the present.

(Tables S1,2) Stable isotopes in muscle tissue of polar bears (Ursus maritimus) from various regions of the Arctic

The relative contribution of regional contamination versus dietary differences to geographic variation in polar bear (Ursus maritimus) contaminant levels is unknown. Dietary variation between Alaska, Canada, East Greenland, and Svalbard subpopulations was assessed by muscle nitrogen and carbon stable isotope (d15N, d13C) and adipose fatty acid (FA) signatures relative to their main prey (ringed seals). Western and southern Hudson Bay signatures were characterized by depleted d15N and d13C, lower proportions of C20 and C22 monounsaturated FAs and higher proportions of C18 and longer chain polyunsaturated FAs. East Greenland and Svalbard signatures were reversed relative to Hudson Bay. Alaskan and Canadian Arctic signatures were intermediate. Between-subpopulation dietary differences predominated over interannual, seasonal, sex, or age variation. Among various brominated and chlorinated contaminants, diet signatures significantly explained variation in adipose levels of polybrominated diphenyl ether (PBDE) flame retardants (14-15%) and legacy PCBs (18-21%). However, dietary influence was contaminant class-specific, since only low or nonsignificant proportions of variation in organochlorine pesticide (e.g., chlordane) levels were explained by diet. Hudson Bay diet signatures were associated with lower PCB and PBDE levels, whereas East Greenland and Svalbard signatures were associated with higher levels. Understanding diet/food web factors is important to accurately interpret contaminant trends, particularly in a changing Arctic.

Fossil associations from the middle and upper Eocene strata of the Pamplona Basin and surrounding areas (Navarre, western Pyrenees)

Fossil associations from the middle and upper Eocene (Bartonian and Priabonian) sedimentary succession of the Pamplona Basin are described. This succession was accumulated in the western part of the South Pyrenean peripheral foreland basin and extends from deep-marine turbiditic (Ezkaba Sandstone Formation) to deltaic (Pamplona Marl, Ardanatz Sandstone and Ilundain Marl formations) and marginal marine deposits (Gendulain Formation). The micropalaeontological content is high. It is dominated by foraminifera, and common ostracods and other microfossils are also present. The fossil ichnoasssemblages include at least 23 ichnogenera and 28 ichnospecies indicative of Nereites, Cruziana, Glossifungites and ?Scoyenia-Mermia ichnofacies. Body macrofossils of 78 taxa corresponding to macroforaminifera, sponges, corals, bryozoans, brachiopods, annelids, molluscs, arthropods, echinoderms and vertebrates have been identified. Both the number of ichnotaxa and of species (e. g. bryozoans, molluscs and condrichthyans) may be considerably higher. Body fossil assemblages are comparable to those from the Eocene of the Nord Pyrenean area (Basque Coast), and also to those from the Eocene of the west-central and eastern part of South Pyrenean area (Aragon and Catalonia). At the European scale, the molluscs assemblages seem endemic from the Pyrenean area, although several Tethyan (Italy and Alps) and Northern elements (Paris basin and Normandy) have been recorded. Palaeontological data of studied sedimentary units fit well with the shallowing process that throughout the middle and late Eocene occurs in the area, according to the sedimentological and stratigraphical data.

El proceso de la elaboración de los códices "Borgia" y "Vaticano B" basado en su estudio codicológico

El objetivo de este artículo es presentar las observaciones realizadas durante la consulta de los originales de los códices Borgia (Borg. Mess. 1) y Vaticano B (Vat. Lat. 3773) en la Biblioteca Apostólica Vaticana en 2014. Este estudio codicológico, aunque a la fuerza parcial, dado que fue realizado solamente por medio de una observación directa, revela nuevos datos acerca de la elaboración de los manuscritos prehispánicos, tanto en la preparación de la piel como soporte como en los procedimientos aplicados a la hora de trazar las imágenes y corregir las equivocaciones.

Uhri-altar: sangar-weisu 5:ssä laulussa

Imprimatur: Borgå domkapitel 8.8.1846 Clas Molander.