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BackgroundJuvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child’s treatment and may experience anxiety and powerlessness concerning their child’s illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents’ confidence in managing their child’s illness and reduce parenting stress. ObjectiveThe aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. MethodsA multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child’s health care, satisfaction with health care, and child’s health-related quality of life. ResultsA total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. ConclusionsThe WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730

Cardiac haemangiomas are rare causes of atrial masses. This case report is of a 44-year-old male who presented with a right atrial mass that was found incidentally on a CT performed for renal colic. The mass was further investigated with a transthoracic echocardiogram that showed that it was echodense and arising from the Eustachian valve in the right atrium. Coronary angiogram revealed large well-developed atrial branches that crossed superiorly over the left atrium and entered the mass in the right atrium. Surgical resection was undertaken, and this confirmed that the mass had a fleshy, encapsulated appearance with a sessile stalk. Histology demonstrated a cavernous haemangioma. The patient had a residual small defect in the interatrial septum postoperatively but otherwise made a good recovery.

Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. This survey explores perceptions and experiences of obstetric anesthetists managing failed intubation. Methods. Anesthetists attending the Group of Obstetric Anaesthetists London (GOAL) Meeting in April 2014 were surveyed. Results. Ninety-three percent of anesthetists surveyed would not always wake the patient in the event of failed intubation for emergency cesarean delivery performed for fetal compromise. The median (interquartile range) of perceived acceptability of continuing anesthesia with a well-fitting supraglottic airway device, assessed using a visual analogue scale (0–100; 0 completely unacceptable; 100 completely acceptable), was 90 [22.5]. Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.

Design education, especially in an undergraduate course of study, seeks to prepare students for professions and for citizenship in a world they hardly know. The studio typically provides only a surrogate experience in addressing formal and spatial problems, and is limited by time, by its geographic space, and by a dialogue that is more often than not, self-referential. It very rarely engages systemic questions of public policy, or the specific challenges of implementing at full scale ideas that are conceived through representational means. The constrained intellectual context is most poignantly seen in the urban design studios where problems are situated in the real world, and where issues outside the purview of design are found embedded in a place. Form-focused studio exercises that are necessarily a part of beginning architecture education are inadequate for exploring the indeterminacy of urban space and the complexity of human environments. When students enter an urban design studio, especially when they undertake community-based projects, they must take up the mantle of citizenship and engage in an enterprise that is fundamentally relational and grounded in experience. They need more information and more ways of knowing the world than traditionally the design disciplines can offer. This paper presents the outcomes of an experimental neighborhood-based teaching project undertaken as a collaboration among classes in architecture, landscape architecture, urban geography and the fine arts at Temple University. Although initiated through the architecture faculty’s desire to enrich its own undergraduate urban design studio, all the collaborators shared our concern about the narrowing effects of disciplinary bracketing on student learning, especially when the goal was to address real world situations. Each discipline brought to the project its particular disciplinary culture -- its language, methodology and areas of concern -- and a shared aspiration to puzzle together these diverse perspectives around questions of making places that are meaningful, humane and sustainable. The struggles and synergies among disciplines were alternatively inspiring, annoying, challenging, rich and imperfect. But intense engagement with a community re-centered the dialogue from inside the academic context to outside, and framed a multidisciplinary way of thought. The community itself proved to be a powerful coalescing agent; the inherent layering of issues in the real-world context made it virtually impossible to remain insensible to interdependencies in life that transcend disciplinary boundaries. Here Richard Sennett’s definition of what constitutes a democratic urbanity was applicable. The Greek term for “public”, synkoikismos, means “to bring together in the same place people that need each other but worship different household gods.” (47) This deceptively simple public-making concept became the basis for a process of learning, and a vehicle for working with the larger truths about how cities are formed and experienced.

Objectives: To describe the frequency of preventive healthcare practice (assess, advice, refer for support) provided by allied health professionals (AHPs) practicing in regional and rural healthcare settings to address smoking, diet and physical inactivity. To identify factors that influence the delivery of preventive healthcare practice., Methods: AHPs working in public healthcare services in the Loddon Mallee region of Victoria were surveyed. Clinicians reported on the proportion of clients where they had provided preventive care. Likert scale questions measured factors influencing preventive healthcare practice., Results: In total, 115 clinicians completed the survey. AHPs reported that they assess for smoking and physical activity behaviours but not diet. Preventive health practice that included providing advice or referrals for follow-on support was rarely undertaken. Availability of screening tools and automated referral letters increased the likelihood of preventive healthcare practice., Conclusions: Greater attention to addressing modifiable lifestyle behaviours by AHPs might be warranted to match the rates of risk factors in rural and regional Victoria. Integrating support systems, for example, embedding screening questions within clinical assessments can assist preventive healthcare practice., Implication for Public Health: Many AHPs are not promoting healthy behaviours to prevent poor health. We present some strategies that could potentially improve this., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)