‘Breaking good news’: neurologists’ experiences of discussing SUDEP with patients in Scotland

Since the findings of a Fatal Accident Inquiry (FAI) in 2010, clinicians working in Scotland have been advised to discuss the risk of Sudden Unexpected Death in Epilepsy (SUDEP) with patients immediately or soon after a diagnosis of epilepsy is made. A thematic analysis was used to describe the experiences discussing SUDEP of 10 clinicians (six Consultant Neurologists and four Neurology Registrars) working in Scotland. Five themes were found: Clinicians employ a ‘SUDEP protocol’, suggesting there is a standardised way of discussing SUDEP with patients and all clinicians routinely discuss SUDEP with newly diagnosed epilepsy patients; The FAI has diffused into practice through meetings and discussions with colleagues; ‘Breaking Good News’ refers to the ambivalence clinicians feel about discussing SUDEP; ‘Falsely anticipating anxiety’ refers to clinicians anticipating a distressed response from patients despite this very rarely occurring; Clinicians suggest that ‘pressure hinders effective communication’ to patients – suggesting that the pressure to discuss SUDEP early after diagnosis may have an emotional impact on patients and affect the amount of information they can take in. Implications for guideline development are discussed.

Geographical literacy, attitudes, and experiences of freshman students: A qualitative study at Florida International University

The purpose of the study was to explore the geography literacy, attitudes and experiences of Florida International University (FIU) freshman students scoring at the low and high ends of a geography literacy survey. The Geography Literacy and ABC Models formed the conceptual framework. Participants were freshman students enrolled in the Finite Math course at FIU. Since it is assumed that students who perform poorly on geography assessments do not have an interest in the subject, testing and interviewing students allowed the researcher to explore the assumption. ^ In Phase I, participants completed the Geography Literacy Survey (GLS) with items taken from the 2010 NAEP Geography Subject Area Assessment. The low 35% and high 20% performers were invited for Phase II, which consisted of semi-structured interviews. A total of 187 students participated in Phase I and 12 in Phase II. ^ The primary research question asked was what are the geography attitudes and experiences of freshman students scoring at the low and high ends of a geographical literacy survey? The students had positive attitudes regardless of how they performed on the GLS. ^ The study included a quantitative sub-question regarding the performance of the students on the GLS. The students’ performance on the GLS was equivalent to the performance of 12th grade students from the NAEP Assessment. There were three qualitative sub-questions from which the following themes were identified: the students’ definition of geography is limited, students recall more out of school experiences with geography, and students find geography valuable. In addition, there were five emergent themes: there is a concern regarding a lack of geographical knowledge, rote memorization of geographical content is overemphasized, geographical concepts are related to other subjects, taking the high school level AP Human Geography course is powerful, and there is a need for real-world applications of geographical knowledge. ^ The researcher offered as suggestions for practice to reposition geography in our schools to avoid misunderstandings, highlight its interconnectedness to other fields, connect the material to real world events/daily decision-making, make research projects meaningful, partner with local geographers, and offer a mandatory geography courses at all educational levels.^

Romantic relationships and adjustment in early adulthood: The role of cross-sex experience in the context of social norms and support

Attachment and interpersonal theory suggest a sequential pattern of relationships beginning in the earliest stage of development and progressing to social and eventually romantic relationships. Theoretically, cross-sex experiences have an important role in the progression of interpersonal relationships. Despite the prevalence of these theories about the nature of romantic relationship development, the linkage of cross-sex experience (CSE) to romantic relationships has not been established. Indeed, it is an intuitive assumption, especially within Western society and these theories do not consider socio-cultural factors that may influence CSE and relationship satisfaction. This study addresses the varying contextual factors that may contribute to relationship satisfaction and adjustment, aside from CSE, and is divided into two parts. Study 1, addresses CSE, relationship satisfaction, and adjustment in a unique population, ultra-Orthodox Jews. Among this population, social or romantic CSE is limited and sexes are effectively segregated. Study 2, expanded the study to a larger sample of U.S. college students, to assess the linkage of CSE to romantic relationship satisfaction in a more typical Western population. It included social norm and support variables to address the contextual nature of relationship development and satisfaction. Results demonstrated clear differences in the relation between CSE and relationship satisfaction in the two samples. In the first sample CSE was unrelated to relationship satisfaction; nevertheless, relationship satisfaction was associated with adjustment as it is for more typical populations with greater CSE. These results suggested the importance of specifying how social norms and social support relate to CSE, relationship satisfaction and adjustment. The results from the second sample were consistent with the theoretical framework upon which the social/romantic literature is based. CSE was directly connected to relationship satisfaction. As anticipated, CSE, relationship satisfaction, and adjustment also varied as a function of social norms and support. These findings further validate the influence of socio-cultural factors on relationship satisfaction and adjustment. This study contributes to the romantic relationship literature and broadens our understanding of the complex nature of interpersonal and romantic relationships.^

Patient experiences of a bariatric group programme for managing obesity:a qualitative interview study

Objectives: People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients’ experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients’ perceptions of its impact on health outcomes. Design: A qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis. Methods: Twenty patients (12 females) with a BMI ≥ 35 kg/m2 participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery. Results: Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants’ narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight ‘problem’ through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. Discussion: Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes.

“Who wants to go repeatedly to the hospital?” : Perceptions and experiences of simplified medical abortion in Rajasthan, India

The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.

Experiences from the course “Pedagogical Intervention in Preschool Education”: the vision from the faculty trainers, preschool teachers and students

As part of the educational formation of students from II level of the Associate dregree, from the Pedagogy major with an emphasis on preschool teaching from Universidad Nacional. There is a course named “Pedagogical Intervention in Early Childhood Education” which carries out the process of the intensive practicum. In this article you will find a review of the program’s objetives, experiences and challenges, taking the experiences from the academic team, who have guided this process over the past two years, and the point of views from students and preschool teachers.

Enhanced switchgear connection testing through augmented reality: early developments

Augmented reality is an emerging field of interactive design in which virtual material is seamlessly blended with displays of real world environments. The tremendous potential of augmented reality has begun to be explored with the emergence of personal mobile devices capable of constructing engaging augmented reality experiences. This work is part of a project aiming at using augmented reality goggles to bring advance information to the user interacting with switch-gear during automation cabling. In particular we will be focusing on the recognition and definition of the figures of the component on the AR device. In this part we are using standard camera that allows us to get real images and helps us to localize the gearbox in space through ARUCO marker and we can exploit in order to re-project the actual shape of the component that are currently interested in manipulation by exploiting the data provided by the database. The experiments are carried out using the camera to get the images of the real world switch-gear and re-project those images with the component superimposed on it. Using transforms of the database we did localization to re-project the rendered image of component exactly on the real world component, which can be further integrated in AR goggles to see the component superimposed in real-time.

Fractalkine (cx3cl1) Is Involved In The Early Activation Of Hypothalamic Inflammation In Experimental Obesity.

Hypothalamic inflammation is a common feature of experimental obesity. Dietary fats are important triggers of this process, inducing the activation of toll-like receptor-4 (TLR4) signaling and endoplasmic reticulum stress. Microglia cells, which are the cellular components of the innate immune system in the brain, are expected to play a role in the early activation of diet-induced hypothalamic inflammation. Here, we use bone marrow transplants to generate mice chimeras that express a functional TLR4 in the entire body except in bone marrow-derived cells or only in bone marrow-derived cells. We show that a functional TLR4 in bone marrow-derived cells is required for the complete expression of the diet-induced obese phenotype and for the perpetuation of inflammation in the hypothalamus. In an obesity-prone mouse strain, the chemokine CX3CL1 (fractalkine) is rapidly induced in the neurons of the hypothalamus after the introduction of a high-fat diet. The inhibition of hypothalamic fractalkine reduces diet-induced hypothalamic inflammation and the recruitment of bone marrow-derived monocytic cells to the hypothalamus; in addition, this inhibition reduces obesity and protects against diet-induced glucose intolerance. Thus, fractalkine is an important player in the early induction of diet-induced hypothalamic inflammation, and its inhibition impairs the induction of the obese and glucose intolerance phenotypes.

Neonatal Outcomes Of Late Preterm And Early Term Birth.

To compare neonatal deaths and complications in infants born at 34-36 weeks and six days (late preterm: LPT) with those born at term (37-41 weeks and six days); to compare deaths of early term (37-38 weeks) versus late term (39-41 weeks and six days) infants; to search for any temporal trend in LPT rate. A retrospective cohort study of live births was conducted in the Campinas State University, Brazil, from January 2004 to December 2010. Multiple pregnancies, malformations and congenital diseases were excluded. Control for confounders was performed. The level of significance was set at p<0.05. After exclusions, there were 17,988 births (1653 late preterm and 16,345 term infants). A higher mortality in LPT versus term was observed, with an adjusted odds ratio (OR) of 5.29 (p<0.0001). Most complications were significantly associated with LPT births. There was a significant increase in LPT rate throughout the study period, but no significant trend in the rate of medically indicated deliveries. A higher mortality was observed in early term versus late term infants, with adjusted OR: 2.43 (p=0.038). LPT and early term infants have a significantly higher risk of death.

Newborn Hearing Screening And Early Diagnostic In The Nicu.

The aim was to describe the outcome of neonatal hearing screening (NHS) and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage). In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%). Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%), conductive (1.83%) and auditory neuropathy spectrum (0.19%).

Hypothermia And Early Neonatal Mortality In Preterm Infants.

To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants. This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.

Experiences From The Brazilian Atlantic Forest: Ecological Findings And Conservation Initiatives.

The Brazilian Atlantic Forest hosts one of the world's most diverse and threatened tropical forest biota. In many ways, its history of degradation describes the fate experienced by tropical forests around the world. After five centuries of human expansion, most Atlantic Forest landscapes are archipelagos of small forest fragments surrounded by open-habitat matrices. This 'natural laboratory' has contributed to a better understanding of the evolutionary history and ecology of tropical forests and to determining the extent to which this irreplaceable biota is susceptible to major human disturbances. We share some of the major findings with respect to the responses of tropical forests to human disturbances across multiple biological levels and spatial scales and discuss some of the conservation initiatives adopted in the past decade. First, we provide a short description of the Atlantic Forest biota and its historical degradation. Secondly, we offer conceptual models describing major shifts experienced by tree assemblages at local scales and discuss landscape ecological processes that can help to maintain this biota at larger scales. We also examine potential plant responses to climate change. Finally, we propose a research agenda to improve the conservation value of human-modified landscapes and safeguard the biological heritage of tropical forests.

[the Modified Us7 Score In The Assessment Of Synovitis In Early Rheumatoid Arthritis].

To evaluate the modified US7 score (MUS7 score SYN) in the assessment of patients with early rheumatoid arthritis (ERA). In addition, dorsal and palmar recesses of the wrists as well as of small joints of the hands and feet were examined for the presence of synovitis by means of a global assessment of joints. The study sample comprised 32 patients treated for arthritis, with an average disease duration of 13 months. An ultrasound machine with high frequency transducer was used. Hands were also X-rayed and analysed by Larsen score. Out of the 832 examined joints, synovitis was detected in 173 (20,79%), tenosynovitis in 22 (4,91%), and erosions in 3 (1,56%). Synovitis was predominantly detected in the dorsal recess (73,38%) of MCP and PIP joints, when compared with palmar recess (26%). The presence of synovitis in the joints evaluated correlated with clinical (HAQ-DI, DAS28), laboratory (ACPA, RF, CRP), and ultrasound results (r = 0,37 to r = 0,42; p = 0,04 to p = 0,003). We found correlation of the MUS7 score SYN of the gray scale US or of the power Doppler US with DAS28 (PCR) values (r = 0,38; p = 0,0332), and with CRP results (r = 0,39; p = 0,0280), respectively. The dorsal recess, the wrist, and small joints can be considered as important sites to detect synovitis by the MUS7 score SYN in patients with ERA.

Facial Changes After Early Treatment Of Unilateral Coronal Synostosis Question The Necessity Of Primary Nasal Osteotomy.

The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS. Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed. Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05). Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.

Prospects For Early Investigational Therapies For Sickle Cell Disease.

Sickle cell disease (SCD) is a genetic disorder characterized by the production of abnormal hemoglobin that polymerizes at low oxygen concentrations, causing the erythrocyte to adopt a sickle-shaped morphology. SCD pathophysiology is extremely complex and can lead to numerous clinical complications, including painful vaso-occlusive crises (VOC), end-organ damage, and a shortened lifespan. An impressive number of investigational drugs are currently in early stages of clinical development with prospects for use either as chronic therapies to reduce VOC frequency and end-organ damage in SCD or for use at the time of VOC onset. Many of these agents have been developed using a pathophysiological-based approach to SCD, targeting one or more of the mechanisms that contribute to the disease process. It is plausible that a multi-drug approach to treating the disease will evolve in the coming years, whereby hydroxyurea (HU) (the only drug currently FDA-approved for SCD) is used in combination with drugs that amplify nitric oxide signaling and/or counteract hemolytic effects, platelet activation and inflammation.