Feasibility, acceptability and potential effectiveness of dignity therapy for family carers of people with motor neurone disease

BACKGROUND: Dignity therapy is a brief psychotherapy that has been shown to enhance the end of life experience. Dignity therapy often involves family carers to support patients weakened by illness and family carers are also the usual recipients of the legacy documents created. No research to date has examined the impact of dignity therapy on family carers at the time of the intervention. This study examined the effects of dignity therapy on family carers of people with motor neurone disease (MND). METHODS: This is a cross-sectional study utilizing a one-group pre-test post-test design with 18 family carers of people diagnosed with MND. Outcomes measured caregiver burden, anxiety, depression, and hopefulness. Acceptability was measured with a questionnaire. Feasibility was assessed by examining family carers’ involvement in the therapy sessions, time taken to conduct sessions, and any special accommodations or deviations from the dignity therapy protocol.RESULTS: There were no significant pre-test post-test changes on the group level, but there were decreases in anxiety and depression on the individual level. Baseline measures indicate that 50% of family carers had moderate to severe scores for anxiety prior to dignity therapy. MND family carers saw benefits to the person with MND and to themselves after bereavement, but acceptability of dignity therapy at the time of the intervention was mixed with some family carers indicating it was helpful, some indicating it was harmful, and many expressing ambivalence. Dignity therapy involving MND family carers is feasible and the involvement of family carers has minimal impact on the therapy. CONCLUSION: Dignity therapy is not likely to alleviate caregiver burden in MND family carers, but it may have the ability to decrease or moderate anxiety and depression in distressed MND family carers. Dignity therapy is feasible and generally acceptable to MND family carers. Dignity therapists may provide a better experience for family carers when they are aware of acceptance levels and the quality of partner relationships

Query Filtering with Low-Dimensional Local Embeddings

The concept of local pivoting is to partition a metric space so that each element in the space is associated with precisely one of a fixed set of reference objects or pivots. The idea is that each object of the data set is associated with the reference object that is best suited to filter that particular object if it is not relevant to a query, maximising the probability of excluding it from a search. The notion does not in itself lead to a scalable search mechanism, but instead gives a good chance of exclusion based on a tiny memory footprint and a fast calculation. It is therefore most useful in contexts where main memory is at a premium, or in conjunction with another, scalable, mechanism. In this paper we apply similar reasoning to metric spaces which possess the four-point property, which notably include Euclidean, Cosine, Triangular, Jensen-Shannon, and Quadratic Form. In this case, each element of the space can be associated with two reference objects, and a four-point lower-bound property is used instead of the simple triangle inequality. The probability of exclusion is strictly greater than with simple local pivoting; the space required per object and the calculation are again tiny in relative terms. We show that the resulting mechanism can be very effective. A consequence of using the four-point property is that, for m reference points, there arèarè m 2 ´ pivot pairs to choose from, giving a very good chance of a good selection being available from a small number of distance calculations. Finding the best pair has a quadratic cost with the number of references ; however, we provide experimental evidence that good heuristics exist. Finally, we show how the resulting mechanism can be integrated with a more scalable technique to provide a very significant performance improvement, for a very small overhead in build-time and memory cost. Keywords: metric search · extreme pivoting · supermetric space · four-point property · pivot based index 2 Chávez et al

Serum miR-502: A potential biomarker in the diagnosis of concussion in a pilot study of patients with normal structural brain imaging

Establishing a diagnosis of concussion within the context of competitive sport is frequently difficult due to the heterogeneity of presentation. Over the years, many endogenous proteins, including the recent Food and Drug Administration approved for mild-to-moderate traumatic brain injury, glial fibrillary acid protein and ubiquitin carboxy-terminal hydrolase, have been studied as potential biomarkers for the diagnosis of mild traumatic brain injury. Recently, a new class of potential biomarkers, the microRNAs, has shown promise as indicators of traumatic brain injury. In this pilot study, we have analysed the ability of pre-validated serum microRNAs (mi-425-5p and miR-502) to diagnose concussion, in cases without structural pathology. Their performance has been assessed alongside a set of identified protein biomarkers for traumatic brain injury in cohort of 41 concussed athletes. Athletes with a confirmed concussion underwent blood sampling after 48 h from concussion along with magnetic resonance imaging. Serum mi-425-5p and miR-502 were analysed by quantitative reverse transcription polymerase chain reaction, and digital immunoassay was used to determine serum concentrations of ubiquitin carboxy-terminal hydrolase, glial fibrillary acid protein, neurofilament light and Tau. Results were matched with 15 healthy volunteers. No structural/haemorrhagic pathology was identified. Protein biomarkers demonstrated variability among groups reflecting previous performance in the literature. Neurofilament light was the only marker to positively correlate with symptoms reported and SCAT5 scores. Despite the sub optimal timing of sampling beyond the optimal window for many of the protein biomarkers measured, miR-502 was significantly downregulated at all time points within a week form concussion ictus, showing a diagnostic sensitivity in cases beyond 48 h and without structural pathology

Detection of recombination events in bacterial genomes from large population samples

Peer reviewe

Safety and effectiveness of BufferGel and 0.5% PRO 2000 gel for the prevention of HIV infection in women.

Results of the HPTN 035 trial. Abstract 48LB (16th Conference on Retroviruses and Opportunistic Infections, 2009).Objective: To determine the safety and effectiveness of BufferGel and 0.5% PRO2000 microbicide gels for the prevention of male-to-female HIV transmission. Design: Phase II/IIb, randomized, placebo-controlled trial with three double-blinded gel arms and an open-label no gel arm. Methods: Study participants from Malawi, South Africa, Zambia, Zimbabwe, and the USA were instructed to apply study gel up to 1 h before each sex act and safety, sexual behavior, pregnancy, gel adherence, acceptability, and HIV serostatus were assessed during follow-up. Results: The 3101 enrolled women were followed for an average of 20.4 months with 93.6% retention and 81.1% self-reported gel adherence. Adverse event rates were similar in all study arms. HIV incidence rates in the 0.5% PRO2000 gel, BufferGel, placebo gel, and no gel arms were 2.70, 4.14, 3.91, and 4.02 per 100 women-years, respectively. HIV incidence in the 0.5% PRO2000 gel arm was lower than the placebo gel arm (hazard ratio = 0.7, P=0.10) and the no gel arm (hazard ratio = 0.67, P=0.06). HIV incidence rates were similar in the BufferGel and both placebo gel (hazard ratio =1.10, P=0.63) and no gel control arms (hazard ratio =1.05, P=0.78). HIV incidence was similar in the placebo gel and no gel arms (hazard ratio =0.97, P=0.89). Conclusion: The 0.5% PRO2000 gel demonstrated a modest 30% reduction in HIV acquisition in women. However, these results were not statistically significant and subsequent findings from the Microbicide Development Programme (MDP) 301 trial have confirmed that 0.5% PRO2000 gel has little or no protective effect. BufferGel did not alter the risk of HIV infection. Both products were well tolerated

Barry Unsworth's Morality Play: Narrative, detection, history

© 2016 Macmillan Publishers Ltd. Morality Play is a historical detective novel set in the late fourteenth century and published in 1995, at a time of flourishing for historical fiction in Britain. This article argues that the novel shares some of the features of contemporary British historical fiction (notably, a degree of self-referentiality and a concern with the relationship between reality and representation), but also retains more traditional historical novels' desire to show the fate of individuals caught at moments of historical change. Using White's reflections on forms of historical writing and an understanding of the history of detective fiction, the article brings this currently under-examined text to critical attention and, in so doing, contributes to current scholarly understanding of the so-called 'historical turn' in late-twentieth century British fiction

Post-millennial Literature

This chapter investigates the British novel since 2000 by thinking about how a range of novels demonstrate a concern with the ability of contemporary prose fiction to maintain the 'meanwhile' which, according to Benedict Anderson, has been crucial to the novel's representational techniques since its inception

Reliability of a tool for measuring theory of planned behaviour constructs for use in evaluating research use in policymaking

<p>Abstract</p> <p>Background</p> <p>Although measures of knowledge translation and exchange (KTE) effectiveness based on the theory of planned behavior (TPB) have been used among patients and providers, no measure has been developed for use among health system policymakers and stakeholders. A tool that measures the intention to use research evidence in policymaking could assist researchers in evaluating the effectiveness of KTE strategies that aim to support evidence-informed health system decision-making. Therefore, we developed a 15-item tool to measure four TPB constructs (intention, attitude, subjective norm and perceived control) and assessed its face validity through key informant interviews.</p> <p>Methods</p> <p>We carried out a reliability study to assess the tool's internal consistency and test-retest reliability. Our study sample consisted of 62 policymakers and stakeholders that participated in deliberative dialogues. We assessed internal consistency using Cronbach's alpha and generalizability (G) coefficients, and we assessed test-retest reliability by calculating Pearson correlation coefficients (<it>r</it>) and G coefficients for each construct and the tool overall.</p> <p>Results</p> <p>The internal consistency of items within each construct was good with alpha ranging from 0.68 to alpha = 0.89. G-coefficients were lower for a single administration (G = 0.34 to G = 0.73) than for the average of two administrations (G = 0.79 to G = 0.89). Test-retest reliability coefficients for the constructs ranged from <it>r </it>= 0.26 to <it>r </it>= 0.77 and from G = 0.31 to G = 0.62 for a single administration, and from G = 0.47 to G = 0.86 for the average of two administrations. Test-retest reliability of the tool using G theory was moderate (G = 0.5) when we generalized across a single observation, but became strong (G = 0.9) when we averaged across both administrations.</p> <p>Conclusion</p> <p>This study provides preliminary evidence for the reliability of a tool that can be used to measure TPB constructs in relation to research use in policymaking. Our findings suggest that the tool should be administered on more than one occasion when the intervention promotes an initial 'spike' in enthusiasm for using research evidence (as it seemed to do in this case with deliberative dialogues). The findings from this study will be used to modify the tool and inform further psychometric testing following different KTE interventions.</p

Reducing anemia prevalence in Afghanistan: socioeconomic correlates and the particular role of agricultural assets

This research aims to examine the socio-economic correlates of anemia in women, and potential sources of iron in household diets in Afghanistan. It also examines whether ownership of agricultural (particularly livestock) assets and their use in food production has a role in alleviating anaemia, especially where local markets may be inadequate. We analyse data from the 2010/11 Afghanistan Multiple Indicator Cluster Survey, estimating a logistic regression to examine how anemia status of women is associated with socio-economic covariates. A key result found is that sheep ownership has a protective effect in reducing anemia (prevalence odds ratio of sheep ownership on anemia of 0.83, 95% confidence interval (CI): 0.73–0.94) after controlling for wealth and other covariates. This association is found to be robust to alternative model specifications. Given the central role of red meat in heme iron provision and absorption of non-heme iron, we hypothesise that sheep ownership promotes mutton consumption from own-production in a setting where market-sourced provision of nutritious food is a challenge. We then use the 2011/12 National Risk and Vulnerability Assessment household data to understand the Afghan diet from the perspective of dietary iron provision, and to understand interactions between own-production, market sourcing and mutton consumption. Sheep ownership is found to increase the likelihood that a household consumed mutton (odds ratio of 1.27, 95% CI: 1.15–1.42), the number of days in the week that mutton was consumed (prevalence rate ratio of 1.24. 95% CI: 1.12–1.37) and the quantity of mutton consumed (7 grams/person/week). In the subsample of mutton consumers, households sourcing mutton mostly from own production consumed mutton 1.5 days more frequently on average than households relying on market purchase, resulting in 100 grams per person per week higher mutton intake. Thus this analysis lends support to the notion that the linkage between sheep ownership and anemia risk is at least partly due to consumption arising from own-production in the presence of market incompleteness

Late Modernism, Postmodernism, and After

This chapter focuses on the parallel strands that run through the last decades of British fiction, whereby a continuing investment in realism runs alongside the explosion of postmodern forms, particularly in fiction, which in turn sits alongside a late modernist movement in British fiction of the period. The prominence of writers such as Ian McEwan, Kazuo Ishiguro, Pat Barker and Zadie Smith might suggest that there is an underlying connection between British writing and realism, that British writers are at their best when writing in a form that has its roots in the realism of Thomas Hardy and George Eliot. But alongside the continuing development of the realist novel, there is a marked development of what might be called a postmodern aesthetic in British writing, that is sometimes entangled with British realism, but often diverts from it. This includes the self-conscious literary fiction of Martin Amis and Salman Rushdie, the magic realism of Angela Carter, and the generically unstable later work of J.G. Ballard. And alongside these divergent paths in the novel is the late modernist fiction of writers such as Samuel Beckett. This chapter traces these strands as they run though the period, and closes by looking at the emergence of work, in the first decades of the current century, which moves beyond the opposition between realism and postmodernism, and which points towards a new phase in the development of British writing