Posttraumatic Growth in Parents of Childhood Cancer Survivors

BACKGROUND: When a child is diagnosed with cancer, parents are confronted with the potential fatality of the disease. This traumatic stressor is often followed by additional stressful events during treatment. However, once their child is cured many parents also reported experiencing psychological growth. We aimed to describe post-traumatic growth (PTG) in parents of adolescent childhood cancer survivors, compare it with PTG in existing samples experiencing stressful events, and describe characteristics of parents who report PTG.

Blocking brain-derived neurotrophic factor inhibits injury-induced hyperexcitability of hippocampal CA3 neurons

Brain trauma can disrupt synaptic connections, and this in turn can prompt axons to sprout and form new connections. If these new axonal connections are aberrant, hyperexcitability can result. It has been shown that ablating tropomyosin-related kinase B (TrkB), a receptor for brain-derived neurotrophic factor (BDNF), can reduce axonal sprouting after hippocampal injury. However, it is unknown whether inhibiting BDNF-mediated axonal sprouting will reduce hyperexcitability. Given this, our purpose here was to determine whether pharmacologically blocking BDNF inhibits hyperexcitability after injury-induced axonal sprouting in the hippocampus. To induce injury, we made Schaffer collateral lesions in organotypic hippocampal slice cultures. As reported by others, we observed a 50% reduction in axonal sprouting in cultures treated with a BDNF blocker (TrkB-Fc) 14 days after injury. Furthermore, lesioned cultures treated with TrkB-Fc were less hyperexcitable than lesioned untreated cultures. Using electrophysiology, we observed a two-fold decrease in the number of CA3 neurons that showed bursting responses after lesion with TrkB-Fc treatment, whereas we found no change in intrinsic neuronal firing properties. Finally, evoked field excitatory postsynaptic potential recordings indicated an increase in network activity within area CA3 after lesion, which was prevented with chronic TrkB-Fc treatment. Taken together, our results demonstrate that blocking BDNF attenuates injury-induced hyperexcitability of hippocampal CA3 neurons. Axonal sprouting has been found in patients with post-traumatic epilepsy. Therefore, our data suggest that blocking the BDNF-TrkB signaling cascade shortly after injury may be a potential therapeutic target for the treatment of post-traumatic epilepsy.

Transient loss of consciousness and syncope

Syncope describes a sudden and brief transient loss of consciousness (TLOC) with postural failure due to cerebral global hypoperfusion. The term TLOC is used when the cause is either unrelated to cerebral hypoperfusion or is unknown. The most common causes of syncopal TLOC include: (1) cardiogenic syncope (cardiac arrhythmias, structural cardiac diseases, others); (2) orthostatic hypotension (due to drugs, hypovolemia, primary or secondary autonomic failure, others); (3) neurally mediated syncope (cardioinhibitory, vasodepressor, and mixed forms). Rarely neurologic disorders (such as epilepsy, transient ischemic attacks, and the subclavian steal syndrome) can lead to cerebal hypoperfusion and syncope. Nonsyncopal TLOC may be due to neurologic (epilepsy, sleep attacks, and other states with fluctuating vigilance), medical (hypoglycemia, drugs), psychiatric, or post-traumatic disorders. Basic diagnostic workup of TLOC includes a thorough history and physical examination, and a 12-lead electrocardiogram (ECG). Blood testing, electroencephalogram (EEG), magnetic resonance imaging (MRI) of the brain, echocardiography, head-up tilt test, carotid sinus massage, Holter monitoring, and loop recorders should be obtained only in specific contexts. Management strategies involve pharmacologic and nonpharmacologic interventions, and cardiac pacing.

Influence of pre-anaesthetic thoracic radiographs on ASA physical status classification and anaesthetic protocols in traumatized dogs and cats

The purpose of this study was to evaluate if pre-anaesthetic thoracic radiographs contribute to the anaesthetic management of trauma patients by comparing American Society of Anesthesiologists Physical Status Classification (ASA grade) with and without information from thoracic radiography findings. Case records of 157 dogs and cats being anaesthetized with or without post-traumatic, pre-anaesthetic chest radiographs were retrospectively evaluated for clinical parameters, radiographic abnormalities and anaesthetic protocol. Animals were retrospectively assigned an ASA grade. ASA grades, clinical signs of respiratory abnormalities and anaesthesia protocols were compared between animals with and without chest radiographs. The group of animals without pre-anaesthetic radiographs was anaesthetized earlier after trauma and showed less respiratory abnormalities at presentation. The retrospectively evaluated ASA grade significantly increased with the information from thoracic radiography. Animals with a higher ASA grade were less frequently mechanically ventilated. Pre-anaesthetic radiographs may provide important information to assess the ASA grade in traumatized patients and may therefore influence the anesthesia protocol.

German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.

Do trials of perpetrators retraumatize crime victims?

Attendance at trials of perpetrators could be retraumatizing for crime victims suffering from posttraumatic stress disorder. To investigate this hypothesis, two studies were conducted in which retraumatization was defined as a significant increase in posttraumatic stress reactions. A cross-sectional study of 137 victims of rape and nonsexual assault revealed that trial variables do virtually not predict posttraumatic stress reactions at a time several years after trial.Alongitudinal study of 31 victims of rape and nonsexual assault revealed intraindividual stability of posttraumatic stress reactions for the time interval from a few weeks before the trial to a few weeks after the trial; in addition, interindividual stability was high. The results of both studies do not support the retraumatization hypothesis, which should therefore be used with caution.

Rachegefühle und posttraumatische Belastungsreaktionen bei Opfern von Gewalttaten

Theoretischer Hintergrund: Beschreibungen der posttraumatischen Belastungsstörung (PTB) besagen, dass Personen mit PTB häufig starke Rachegefühle erleben. Es besteht jedoch ein Mangel an bestätigenden empirischen Untersuchungen. Fragestellung: Der Zusammenhang zwischen Rachegefühlen und posttraumatischen Belastungsreaktionen wird untersucht. Methode: Die Daten wurden mittels Selbstbeurteilung bei 174 Opfern von Gewalttaten erfasst. Zur Messung der Belastungsreaktionen wurde die Impact of Event-Skala – revidierte Version (IES-R) eingesetzt. Ergebnisse: Rachegefühle korrelieren bedeutsam mit posttraumatischer Intrusion und Übererregung, jedoch nicht mit Vermeidung. Rachegefühle leisten einen Beitrag zur Varianzaufklärung, der über den Vorhersagebeitrag viktimologischer Standardvariablen hinausgeht. Der Zusammenhang wird jedoch erst mit wachsendem zeitlichen Abstand vom Ereignis enger. Schlussfolgerungen: Rachegefühle sind vermutlich als dysfunktionale Bewältigungsreaktion auf erlittene Ungerechtigkeit zu bewerten, jedoch nicht in der ersten Zeit nach einer kriminellen Viktimisierung.

Intervenções em centros urbanos e conflitos distributivos: modelos regulatórios, circuitos de valorização e estratégias discursivas

Este trabalho discute as transformações no modo de intervenção do Estado na produção do espaço urbano no capitalismo contemporâneo a partir de uma reflexão sobre as políticas de revitalização de centros urbanos e os conflitos de natureza distributiva relacionados a esses projetos. Situando-se no campo do direito econômico, o trabalho explora as relações entre a acumulação capitalista e os padrões de intervenção do Estado sobre o espaço urbano a partir de diferentes níveis de análise, articulando elementos teóricos, jurídico-institucionais e empíricos. O processo de reestruturação do capitalismo que se iniciou nos anos 1970 teve desdobramentos relevantes no campo da regulação urbanística, desencadeando mudanças que atingiram suas funções e formas, e que perpassam diversas escalas geográficas. A ordem social e econômica que se configurou no capitalismo contemporâneo, marcada pela difusão de uma agenda política neoliberal e pela emergência de um regime de acumulação com dominância financeira, tem seus desdobramentos específicos na escala das cidades. Nesse contexto, as políticas urbanas passaram a ser progressivamente norteadas por uma racionalidade pragmática e empresarial, fechando-se à influência de esferas democráticas e desviando-se da institucionalização de compromissos redistributivos. Essa mudança qualitativa é mediada por formas institucionais e arranjos regulatórios que não se limitam à escala urbana e ao direito urbanístico propriamente dito, perpassando normas que regulam o regime jurídico da propriedade imobiliária e suas conexões com a esfera financeira, os padrões de financiamento das políticas urbanas, entre outras. A partir de um estudo sobre o Projeto Porto Maravilha uma intervenção urbanística de grande porte, e amplamente conectada a fluxos econômicos globais, que está sendo implementada na cidade do Rio de Janeiro desde 2009 , desenvolvemos uma reflexão sobre alguns vetores de mudança no papel exercido pelo Estado nos processos de urbanização. Este trabalho apresenta duas hipóteses articuladas. A primeira é a de que os padrões de regulação urbanística que emergiram no capitalismo contemporâneo não são meros reflexos de transformações mais abrangentes, mas sim fatores constitutivos dessas mudanças. A segunda a é de que as políticas de revitalização de centros urbanos agem como vetores de aprofundamento das conexões entre dinâmicas locais e processos globais, e também como incubadoras de novos padrões de regulação urbanística.

Discursive constructions of social and environmental accounting in Brazil: the case of Petrobras.

In the 29 years following \"Our Common Future\" by the United Nations, there is considerable debate among governments, civil society, interest groups and business organisations about what constitutes sustainable development, which constitutes evidence for a contested discourse concerning sustainability. The purpose of this study is to understand this debate in the developing economic context of Brazil, and in particular, to understand and critique the social and environmental accounting [SEA] discursive constructions relating to the State-owned, Petrobras as well as to understand the Brazilian literature on SEA. The discourse theory [DT]-based analysis employs rhetorical redescription to analyse twenty-two reports from Petrobras from 2004-2013. I investigate the political notions by employing the methodological framework of the Logics of Critical Explanation [LCE]. LCE engenders five methodological steps: problematisation, retroduction, logics (social, political and fantasmatic), articulation and critique. The empirical discussion suggests that the hegemony of economic development operates to obfuscate, rhetorically, the development of sustainability, so as to maintain the core business of Petrobras conceived as capital accumulation. Equally, these articulations also illustrate how the constructions of SEA operate to serve the company\'s purpose with few (none) profound changes in integration of sustainability. The Brazilian literature on SEA sustains the status quo of neo-liberal market policies that operate to protect the dominant business case approach to maintain an agenda of wealth-creation in relation to social and environmental needs. The articulations of the case manifested in policies regarding, for example, corruption, which involved over-payments for contracts and unsustainable practices relating to the use of fossil fuels and demonstrated that there was antagonism between action and disclosure. The corruption scandal that emerged after SEA disclosures highlighted the rhetorical nature of disclosure when financial resources were subtracted from the company for political parties and engineering contractors hid facts through incomplete disclosures. The articulations of SEA misrepresent a broader context of the meanings associated with sustainability, which restricted the constructions of SEA to principally serve and represent the intention of the most powerful groups. The significance of SEA, then is narrowed to represent particular interests. The study argues for more critical studies as limited Brazilian literature concerning SEA kept a \'safe distance\' from substantively critiquing the constructions of SEA and its articulations in the Brazilian context. The literature review and the Petrobras\' case illustrate a variety of naming, instituting and articulatory practices that endeavour to maintain the current hegemony of development in an emerging economy, which allows Petrobras to continue to exercise significant profit at the expense of the social and environmental. The constructed idea of development in Petrobras\' discourses emphasises a rhetoric of wider development, but, in reality, these discourses were the antithesis of political, social and ethical developmental issues. These constructions aim to hide struggles between social inequalities and exploitation of natural resources and constitute excuses about a fanciful notion of rhetorical and hegemonic neo-liberal development. In summary, this thesis contributes to the prior literature in five ways: (i) the addition of DT to the analysis of SEA enhances the discussion of political elements such as hegemony, antagonism, logic of equivalence/difference, ideology and articulation; (ii) the analysis of an emerging economy such as Brazil incorporates a new perspective of the discussion of the discourses of SEA and development; (iii) this thesis includes a focus on rhetoric to discuss the maintenance of the status quo; (iv) the holistic structure of the LCE approach enlarges the understanding of the social, political and fantasmatic logics of SEA studies and; (v) this thesis combines an analysis of the literature and the case of Petrobras to characterise and critique the state of the Brazilian academy and its impacts and reflections on the significance of SEA. This thesis, therefore, argues for more critical studies in the Brazilian academy due to the persistence of idea of SEA and development that takes-for-granted deep exclusions and contradictions and provide little space for critiques.

Attentional processes associated with victimization history and posttraumatic symptomatology in women exposed to intimate partner violence

Exposure to intimate partner violence (IPV) puts women at risk for severe and chronic physical and mental health consequences, including elevations in IPV-related psychopathology and increased risk for future victimization. Previous research has examined attention as one of the key information processing mechanisms associated with elevated psychopathology and risk for victimization; however, the nature of attentional processing in response to IPV-related information in women exposed to IPV is poorly understood. Therefore, the current study aimed to further understanding of associations between attentional processing, IPV exposure, and related distress using measures of eye movement and subjective interpretations of IPV-related information. A sample of women exposed to IPV (n = 57) viewed sets of negative, positive, and neutral relationship images for 15 s each while having their eye movements monitored and later provided subjective ratings and interpretations of levels of risk and safety in those images. We examined associations of outcome measures with proximal victimization experiences and IPV-related psychopathology (i.e., depression, posttraumatic stress disorder (PTSD), anxiety, and dissociation). Results indicated a bias to attend to negative relationship images relative to positive and neutral images, though this attention bias fluctuated over time and varied as a function of symptomatology such that depression corresponded with increases in attention to negative images over time and PTSD corresponded with decreases in attention to negative images. The general attention bias for negative images appeared to be explained by rumination on and/or difficulty disengaging from negative images, which was related to general elevations in psychopathology as well as exposure to revictimization by different perpetrators. Subjective interpretations and perception of danger cues were related to victimization history and level and type of IPV-related distress. We replicated these procedures with a sample of undergraduate students without IPV histories or related symptomatology (n = 33) and found that the overall attention bias for negative images was not replicated, despite general similarities in patterns of attention over time. Results therefore indicated associations between attentional processing and IPV exposure and related symptomatology. Implications for models of IPV-related psychopathology and attentional processing as well as directions for future study and interventions are discussed.

Using the R-PAS' Aggressive Content Score For the Evaluation of Aggressive Behaviors in Children

The Rorschach Performance Assessment System (R-PAS) was developed in 2011 as analternative to the previous Comprehensive System. The goal was to improve the psychometrics,and particularly the validity, of this assessment method. The norms for children werequestionable in the Comprehensive system (e.g., outdated, low numbers of subjects) and validitystudies for children were sparse. One of the indicators included in the R-PAS system, theaggressive content indicator (AgC), is intended to reflect aggressive behavior, but few studieshave examined the validity of this indicator. This study examined the validity of AgC in asample of 32 children and adolescents receiving services at a residential treatment center.Subjects' AgC scores were analyzed in relation to demographics and diagnosis, as well as ratingsof aggression and conduct problems from the Behavioral Assessment System for Children-2(BASC-2) Parent and Teacher Reports. Correlations between the AgC score and BASC-2aggression and conduct problems scores were not statistically significant. None of thecorrelations between AgC score and a diagnosis of Conduct Disorder, Oppositional DefiantDisorder, Posttraumatic Stress Disorder, or Mood Disorders were significant either. Given thesmall sample size, null results may be a result of power concerns. The lack of significantcorrelations may however, indicate that operational definitions of aggression used in variousforms of measurement reflect different constructs.

Everyone Has Their Scars: Meaning Making In a Burn Survivor Support Group.

In the Burn Care literature, there is little on the lived experiences of burn support group members, the perceived benefits of burn support groups for the members, and even less on the meaning the survivors make of the support they receive. In order to provide effective services and to meet the psychosocial needs of burn survivors, it is important to understand the influence a support group has on its members as well as the personal experiences of those individuals who attend these groups. The purpose of this study was to explore the meaning that burn survivors make in a burn survivor support group. A non-random, purposeful convenience sample of six self-identified burn survivors was interviewed using a guided in-depth interview technique to explore their experiences in the support group. Key informant interviews and group observations served to triangulate the data collected in the individual interviews. The experiences of the group's members coalesced around five main themes: acceptance of self, perspective change, value of community, reciprocity, and structural meaning making components. The findings demonstrated the overall positive impact the support group had on psychosocial recovery. Additionally, analysis suggested that the meaning making process experience included Post Traumatic Growth and highlighted the importance of community in psychosocial recovery. Burn survivors reported unique growth opportunities that allowed them to integrate their injury into their identity within an encouraging and safe environment. Certain factors, such as improving group attendance, were addressed and both survivors and support staff generated suggestions for reaching others in need of support.

A single-centre experience of post-renal transplant lymphoproliferative disorder

Post-transplant lymphoproliferative disorder (PTLD) complicates 1 to 10% of all transplantations. Previous clinicopathological studies of PTLD have been limited by small numbers, short follow-up times, outdated data, heterogeneity of pooled solid-organ transplant results, and selective inclusion of early-onset disease. We therefore undertake here a retrospective analysis and identify all cases of PTLD that complicated renal transplantation at the Princess Alexandra Hospital between 30 June 1969 and 31 May 2001. Tumour samples were subsequently retrieved for pathological review and for Epstein-Barr virus-encoded RNA in situ hybridisation (EBER-ISH). Of 2,030 renal transplantation patients, 29 (1.4%) developed PTLD after a median period of 0.5 years (range 0.1 to 23.3 years). PTLD patients were more likely to have received cyclosporine (76% versus 62%, P

Blunted prolactin response to D-fenfluramine in post-stroke major depression

Background: This study investigated whether patients suffering from post-stroke depressive disorder had a similar disturbance in central serotonergic function to that described in non-brain injured depressed patients. Methods: Twenty-three depressed patients (nine major, 14 minor) and 38 non-depressed patients were examined 4-8 weeks post-stroke with a structured interview, rating scales and MRI brain scans. Patients were administered 30 mg D-fenfluramine orally and plasma prolactin and D-fenfluramine concentrations were measured for 6 h post-dose. Results: The prolactin response was significantly blunted in major depression compared to minor depression and non-depressed patients as measured by both delta prolactin and area under the prolactin versus time curve. There was no significant relationship between prolactin response and lesion lateralization or any of the measured clinical characteristics. Limitations: The major limitation of the study is the relatively small number in each depressive group. Conclusions: Patients suffering from major depression in the post-stroke period have a blunted prolactin response to D-fenfluramine. This indicates a serotonergic abnormality consistent with that found in major depression where neurological disease is not present. (C) 2003 Elsevier B.V. All rights reserved.

The jigsaw sign. A reliable indicator of congenital aetiology in os odontoideum

There is evidence in the literature for both a congenital and a post-traumatic aetiology for os odontoideum. In no series published to date has CT been used to aid in the diagnosis. This is a prospective study of the history of trauma and presence of diagnostic features on CT of 18 consecutive cases with os odontoideum. Our objective was to derive clinically useful radiological features enabling accurate differentiation between congenital and post-traumatic aetiologies. A mid-sagittal CT reconstruction of the atlanto-dens joint was obtained. Hypertrophy of the anterior arch of the atlas was quantified by measurement of the arch-peg-area ratio. The presence of dysplastic features (a positive jigsaw sign) of the atlanto-axial joint were noted. These included narrowing of the cartilage space and interdigitation of the two joint surfaces. A history of a potential traumatic aetiology was only obtained in one of the 18 (6%) in our series. A significant elevation of the arch-peg ratio was found when comparing this series to 85 controls. And a positive jigsaw sign was observed in 75% of cases. These features were not seen in paediatric cases of atlanto-axial instability, including odontoid non-union. In conclusion, an elevated arch-peg ratio and the presence of a jigsaw sign are sensitive and specific diagnostic criteria for os odontoideum. This series supports a congenital aetiology for this condition.