Training-induced modifications of corticospinal reactivity in severely affected stroke survivors

When permitted access to the appropriate forms of rehabilitation, many severely affected stroke survivors demonstrate a capacity for upper limb functional recovery well in excess of that formerly considered possible. Yet, the mechanisms through which improvements in arm function occur in such profoundly impaired individuals remain poorly understood. An exploratory study was undertaken to investigate the capacity for brain plasticity and functional adaptation, in response to 12-h training of reaching using the SMART Arm device, in a group of severely affected stroke survivors with chronic upper limb paresis. Twenty-eight stroke survivors were enroled. Eleven healthy adults provided normative data. To assess the integrity of ipsilateral and contralateral corticospinal pathways, transcranial magnetic stimulation was applied to evoke responses in triceps brachii during an elbow extension task. When present, contralateral motor-evoked potentials (MEPs) were delayed and reduced in amplitude compared to those obtained in healthy adults. Following training, contralateral responses were more prevalent and their average onset latency was reduced. There were no reliable changes in ipsilateral MEPs. Stroke survivors who exhibited contralateral MEPs prior to training achieved higher levels of arm function and exhibited greater improvements in performance than those who did not initially exhibit contralateral responses. Furthermore, decreases in the onset latency of contralateral MEPs were positively related to improvements in arm function. Our findings demonstrate that when severely impaired stroke survivors are provided with an appropriate rehabilitation modality, modifications of corticospinal reactivity occur in association with sustained improvements in upper limb function.

Irish Social Work and Social Care Law

Irish Social Work and Social Care Law is a new textbook that introduces students to the law governing the practice of social work and social care in Ireland. The book provides a clear and concise guide to both the legal framework and the substantive law relating to social care and social work. It presents social care and social work law in an accessible manner, focussing on the specialist functions performed by social care professionals such as child protection, adopting and fostering, disability and mental health. It also considers the broader issues that affect service users in a social care context such as domestic violence, youth justice and the asylum system.

Defending the Faith(s)?:Democracy and Hereditary Right in England

The persistence of traditional monarchies in modern societies, which are otherwise characterized by democratic and egalitarian values, remains a paradox in the social sciences. In part this is attributable to the lack of psychological investigation into the relationship between subject and sovereign, and in particular the ways in which the political and social values of the citizenry shape understandings of a hereditary monarch’s right to represent a national community. Adopting the qualitative analysis methods of discursive psychology and grounded theory, the current study examines vernacular accounts of nationhood and monarchy in England in both formalized conversational interviews (n = 60) and impromptu street interviews (n = 56). Focusing on accounts of Prince Charles’s recent proposal to change the role of the monarch, from “Defender of the (Christian) Faith” to “Defender of Faiths,” those in favor treated it as a positive step towards reflecting a diverse (religious) community, bringing the monarchy into line with current concerns of pluralism and upholding
values of personal choice and individual rights. Participants who rejected the proposed change in title construed it as antithetical to these values in terms of reflecting personal stake and interest, an abuse of power, or an imposition on other faiths. In all accounts, the prime concern was in safeguarding the political and social values of the citizenry. In conclusion it is argued that the study of subjects’ relationship to the monarch, its function and legitimacy, can provide an opportunity to examine how values can characterize a national community and facilitate national diversity.

Holocene tephras highlight complexity of volcanic signals in Greenland ice cores

Acidity peaks in Greenland ice cores have been used as critical reference horizons for synchronizing ice core records, aiding the construction of a single Greenland Ice Core Chronology (GICC05) for the Holocene. Guided by GICC05, we examined sub-sections of three Greenland cores in the search for tephra from specific eruptions that might facilitate the linkage of ice core records, the dating of prehistoric tephras and the understanding of the eruptions. Here we report the identification of 14 horizons with tephra particles, including 11 that have not previously been reported from the North Atlantic region and that have the potential to be valuable isochrons. The positions of tephras whose major element data are consistent with ash from the Katmai AD 1912 and Öraefajökull AD 1362 eruptions confirm the annually resolved ice core chronology for the last 700 years. We provide a more refined date for the so-called “AD860B” tephra, a widespread isochron found across NW Europe, and present new evidence relating to the 17th century BC Thera/Aniakchak debate that shows N. American eruptions likely contributed to the acid signals at this time. Our results emphasize the variable spatial and temporal distributions of volcanic products in Greenland ice that call for a more cautious approach in the attribution of acid signals to specific eruptive events.

Public health education for midwives and midwifery students: a mixed methods study

Background: Current national and international maternity policy supports the importance of addressing public health goals and investing in early years. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health. Midwives are in a unique position, given the emphasis of the philosophy of midwifery care on building relationships and incorporating a holistic approach, to support women to make healthy choices with the aim of promoting health and preventing ill health. However, exploration of the educational preparation of midwives to facilitate public health interventions has been relatively limited. The aim of the study was to identify the scope of current midwifery pre registration educational provision in relation to public health and to explore the perspectives of midwives and midwifery students about the public health role of the midwife.

Methods: This was a mixed methods study incorporating a survey of Higher Educational Institutions providing pre registration midwifery education across the UK and focus groups with midwifery students and registered midwives.

Results: Twenty nine institutions (53% response) participated in the survey and nine focus groups were conducted (59 participants). Public health education was generally integrated into pre registration midwifery curricula as opposed to taught as a discrete subject. There was considerable variation in the provision of public health topics within midwifery curricula and the hours of teaching allocated to them. Focus group data indicated that it was consistently difficult for both midwifery students and midwives to articulate clearly their understanding and definition of public health in relation to midwifery.

Conclusions: There is a unique opportunity to impact on maternal and infant health throughout the reproductive period; however the current approach to public health within midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.

Regional Follow up of Late Preterm Neonatal Intensive Care Graduates: Methodological Considerations.

The aim is to guide researchers who are contemplating embarking on research by discussing the methodological challenges encountered in a retrospective follow-up study of three-year-old, late preterm infants (LPIs) who received neonatal intensive care (NIC) in Northern Ireland in 2006. The importance of effective research examining the longer term outcomes of infants admitted to NIC has received increasing recognition. Follow-up cohort and longitudinal studies have grown in number globally, yet the research methodology relating to follow up of NIC graduates is unclear. This paper highlights the methodological challenges of conducting retrospective follow-up research, from the initial planning stages through to the collection of data from the children, including identification of infants from a retrospective database, ethical issues, child-safety concerns and recruitment challenges. This paper creates an awareness of potential issues that may arise in follow-up research with NIC graduates. The paper also offers practical and effective examples of dealing with these issues, helping to ensure the smooth running of an ethical, professionally conducted, methodologically sound and clinically relevant follow-up study.

Components of Shame and Eating Disturbance among Clinical and Non-Clinical Populations

OBJECTIVE: To examine the association between components of shame (characterological, behavioural and bodily) and eating disturbance.

METHOD: This was a cross sectional study of 859 female and 256 male participants from the general population [non-clinical (NCP)] and 167 female participants from an eating disordered population [clinical (CP)] completing the Experience of Shame Scale. The NCP samples also completed the Eating Attitudes Test-26, and the CP samples completed the Eating Disorder Risk Composite of the Eating Disorder Inventory-3. Participants were recruited via schools/colleges, eating disorder charities and the Internet.

RESULTS: Bodily and characterological shame were independently predictive of eating disturbance in female NCP samples (both, p?<?.001); bodily shame was uniquely predictive of eating disturbance for the male NCP (p?<?.05) and female CP samples (p?<?.001).

CONCLUSION: The aetiology of eating disturbance may be different for male and female NCP samples. The male NCP and the female CP samples displayed a similar pathway to eating disturbance. It is important to acknowledge the different components of shame associated with eating disturbance in different populations.

Posting Incognito ... Males with Eating Problems: Online Emotional Expression and Support

Qualitative research in the area of eating disorders (eds) has predominantly focused on females,whilst the experiences of males’ remains poorly understood. due to the secretive nature of eating problems/eds it can be difficult to explore the experiences of males with these problems; however, online support groups/message boards, which are common and popular, provide a non-invasive
forum for researchers to conduct research. This study analyzed naturally occurring discussions on an internet message board dedicated to males and eating problems using content analysis. Two major overarching themes of emotional expression (sharing feelings of disturbed eating attitudes and emotions; being secretive) and support (informational and emotional) were identified. The message board provided a vital support system for this group, suggesting that online message boards may be an important avenue for health professionals to provide information, support, and advice.

New susceptibility Loci associated with kidney disease in type 1 diabetes

Diabetic kidney disease, or diabetic nephropathy (DN), is a major complication of diabetes and the leading cause of end-stage renal disease (ESRD) that requires dialysis treatment or kidney transplantation. In addition to the decrease in the quality of life, DN accounts for a large proportion of the excess mortality associated with type 1 diabetes (T1D). Whereas the degree of glycemia plays a pivotal role in DN, a subset of individuals with poorly controlled T1D do not develop DN. Furthermore, strong familial aggregation supports genetic susceptibility to DN. However, the genes and the molecular mechanisms behind the disease remain poorly understood, and current therapeutic strategies rarely result in reversal of DN. In the GEnetics of Nephropathy: an International Effort (GENIE) consortium, we have undertaken a meta-analysis of genome-wide association studies (GWAS) of T1D DN comprising ~2.4 million single nucleotide polymorphisms (SNPs) imputed in 6,691 individuals. After additional genotyping of 41 top ranked SNPs representing 24 independent signals in 5,873 individuals, combined meta-analysis revealed association of two SNPs with ESRD: rs7583877 in the AFF3 gene (P?=?1.2×10(-8)) and an intergenic SNP on chromosome 15q26 between the genes RGMA and MCTP2, rs12437854 (P?=?2.0×10(-9)). Functional data suggest that AFF3 influences renal tubule fibrosis via the transforming growth factor-beta (TGF-ß1) pathway. The strongest association with DN as a primary phenotype was seen for an intronic SNP in the ERBB4 gene (rs7588550, P?=?2.1×10(-7)), a gene with type 2 diabetes DN differential expression and in the same intron as a variant with cis-eQTL expression of ERBB4. All these detected associations represent new signals in the pathogenesis of DN.

Improved prognosis for congenital nephrotic syndrome of the Finnish type in Irish families

Congenital nephrotic syndrome of the Finnish type is a rare autosomal recessive disease with a high infant mortality without aggressive treatment. The biochemical basis of the disease is not understood fully but the disease locus has been mapped recently to chromosome 19q12-q13.1 in Finnish families. This paper describes the clinical features and outcome of 20 patients in Ireland with congenital nephrotic syndrome of the Finnish type who have presented since 1980. Before 1987, all infants died by the age of 3 years. After the introduction of daily intravenous albumin infusion, nutritional support, elective bilateral nephrectomy, and renal transplantation, mortality in the past decade has fallen to 30%, with no deaths in the past five years. Genetic linkage analysis was performed in six families in whom DNA was available and the locus responsible was mapped to the same region on chromosome 19 as in Finnish families, suggesting that Irish families share the same disease locus.