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This paper sets out to discuss pedagogical aspects of a collaborative project between Denmark and South Africa, two partner countries with a long history of educational partnerships. The project na...

Background:Fremanezumab is an anti-calcitonin gene-related peptide monoclonal antibody efficacious for chronic migraine prophylaxis. We evaluated real-world prophylactic efficacy of fremanezumab for refractory chronic migraine in a United Kingdom specialist centre (Hull Migraine Clinic).Methods:289 adult chronic migraineurs commenced fremanezumab with prospective follow-up, maintaining headache diaries for ≥1 month pre-fremanezumab initiation and continuously thereafter. Patients failed 6 median previous prophylactics. We measured monthly headache days, migraine days, headache-free days, analgesia medication days, triptan days and Headache Impact Test-6 scores at baseline and during treatment.Results:All outcomes significantly improved in results of 182 patients at 4-month follow-up (p50% and >75% reduction. 58%, 39% and 17% patients achieved ≥30%, >50% and >75% headache day reduction. OnabotulinumtoxinA-unresponsive patients exhibited substantial responses, with 78%, 66% and 39% patients achieving ≥30%, >50% and >75% migraine reduction. Medication-overuse did not affect responses. 45% patients achieved ppConclusion:Fremanezumab demonstrates real-world efficacy at 4 months in highly-refractory and onabotulinumtoxinA-unresponsive chronic migraine, irrespective of medication-overuse. Baseline headache-freedom, lower migraine-days and lower Headache Impact Test-6 score heralded superior responses.

Neuropathic pain is a significant problem with few effective treatments lacking adverse effects. The sigma-1 receptor (S1R) is a potential therapeutic target for neuropathic pain, as antagonists for this receptor effectively ameliorate pain in both preclinical and clinical studies. The current research examines the antinociceptive and anti-allodynic efficacy of SI 1/28, a recently reported benzylpiperazine derivative and analog of the S1R antagonist SI 1/13, that was 423-fold more selective for S1R over the sigma-2 receptor (S2R). In addition, possible liabilities of respiration, sedation, and drug reinforcement caused by SI 1/28 have been evaluated. Inflammatory and chemical nociception, chronic nerve constriction injury (CCI) induced mechanical allodynia, and adverse effects of sedation in a rotarod assay, conditioned place preference (CPP), and changes in breath rate and locomotor activity were assessed after i.p. administration of SI 1/28. Pretreatment with SI 1/28 produced dose-dependent antinociception in the formalin test, with an ED50 (and 95% C.I.) value of 13.2 (7.42–28.3) mg/kg, i.p. Likewise, SI 1/28 produced dose-dependent antinociception against visceral nociception and anti-allodynia against CCI-induced neuropathic pain. SI 1/28 demonstrated no impairment of locomotor activity, conditioned place preference, or respiratory depression. In summary, SI 1/28 proved efficacious in the treatment of acute inflammatory pain and chronic neuropathy without liabilities at therapeutic doses, supporting the development of S1R antagonists as therapeutics for chronic pain.

International Journal of Education and the Arts, Volume 23

PURPOSE: Numerous etiologies may lead to nonimmune hydrops fetalis (NIHF), and the underlying cause often remains unclear. We aimed to determine the proportion of NIHF cases in which the etiology was clearly determined in a large, contemporary, and diverse cohort, as well as to describe the etiologies with a focus on genetic causes. METHODS: Retrospective review of NIHF cases between 2015 and 2017 from the five University of California Fetal–Maternal Consortium sites. Singleton pregnancies with prenatally diagnosed NIHF were included, and cases with maternal alloimmunization were excluded. Cases were categorized as being of confirmed, suspected, or unknown etiology. RESULTS: Sixty-five NIHF cases were identified. Forty-six percent (30/65) remained of unknown etiology, while 9.2% (6/65) had a suspected etiology and 44.6% (29/65) were of confirmed etiology. Among confirmed cases, 11 resulted from aneuploidy; 7 from fetal structural anomalies; 2 each from fetal arrhythmia, Noonan syndrome, and generalized lymphatic dysplasia; and 1 each from arthrogryposis, parvovirus, neonatal alloimmune thrombocytopenia, fetal goiter, and Kasabach–Merritt syndrome. CONCLUSION: In this contemporary, multicenter study, the cause of prenatally diagnosed NIHF was confirmed in only 44% of cases, and a genetic etiology was found in only 25% of those that received standard of care genetic testing.

Conboy Lake National Wildlife Refuge (CLNWR) in Washington State supports one of the largest remaining populations of federally listed Oregon Spotted Frogs (OSF; Rana pretiosa). Invasive American Bullfrogs (Lithobates catesbeianus [Rana catesbeiana]), implicated in amphibian declines, are also abundant at CLNWR. Owing to the likely negative effect of this aquatic invader on the highly aquatic OSF, bullfrog control strategies are needed. One method is to limit habitat used by bullfrogs while retaining or enhancing OSF habitat, but for such an approach to be implemented, the 2 species must partition habitat sufficiently. We used radiotelemetry to characterize OSF and bullfrog active-season and pre-overwintering habitat in the human-engineered ditch system at CLNWR. We tracked 12 OSF and 10 bullfrogs from mid-to-late summer, recorded data on frog location and habitat, and analyzed movement patterns, niche breadth, and spatial differences between species. Based on minimum convex polygons, bullfrogs overlapped extensively with OSF habitat space in the ditch system. During the active season, niche analyses also showed extensive overlap in the species' vegetation associations, with selected exceptions at the microhabitat scale. However, each species used distinct pre-overwintering habitats. The small differences in active-season microhabitats and pre-overwintering habitats, and our relatively narrow study conditions, create uncertainty about these species' habitat use in a broader context. Nonetheless, these results underscore the challenge of managing an invasive species that is both a habitat generalist and congener and expose the need for further research to guide management approaches to favor OSFs at CLNWR.

This chapter challenges the popular focus on well-being or happiness as the new over-arching policy goal of public and private sectors. It argues instead for a traditional social policy focus on income distribution and social justice as the means to achieve the greatest improvements in well-being. Using a variety of measures, data from the PSE-UK 2012 survey are analysed to demonstrate the material basis of well-being and low life satisfaction. The results show that average well-being scores for those living in poverty are well below the scores for the non-poor. Living with a limiting illness or disability was also found to have a substantial negative effect on well-being. Overall satisfaction with life falls more sharply as household incomes fall, indicating that there are particular gains to be had from focusing on the material needs of the most disadvantaged. Income redistribution is not therefore a zero-sum game. Rather, the results show that the lives of the poor and the long-term sick and disabled would be measurably improved by lifting them out of poverty and improving their material conditions. All in all, the results challenge the idea that well-being is ‘all in the mind’ and detached from material resources.

Townsend argued that poverty is a key barrier to social participation as it limits people’s ability to participate in social activities and to maintain social relationships or networks. The results in this chapter support this argument finding that poverty acts as a barrier to social contact, particularly with friends; that it constrains participation in a range of social activities, and; that it shapes perceptions of support and satisfaction with relationships. People experiencing social and material deprivation have less social contact than they would like, and attribute this to cost or affordability problems, although other factors such as health or caring responsibilities can play a role too. That said, the importance of contact with family in particular emerges clearly in this analysis. For those groups where there are likely to be additional needs for support as a result of poverty, caring roles or health problems, contact with family tends to be significantly higher - likely reflecting the importance of family as both the central source of financial resources and of practical and emotional support. Households in these groups who lack access to such family networks may face particular disadvantages. All in all, the study finds that people experiencing poverty are often in effect excluded from widely accepted norms of social participation in the UK today.

This paper considers arts-based research (ABR) as a useful resource for creating fluid and dialogic spaces between multiple domains of dance knowledge and practices. Through the lens of a multi-disciplinary, arts-based research project Same Story, Different Countries explored the socio-political phenomena of racism in the United States and South Africa. The paper illuminates how arts-based research can bridge important areas of learning, in particular artistic knowledge and social justice learning for postsecondary dance students, teachers and artists. Using a mixed method of qualitative techniques and artistic dance practices the study captured and analyzed dance participants’ perspectives on the benefits of being involved in the project. The project was found to increase participants’ knowledge of various dance practices (performance, choreography, teaching, research) while simultaneously deepening their understanding of racism and racial injustice, and awakening their sense of social responsibi...

Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy.Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05).Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision.Funding: British Heart Foundation.

OBJECTIVES To measure serial interleukin (IL)-6 levels in newly diagnosed patients with giant cell arteritis (GCA), treated in a randomized controlled trial of modified-release prednisone (MR) vs immediate-release prednisolone (IR) used in a tapering regimen conforming to British Society for Rheumatology GCA guidelines. METHODS Patients (n = 12) were randomized into 2 treatment arms (7 MR, 5 IR) and followed over 26 weeks. We measured IL-6 with additional markers. RESULTS A significantly higher overall mean IL-6 level (P

Little has been published regarding general and pelvic floor-related health status in patients who have undergone surgery for colorectal cancer (CRC).The objective of the study was to assess changes in pelvic floor symptoms, physical activity levels, psychological status, and health-related quality of life (HRQoL) in patients with CRC from pre- to 6 months postoperatively.Pelvic floor symptoms, physical activity levels, anxiety and depression, and HRQoL of 30 participants who were undergoing surgery for stages I-III CRC were evaluated pre- and 6 months postoperatively.Six months postoperatively, there were no significant changes in severity of pelvic floor symptoms, or other secondary outcomes (physical activity levels, depression, global HRQoL) compared to preoperative levels (p 0.05). However, fecal incontinence (p = 0.03) and hair loss (p = 0.003) measured with the HRQoL instrument were significantly worse. Participants were engaged in low levels of physical activity before (42.3%) and after surgery (47.4%).The findings of a high percentage of participants with persistent low physical activity levels and worse bowel symptoms after CRC surgery compared to preoperative levels suggest the need for health-care professionals to provide information about the benefits of physical activity and bowel management at postoperative follow-ups. Further investigation in larger studies is warranted.

Chronic hepatitis B virus infection cannot be cured by current therapies, so new treatments are urgently needed. We recently identified novel inhibitors of the hepatitis B virus ribonuclease H that suppress viral replication in cell culture. Here, we employed immunodeficient FRG KO mice whose livers had been engrafted with primary human hepatocytes to ask whether ribonuclease H inhibitors can suppress hepatitis B virus replication in vivo. Humanized FRG KO mice infected with hepatitis B virus were treated for two weeks with the ribonuclease H inhibitors #110, an α-hydroxytropolone, and #208, an N-hydroxypyridinedione. Hepatitis B virus viral titers and S and e antigen plasma levels were measured. Treatment with #110 and #208 caused significant reductions in plasma viremia without affecting hepatitis B virus S or e antigen levels, and viral titers rebounded following treatment cessation. This is the expected pattern for inhibitors of viral DNA synthesis. Compound #208 suppressed viral titers of both hepatitis B virus genotype A and C isolates. These data indicate that Hepatitis B virus replication can be suppressed during infection in an animal by inhibiting the viral ribonuclease H, validating the ribonuclease H as a novel target for antiviral drug development.

Objectives To provide an account of implementation of the Epic Beaker 2014 clinical pathology module at Stanford University Medical Center and highlight strengths and weaknesses of the system. Methods Based on a formal selection process, Stanford selected Epic Beaker to replace Sunquest as the clinical laboratory information system (LIS). The rationale included integration between the LIS and already installed Epic electronic medical record (EMR), reduction in the number of systems and interfaces, and positive patient identification (PPID). The build was significantly customized and included a first of its kind Epic-to-Epic interface. This was due to the clinical laboratory serving two hospitals (pediatric and adult) with independent instances of Epic. Results Test turnaround times showed improvement from historical baselines, mostly because of the implementation of PPID. PPID also resulted in significant reduction in mislabeled specimens. Conclusions Epic 2014 Beaker clinical pathology is a viable LIS with adequate functionality for a large academic center. Strengths include PPID and integration with the EMR. Integration provides laboratory users with ready access to the patient's relevant clinical history to assist releasing of results and gives physician and nurse providers sophisticated add-on ordering and specimen collection workflows. Areas that could use further development include specimen aliquoting, quality control reporting, and maintenance tools.

Historically, during the first wave of globalization, then known as colonialism, efforts were made by colonizers to silence indigenous cultural expressions as a means of establishing power and control. In this current wave of globalization, which is marked by an aggressive technological revolution that has facilitated greater connectedness and spread of the more dominant North Atlantic aesthetic values and practices across the globe, Afro-Caribbean traditional cultural expressions face the potential risk of being obsolete and powerless in the dancing lives of young studio-based dancers in the Caribbean. This paper presents findings of a qualitative study into measures taken by Caribbean dance teachers (n = 6), from Jamaica, Grenada, and St. Vincent and the Grenadines, to promote Afro-Caribbean movement aesthetics and practices in their dance studios with young people. I will argue that such measures are important to the empowerment of the Afro-Caribbean dancing body and to safeguard against colonial structures in post-colonial Caribbean dance education.

Background/aim The National Male Health Policy identifies several groups of males at different transitional life stages that are at particular risk, including teenage boys at risk of social exclusion and recently retired older men. A novel intergenerational mentoring program was developed to bring these groups together through participation in meaningful occupation. This research aimed to investigate the mentors' experiences of the program, their views about the teenage boys and the structure of the program. Methods Nine teenage boys (14–16 years) at risk of social exclusion participated in a weekly shared construction project with older male mentors (60–75 years) at a local Sydney school over one school term. A post-project focus group and individual interviews were conducted with six of the mentors pre- and post-project. Data were analysed using the constant comparative method of grounded theory; all authors developed themes individually and then collectively. Results The core theme that emerged was a values-led male reconnection. Centred in themes of gendered valuing, respect, tradition and the handing down of life experience, occupational engagement was integral to bridging the generational gap and facilitating intergeneration discourse. Conclusion Older males with a strong sense of generativity are a valuable resource in delivering such programs, and reported a sense of accomplishment and enhanced self-worth. Given the central role that occupational engagement played in fusing the project, this study highlights the untapped role of occupational therapy in developing programs aimed at promoting the health and wellbeing of Australian men.

Summary Backgrounds & aims Malnutrition in western health care involves a tremendous burden of illness. In this study the economic implications of malnutrition in Dutch nursing homes are investigated as part of the Health and Economic Impact of Malnutrition in Europe Study from the European Nutrition for Health Alliance. Methods A questionnaire was developed, focussing on the additional time and resources spent to execute all relevant nutritional activities in nursing home patients with at risk of malnutrition or malnourished. Results were extrapolated on national level, based on the prevalence rates gathered within the national Prevalence Measurement of Care Problems 2009. Results The normal nutritional costs are 319 million Euro per year. The total additional costs of managing the problem of malnutrition in Dutch nursing homes involve 279 million Euro per year and are related to extra efforts in nutritional screening, monitoring and treatment. The extra costs for managing nursing home residents at risk of malnutrition are 8000 euro per patient and 10000 euro for malnourished patients. Conclusions The extra costs related to malnutrition are a considerable burden for the nursing home sector and urge for preventive measures.

Recruitment and retention issues in cardiorespiratory physiotherapy (CRP) have led to concerns for the future of this specialist area of physiotherapy. This study evaluated the career choices of student physiotherapists and elicited factors that influenced their perceptions of CRP. A postal questionnaire to two schools of physiotherapy in New Zealand and two in Australia was administered. Final year students were randomly selected and invited to complete the questionnaire. Details of respondents’ clinical experience, future career intentions, and perceptions of CRP as a specialism were ascertained. A response rate of 61% (n= 149) was obtained. Although the majority of respondents had undertaken cardiorespiratory placements, only 3% of respondents reported being “extremely interested” in specializing in CRP. The variety and timing of clinical placements and educational and clinical supervision were key factors that had the potential to both positively and negatively influence students’ opinions of CRP. An understanding of the role of CRP beyond that of inpatient care appeared limited. To promote uptake of CRP as a career option, clinicians, educators, and managers should strive to provide positive clinical placements and educational opportunities. The extensive scope of clinical practice of cardiorespiratory physiotherapists could be a greater focus within physiotherapy curricula.

summary Background & aims: To examine the effect of malnutrition on clinical outcomes and healthcare resource use from initial diagnosis by a general practitioner (GP) in the UK. Methods: 1000 records of malnourished patients were randomly selected from The Health Improvement Network database and matched with a sample of 996 patients’ records with no previous history of malnutrition. Patients’ outcomes and resource use were quantified for six months following diagnosis. Results: Malnourished patients utilised significantly more healthcare resources (e.g. 18.90 versus 9.12 GP consultations; p < 0.001, and 13% versus 5% were hospitalised; p < 0.05). The six-monthly cost of managing the malnourished and non-malnourished group was £1753 and £750 per patient respectively, generating an incremental cost of care following a diagnosis of malnutrition of £1003 per patient. Thirteen percent and 2% of patients died in the malnourished and non-malnourished group respectively (p < 0.001). Independent predictors of mortality were: malnutrition (OR: 7.70); age (per 10 years) (OR: 10.46); and the Charlson Comorbidity Index Score (per unit score) (OR: 1.24). Conclusion: The healthcare cost of managing malnourished patients was more than twice that of managing non-malnourished patients, due to increased use of healthcare resources. After adjusting for age and comorbidity, malnutrition remained an independent predictor of mortality.

Summary Background As the proportion of survivors from breast cancer increases it is possible that follow-up care could be delivered wholly by generalists to relieve over subscribed hospital clinics. However, guidelines seldom take into account the nature of interactions between patients and health care professionals involved in hospital-based follow-up. Methods Consultations between four Specialist Breast Nurses (SBNs) and 21 consecutive women attending a hospital-based breast cancer follow-up clinic in Western Australia were audio recorded and subjected to a thematic analysis. Recording of consultations ceased with saturation of themes. We analysed the data with reference to theoretical frameworks which postulate that social support is a powerful factor in determining positive health outcomes. We also drew on theories focusing on biographical disruption, biographical reinforcement and biographical reinvention. Results The majority of participants were Australian born, married women in their sixties. The mean duration of the consultations was 19min (SD=7.5, min=8, max=43.5). A core theme was the established relationship between the woman and her SBN. Overall, the SBNs played an important role in facilitating the transition of patients by supporting the woman in adjustment to a new self-image and bodily functioning. The SBN accompanies each woman through this phase in her life, while supporting a new narrative, promoting her ‘rebirth' as someone with ideas, concerns and expectations that have altered significantly after the diagnosis of cancer. Five key themes emerged to demonstrate this supportive role: normalising; facilitating access to services; prevention; promoting self-esteem and promoting a proactive approach. Conclusions Many women with breast cancer claimed a new perspective on what was now possible, acceptable or desirable in a host of life domains. Our data suggest that the follow-up care of cancer patients is more than just dealing with a checklist of symptoms but requires an understanding of the biographical disruption occasioned by a diagnosis of breast cancer.

Author(s): Sparks, Teresa N; Thao, Kao; Lianoglou, Billie; Datkhaeva, Ilina; Fratto, Victoria; Laurent, Louise; Mardy, Anne H; Murphy, Aisling M; Wilson, Lisa; Norton, Mary E

BACKGROUND:Although clinicians in both primary and tertiary care settings are involved in the care of breast cancer patientsfollowing the active treatment phase, few studies report how patients interact with health care providers.METHODS:Participants in this breast cancer follow-up study were recruited from a hospital based nurse-led follow-upclinic in Western Australia. Methods included audio taped, transcribed consultations with Specialist BreastNurses (SBNs) and patient self-completed surveys.RESULTS:Preliminary data suggest that SBNs play an important role in supporting women to deal with the impact ofbreast cancer in the years following active treatment. The data suggest that the process of adjustment to adiagnosis of cancer continues for many years after the treatment has ceased. In many cases the women requireon-going support to recalibrate their response to normal physical changes that may or may not be aconsequence of surgery, radiotherapy and chemotherapy.CONCLUSIONS:These preliminary data map the plethora of issues that influence cancer patients in the years followingtreatment. Women who were attending follow-up appointments for breast cancer experienced similar levels ofenablement following SBN consultations as would be expected from consultations with general practitioners.

Objective: To evaluate three current tonsillectomy techniques—intracapsular microdebridement, intracapsular coblation, and traditional extracapsular electrocautery dissection—comparing surgical parameters, efficacy, and morbidity in the treatment for obstructive sleep disordered breathing in children. Study Design: Prospective, double-blinded study with follow-up by telephone interview. Method: From February 2004 to July 2006, a total of 156 patients between the ages of 6 months and 22 years scheduled for adenotonsillectomy were randomly assigned to electrocautery, coblator, and microdebrider groups. Outcome Measures: 1) Patient demographics; 2) Intraoperative time; 3) Surgeon's perception of difficulty; 4) Indicators of postoperative morbidity: pain, use of pain medication, return to diet, and activity level; 5) Complications; 6) Cost. Results: Microdebrider technique produced the shortest total surgical time, averaging 16 minutes. Use of coblation resulted in 2 less days of pain medication compared to electrocautery. Patients in the coblator and microdebrider groups returned to a normal diet 1.51 days and 1.77 days earlier, respectively, than in the electrocautery group. They also returned to preoperative activity levels 1.85 days and 2.06 days earlier than in the electrocautery group. Of all three methods, the microdebrider was the most cost effective. The coblator and microdebrider did not differ significantly from each other in all other parameters. The three techniques showed no statistically significant difference in assessment of difficulty, average pain scores, or postoperative complications. Conclusions: Postoperative recovery following intracapsular adenotonsillectomy in children with obstructive sleep apnea is significantly earlier with use of either the coblator or microdebrider versus traditional extracapsular tonsillectomy with electrocautery. Microdebrider and coblator were comparable in all other areas except for shorter operative time and less cost for the microdebrider. Laryngoscope, 119:162–170, 2009