Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes

Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007. Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span> Discussion: Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study participants that formal community-based support (e.g., handibus, caregiving relief, rehabilitation assessments) should be continued for extended periods (e.g., years) post-stroke. Ongoing contact with health care professionals is valuable to help them navigate in the community as needs change over time.

Inconsistencies in and the inadequacies of the family counselling and FDR confidentiality and admissibility provisions: The need for reform

In this article the author discusses issues arising from counselling and family dispute resolution (FDR) in relation to confidentiality and admissibility, such as whether an admission of abuse to a child, or a threat to harm the other parent, can be disclosed by the counsellor or family dispute resolution practitioner (FDRP) and used in court proceedings. It is found that the admissibility provisions in the Family Law Act 1975 (Cth) are far more narrowly defined than the confidentiality requirements and have been interpreted strictly by the courts. There are competing policy considerations: the strict “traditionalist” approach, that people can have absolute faith in the integrity of counsellors and mediators and in the confidential nature of the process, must be balanced against a more “protectionist” stance, being the individual rights of victims to have all relevant information placed before the court and to be protected from violence and abuse. It is suggested that legislative reform is required to ensure that courts balance these considerations appropriately and don’t compromise the safety of victims of abuse and family violence.

Family type and depression in pregnancy: Factors mediating risk in a community sample

The rate of severe depression among women in single-parent and biological families and in a variety of stepfamilies was examined in a large community sample of 13,088 pregnant women in the United Kingdom. Compared with women in biological families and published population rates, women in single-parent families and step-families reported significantly elevated rates of depression. Family-type differences in several risk factors were examined, including cohabiting (vs. married) status, relationship history, and socioeconomic and psychosocial risks, such as crowding, social support, and stressful life events. Family-type differences in depression were mediated partly by differences in social support, stressful life events, and crowding, but a main effect of family type in predicting depression remained after statistically controlling for these risks.

On an unexpected career path? Using Wittgenstein’s Family Resemblance concept to determine the power of projects to transform project management careers

The power of projects has been demonstrated by the growth in their use across an increasing range of industries and workplaces in recent years. Not only has the number of people involved in project management increased, but the qualifications and backgrounds of those people have also broadened, with engineering no longer being the only path to project management (PM). Predicting the career trajectories in Project Management has become more important for both organisations employing project managers and project managers building career portfolios. Our research involved interviewing more than 75 project officers and project managers across a range of industries to explore their career journey. We used Wittgenstein’s family resemblance theory is to analyse the information from the transcripts to identify the extent to which the roles of participants fit with the commonly accepted definition of project management. Findings demonstrate diversity of project manager backgrounds and experiences and relational competencies across these backgrounds that form and shape PM careers.

Detection of Chlamydiaceae DNA in veterinary specimens using a family-specific PCR

Aims: The aim of this work was to develop a rapid molecular test for the detection of the Chlamydiaceae family, irrespective of the species or animal host. Methods and Results: The method described herein is a polymerase chain reaction targeting the 16S rRNA gene of the Chlamydiaceae family, and the results demonstrate that the test reacts with five reference Chlamydiaceae but none of the 19 other bacterial species or five uninfected animal tissues tested. The results also indicate the enhanced sensitivity of this test when compared with conventional culture or serology techniques. This is demonstrated through parallel testing of six real clinical veterinary cases and confirmatory DNA sequence analysis. Conclusions, Significance and Impact of the Study: This test can be used by veterinary diagnostic laboratories for rapid detection of Chlamydiaceae in veterinary specimens, with no restriction of chlamydial species or animal host. The test does not differentiate chlamydial species, and if required, speciation must be carried out retrospectively using alternate methods. However, for the purpose of prescribing therapy for chlamydiosis, this test would be an invaluable laboratory tool.

‘They rush you and push you too much … and you can't really get any good response off them’: A qualitative examination of family involvement in care of people with dementia in acute care

Aim: To explore the role and needs of the family carer across different acute care contexts and their level of involvement in the care of their relative with dementia in this setting. Method: A pragmatic, exploratory-descriptive qualitative approach. A convenience sample of 30 family carers across three sites completed semi-structured interviews. Results: Family carers wanted to be involved in the acute care of their family member with dementia. They acknowledged the importance of a central source of information, educated staff, guidelines on roles and processes, and positive communication, as well as respect from staff for the carer’s knowledge of the older person and their needs. They also highlighted the need for medical staff to discuss with them the family member’s treatment and care. Conclusion: There is a need for family-focused interventions to improve communication and involvement of family in the care of family members with dementia in the acute setting.

Abaca bunchy top virus, a new member of the genus Babuvirus (family Nanoviridae)

Two isolates of a novel babuvirus causing "bunchy top" symptoms were characterised, one from abaca (Musa textilis) from the Philippines and one from banana (Musa sp.) from Sarawak (Malaysia). The name abacá bunchy top virus (ABTV) is proposed. Both isolates have a genome of six circular DNA components, each ca. 1.0-1.1 kb, analogous to those of isolates of Banana bunchy top virus (BBTV). However, unlike BBTV, both ABTV isolates lack an internal ORF in DNA-R, and the ORF in DNA-U3 found in some BBTV isolates is also absent. In all phylogenetic analyses of nanovirid isolates, ABTV and BBTV fall in the same clade, but on separate branches. However, ABTV and BBTV isolates shared only 79-81% amino acid sequence identity for the putative coat protein and 54-76% overall nucleotide sequence identity across all components. Stem-loop and major common regions were present in ABTV, but there was less than 60% identity with the major common region of BBTV. ABTV and BBTV were also shown to be serologically distinct, with only two out of ten BBTV-specific monoclonal antibodies reacting with ABTV. The two ABTV isolates may represent distinct strains of the species as they are less closely related to each other than are isolates of the two geographic subgroups (Asian and South Pacific) of BBTV.

Genetic control of propagation traits in a single Corymbia torelliana x Corymbia variegata family

Genetic control of vegetative propagation traits was described for a second-generation, outbred, intersectional hybrid family (N = 208) derived from two species, Corymbia torelliana (F. Muell.) K.D. Hill & L.A.S. Johnson and Corymbia variegata (F. Muell.) K.D. Hill & L.A.S. Johnson, which contrast for propagation characteristics and in their capacity to develop lignotubers. Large phenotypic variances were evident for rooting and most other propagation traits, with significant proportions attributable to differences between clones (broad-sense heritabilities 0.2-0.5). Bare root assessment of rooting rate and root quality parameters tended to have the highest heritabilities, whereas rooting percentage based on root emergence from pots and shoot production were intermediate. Root biomass and root initiation had the lowest heritabilities. Strong favourable genetic correlations were found between rooting percentage and root quality traits such as root biomass, volume, and length. Lignotuber development on a seedling was associated with low rooting and a tendency to poor root quality in cuttings and was in accord with the persistence of species parent types due to gametic phase disequilibrium. On average, nodal cuttings rooted more frequently and with higher quality root systems, but significant cutting type x genotype interaction indicated that for some clones, higher rooting rates were obtained from tips. Low germination, survival of seedlings, and rooting rates suggested strong hybrid breakdown in this family.

Kampen om Eros : Om kön och kärlek i Pahlensviten

The Struggle for Eros: On Love and Gender in the Pahlen Series The present dissertation examines how gender, sexuality and motherhood are constructed in the novel series Fröknarna von Pahlen (The Misses von Pahlen, I VII, 1930 1935) by the Swedish author Agnes von Krusenstjerna. The aim of the study is to analyze how the Pahlen series relates to the discourses on gender and sexuality circulating in the 1930s, and how the series opens a dialogue with the feminist thinking of the time especially with the book Lifslinjer I (Love and Marriage, 1903) by the Swedish author Ellen Key. Fröknarna von Pahlen holds a central position in the research on Agnes von Krusenstjerna partly due to the literary debate that the novel series triggered. The debate was connected to the development taking place in the Swedish society in the beginning of the 1930s, in the so-called second phase of the Modern Breakthrough. Sweden was at that time characterized by struggle over the definitions of gender, sexuality and parenthood, and this struggle is also visible in the Pahlen series. The literary debate took place in 1934 1935 and it began after an article by the modernist writer Karin Boye was published in Social-Demokraten on 28 January 1934. In her polemic article, Boye saw the Pahlen series as a sign that the family institution is on the verge of a breakdown and with it the whole moral system that has come to existence through it . Boye went on to state that Krusenstjerna only sees and describes and that she explores neither new literary forms nor new values. Boye wrote the article before the last two parts of the novel series were published, so obviously she could not discuss the utopian vision characterizing those parts. This study, however, strives to demonstrate that Krusenstjerna not only sees and describes, but that she like many of her contemporary female colleagues appears to take the request of Friedrich Nietzsche to revaluate all values seriously. Like the works of her contemporaries, Krusenstjerna s Pahlen series is marked by a double vision on the one hand a critique of the prevailing social order, and on the other hand a dream of a new world and a new human being. In this research the vision of the Pahlen series is characterized as queer in order to emphasize that the series not only criticizes the prevailing gender order and its morals, but is also open for new ways of doing gender, parenthood, and family.

All of Us

All of Us is a ground-breaking Australian government approved anti-bullying educational resource comprised of seven online videos that feature gender diverse, sexual diverse and intersex youths. The videos, along with unit guides and student handouts, have been designed to address a gap in high school curriculum as they teach not just about sexual diversity and gender diversity but also the values of empathy and respect, which has been demonstrated to improve students’ wellbeing and educational engagement. The resource captures the real life experiences of lesbian, gay, bisexual, transgender and intersex young people through a collection of short videos and teaching activities that are aligned to the Year 7/8 Health and Physical Education learning area of the Australian Curriculum. All Of Us has been developed to have a real impact on student attitudes towards lesbian, gay, bisexual, transgender and intersex people and to encourage whole school change that affirms and supports the right of all students, staff and families to feel safe at school. This free video resource is widely available and allows all schools, regardless of experience, location or funding, the chance to create an environment where every student can learn, every teacher can teach and every family can belong from the beginning of 2016. The resource was launched on Thursday, 26 November 2015 at Treasury Theatre, 1 Macarthur St, Melbourne. The launch was attended by almost 200 people including former Safe Schools Coalition Ambassador Jason Ball, Victorian Commissioner for Gender and Sexuality Ro Allen, Chris Bush, Executive Producer of All Of Us, Micah Scott, CEO of Minus18, All Of Us Margot Fink; Safe Schools Coalition Victoria's Manager Roz Ward and; Sally Richardson, National Program Director of Safe Schools Coalition Australia.

Tohtoriksi tulemisen tarina

The study examines the dissertation process. The thesis is based on twenty-three autobiographical stories. They were collected from PhDs who had taken their doctoral degrees at the University of Helsinki. The purpose is to investigate the experiences of these PhD recipients and find out what they recall of the events, traditions, and meanings associated with their PhD studies. An anthology collected from PhDs in the historical sciences, which was published in 1998, was used as reference material. This study begins with a general presentation of the history and values of the university and the traditions of the academic community in Finland. Thereafter, the data and the methodological framework of the study are presented. Attention is paid to the discipline background, sex and age of these PhDs, which may have affected their storytelling. The former studies concerning the academic life together with the experiences of the writers revealed that the process of becoming a PhD graduate is generally considered as an academic rite of passage. The change from student status to becoming a fully accepted professional member of one’s field is real, transforming and at certain points, ritualized. The finding of an inner logic to the doctoral process, which included meaningful turning points, was central to the narrative analysis approach. During the process there were different kinds of struggles and highlights. The family background, university studies and time in employment had directed the doctoral studies of some PhD students enormously. But generally the most memorable and value laden were the phases of actually writing the dissertation, the public examination, and the celebration party in the evening called “karonkka”. The picture that emerged from these various life-stories demonstrated that there was no ivory tower where doctoral candidates live an isolated existence. Everyday cares in ordinary life and tasks in academic life are both demanding and rewarding at the same time. The main point is that the academic community in general and PhD supervisors in particular should concentrate not only on the thesis-writing process their students but also on the doctoral students´ wider life situation. Doctoral students need scientific, financial, and mental support. Somebody must be available to inspire and offer encouragement otherwise the process will be disturbed. The successful completion of the PhD ritual gives the PhD graduate self-confidence and respect but its’ influence on the doctors’ subsequent academic career is diverse. The dissertation process is a personal and unique experience. The aim of the PhD graduation is that this traditional ritual leads to a successful completion and ensures a positive reward for the PhD graduate and the academic community. Keywords: autobiography, narratives, academic traditions, PhD graduates.

Normative values for corneal nerve morphology assessed using corneal confocal microscopy: A multinational normative data set

OBJECTIVE Corneal confocal microscopy is a novel diagnostic technique for the detection of nerve damage and repair in a range of peripheral neuropathies, in particular diabetic neuropathy. Normative reference values are required to enable clinical translation and wider use of this technique. We have therefore undertaken a multicenter collaboration to provide worldwide age-adjusted normative values of corneal nerve fiber parameters. RESEARCH DESIGN AND METHODS A total of 1,965 corneal nerve images from 343 healthy volunteers were pooled from six clinical academic centers. All subjects underwent examination with the Heidelberg Retina Tomograph corneal confocal microscope. Images of the central corneal subbasal nerve plexus were acquired by each center using a standard protocol and analyzed by three trained examiners using manual tracing and semiautomated software (CCMetrics). Age trends were established using simple linear regression, and normative corneal nerve fiber density (CNFD), corneal nerve fiber branch density (CNBD), corneal nerve fiber length (CNFL), and corneal nerve fiber tortuosity (CNFT) reference values were calculated using quantile regression analysis. RESULTS There was a significant linear age-dependent decrease in CNFD (-0.164 no./mm(2) per year for men, P < 0.01, and -0.161 no./mm(2) per year for women, P < 0.01). There was no change with age in CNBD (0.192 no./mm(2) per year for men, P = 0.26, and -0.050 no./mm(2) per year for women, P = 0.78). CNFL decreased in men (-0.045 mm/mm(2) per year, P = 0.07) and women (-0.060 mm/mm(2) per year, P = 0.02). CNFT increased with age in men (0.044 per year, P < 0.01) and women (0.046 per year, P < 0.01). Height, weight, and BMI did not influence the 5th percentile normative values for any corneal nerve parameter. CONCLUSIONS This study provides robust worldwide normative reference values for corneal nerve parameters to be used in research and clinical practice in the study of diabetic and other peripheral neuropathies.

Plasma biochemistry and hematologic values for wild-caught flying foxes (Pteropus giganteus) in India

Although bats of the genus Pteropus are important ecologically as pollinators and natural hosts for zoonotic pathogens, little is known about their basic physiology. Hematology and plasma biochemistries were determined from wild-caught flying foxes (Pteropus giganteus) in northern India (n = 41). Mean lymphocyte differential count was higher for juveniles than adults. Mean platelet count was lower than previously reported. No hemoparasites were observed. No differences were observed between plasma biochemistry values of male and female bats, juveniles and adults, or lactating and nonlactating females. Variation in aspartate aminotransferase (AST) was seen based on body condition score. Blood urea nitrogen and cholesterol concentrations were lower in P. giganteus than other mammalian groups, but were consistent with those reported from other Pteropus species. Alanine aminotransferase and AST concentrations were higher than those reported for Pteropus vampyrus, a closely related species. This study provides basic physiologic information that can be used in future health and disease studies of Indian flying foxes.

Comparing family functionality perception between non-Aymara and indigenous Aymara families in northern Chile

We compared perception of family functioning in a sample (N = 1,496) of Aymara and non-Aymara parents and children living in Arica, Chile. The children were aged from 9 to 15 years and were recruited from the 5th to 8th grades of 9 elementary schools (4 public, 5 government-subsidized private schools) serving lower socioeconomic areas. Participants completed the Family Functioning Test (FF-SIL), which consists of 14 events or characteristics that may occur in a family. The results showed that parents and children from the Aymara group recorded lower scores for their perception of family functioning than did the non-Aymara group. Addressing this issue may be important in the prevention of psychological problems in these families.