The personal tutor as a role model for students: humanising nursing care.

This article explores how nurse academics in one British university uphold and role model the humanising framework developed by Todres et al (2009). It gives a brief overview of nurse education in the UK. Next it outlines the nature of the personal tutor role. It then offers an overview of the humanising framework, its background and embodiment in the undergraduate nursing curriculum. It explores how nurse academics role model humanisation and how this influences and impacts on students’ ability to live and apply the humanising dimensions of nursing to enhance patients’ lived experience of care. It concludes with examples of how this encourages positive meaningful relationships between students and tutors

5-Year survival of pediatric anterior cruciate ligament reconstruction with living donor hamstring tendon grafts

Background: It is well accepted that there is a higher incidence of repeat anterior cruciate ligament (ACL) injuries in the pediatric population after ACL reconstruction (ACLR) with autograft tissue compared with adults. Hamstring autograft harvest may contribute to the risk for repeat ACL injuries in this high functional demand group. A novel method is the use of a living donor hamstring tendon (LDHT) graft from a parent; however, there is currently limited research on the outcomes of this technique, particularly beyond the short term. Purpose/Hypothesis: The purpose was to determine the medium-term survival of the ACL graft and the contralateral ACL (CACL) after primary ACLR with the use of an LDHT graft from a parent in those aged less than 18 years and to identify factors associated with subsequent ACL injuries. It was hypothesized that ACLR with the use of an LDHT provides acceptable midterm outcomes in pediatric patients. Study Design: Case series; Level of evidence, 4. Methods: Between 2005 and 2014, 247 (of 265 eligible) consecutive patients in a prospective database, having undergone primary ACLR with the use of an LDHT graft and aged less than 18 years, were included. Outcomes were assessed at a minimum of 2 years after surgery including data on ACL reinjuries, International Knee Documentation Committee (IKDC) scores, and current symptoms, as well as factors associated with the ACL reinjury risk were investigated. Results: Patients were reviewed at a mean of 4.5 years (range, 24-127 months [10.6 years]) after ACLR with an LDHT graft. Fifty-one patients (20.6%) sustained an ACL graft rupture, 28 patients (11.3%) sustained a CACL rupture, and 2 patients sustained both an ACL graft rupture and a CACL rupture (0.8%). Survival of the ACL graft was 89%, 82%, and 76% at 1, 2, and 5 years, respectively. Survival of the CACL was 99%, 94%, and 86% at 1, 2, and 5 years, respectively. Survival of the ACL graft was favorable in patients with Tanner stage 1-2 at the time of surgery versus those with Tanner stage 3-5 at 5 years (87% vs 69%, respectively; hazard ratio, 3.7; P = .01). The mean IKDC score was 91.7. A return to preinjury levels of activity was reported by 59.1%. Conclusion: After ACLR with an LDHT graft from a parent in those aged less than 18 years, a second ACL injury (ACL graft or CACL injury) occurred in 1 in 3 patients. The 5-year survival rate of the ACL graft was 76%, and the 5-year survival rate of the CACL was 86%. High IKDC scores and continued participation in sports were maintained over the medium term. Importantly, there was favorable survival of the ACL graft in patients with Tanner stage 1-2 compared with patients with Tanner stage 3-5 over 5 years. Patients with Tanner stage 1-2 also had a significantly lower incidence of second ACL injuries over 5 years compared with those with Tanner stage 3-5, occurring in 1 in 5 patients. Thus, an LDHT graft from a parent is an appropriate graft for physically immature children

Fetal liver blood flow distribution: role in human developmental strategy to prioritize fat deposition versus brain development

Among primates, human neonates have the largest brains but also the highest proportion of body fat. If placental nutrient supply is limited, the fetus faces a dilemma: should resources be allocated to brain growth, or to fat deposition for use as a potential postnatal energy reserve? We hypothesised that resolving this dilemma operates at the level of umbilical blood distribution entering the fetal liver. In 381 uncomplicated pregnancies in third trimester, we measured blood flow perfusing the fetal liver, or bypassing it via the ductus venosus to supply the brain and heart using ultrasound techniques. Across the range of fetal growth and independent of the mother's adiposity and parity, greater liver blood flow was associated with greater offspring fat mass measured by dual-energy X-ray absorptiometry, both in the infant at birth (r = 0.43, P<0.001) and at age 4 years (r = 0.16, P = 0.02). In contrast, smaller placentas less able to meet fetal demand for essential nutrients were associated with a brain-sparing flow pattern (r = 0.17, p = 0.02). This flow pattern was also associated with a higher degree of shunting through ductus venosus (P = 0.04). We propose that humans evolved a developmental strategy to prioritize nutrient allocation for prenatal fat deposition when the supply of conditionally essential nutrients requiring hepatic inter-conversion is limited, switching resource allocation to favour the brain if the supply of essential nutrients is limited. Facilitated placental transfer mechanisms for glucose and other nutrients evolved in environments less affluent than those now prevalent in developed populations, and we propose that in circumstances of maternal adiposity and nutrient excess these mechanisms now also lead to prenatal fat deposition. Prenatal developmental influences play important roles in the human propensity to deposit fa

XMM-Newton observations of the nitrogen-rich Wolf-Rayet star WR 1

We present XMM-Newton results for the X-ray spectrum from the N-richWolf-Rayet (WR) star WR1. The EPIC instrument was used to obtain a medium-resolution spectrum. The following features characterize this spectrum: ( a) significant emission "bumps" appear that are coincident with the wavelengths of typical strong lines, such as MgXI, SiXIII, and SXV; (b) little emission is detected above 4 keV, in contrast to recent reports of a hard component in the stars WR 6 and WR 110 which are of similar subtype; and ( c) evidence for sulfur K-edge absorption at about 2.6 keV, which could only arise from absorption of X- rays by the ambient stellar wind. The lack of hard emission in our dataset is suggestive that WR 1 may truly be a single star, thus representing the first detailed X-ray spectrum that isolates the WR wind alone ( in contrast to colliding wind zones). Although the properties of the S-edge are not well- constrained by our data, it does appear to be real, and its detection indicates that at least some of the hot gas in WR 1 must reside interior to the radius of optical depth unity for the total absorptive opacity at the energy of the edge

Treatment response in child anxiety is differentially related to the form of maternal anxiety disorder

An examination was made of the extent to which maternal anxiety predicted response to treatment of children presenting with an anxiety disorder. In a sample of 55 children referred to a local NHS CAMH service for treatment of an anxiety disorder, systematic mental state interview assessment was made of both mothers and children, and both completed self-report questionnaires to assess aspects of anxiety, both immediately before the children received treatment and following treatment. Children of mothers with anxiety disorder overall responded less well to treatment than children of mothers with no anxiety disorder. There was some diagnostic specificity in this in that children of mothers with GAD did as well in treatment as children whose mothers had no anxiety, whereas children of mothers with social phobia did poorly. The outcome for children with anxiety appears to be related to the presence and nature of maternal anxiety. It would seem prudent that treatment of children with anxiety involves assessment of maternal anxiety. It is important to establish in systematic investigation whether treatment of maternal anxiety improves the outcome for child anxiety

VEGAS: A VST Early-type GAlaxy Survey. II. Photometric study of giant ellipticals and their stellar halos

Observations of diffuse starlight in the outskirts of galaxies are thought to be a fundamental source of constraints on the cosmological context of galaxy assembly in the $\Lambda$CDM model. Such observations are not trivial because of the extreme faintness of such regions. In this work, we investigate the photometric properties of six massive early type galaxies (ETGs) in the VEGAS sample (NGC 1399, NGC 3923, NGC 4365, NGC 4472, NGC 5044, and NGC 5846) out to extremely low surface brightness levels, with the goal of characterizing the global structure of their light profiles for comparison to state-of-the-art galaxy formation models. We carry out deep and detailed photometric mapping of our ETG sample taking advantage of deep imaging with VST/OmegaCAM in the g and i bands. By fitting the light profiles, and comparing the results to simulations of elliptical galaxy assembly, we identify signatures of a transition between "relaxed" and "unrelaxed" accreted components and can constrain the balance between in situ and accreted stars. The very good agreement of our results with predictions from theoretical simulations demonstrates that the full VEGAS sample of $\sim 100$ ETGs will allow us to use the distribution of diffuse light as a robust statistical probe of the hierarchical assembly of massive galaxies.Comment: Accepted for publication in Astronomy & Astrophysic