Medical humanities in practice

Stephanie Matthews and colleagues look at why you might want to go to a medical humanities conferenc

Isolated Incudostapedial Cholesteatomas: Unique Radiologic and Surgical Features

info:eu-repo/semantics/publishedVersio

Case Report Breakfast Time Blackouts

We present the case of a 16-year-old girl who suffered from repeated episodes of collapse and loss of consciousness which could be provoked by undertaking a stretching manoeuvre comprising a combined breath hold and neck torsion. A review of the literature is provided on other cases of so-called "stretch syncope" which appears to be a rare form of reflex syncope affecting patients in adolescence

Ground water and climate change

As the world’s largest distributed store of fresh water, ground water plays a central part in sustaining ecosystems and enabling human adaptation to climate variability and change. The strategic importance of ground water for global water and food security will probably intensify under climate change as more frequent and intense climate extremes (droughts and floods) increase variability in precipitation, soil moisture and surface water. Here we critically review recent research assessing the impacts of climate on ground water through natural and human-induced processes as well as through groundwater-driven feedbacks on the climate system. Furthermore, we examine the possible opportunities and challenges of using and sustaining groundwater resources in climate adaptation strategies, and highlight the lack of groundwater observations, which, at present, limits our understanding of the dynamic relationship between ground water and climate

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS:UP, an adapted Mindfulness Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

Background Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial.Methods We recruited community-dwelling stroke survivors (SS) ≥3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥8). Participants could ‘enrol’ a family member/‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions HEADS: UP was then adapted for online delivery; tested in Study 2. The primary outcome (both studies) was feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient reported outcomes measures (PROMs) assessing mood and quality of life), and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement.ResultsStudy 1Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n=9; 69%); 28 (IQR 34) months poststroke. Of these n=10 (76.9%) completed PROMS pre-intervention; n=6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2Feasibility: SS n=9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n=4; 44.4%); 23 (IQR 34) months poststroke. Of these n=5 (55.6%) completed PROMS pre-intervention; n=5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward. KeywordsStroke; anxiety; depression; mindfulness; self-management; feasibility; acceptability; group-based; online; in-person<br/

Linkages between GRACE water storage, hydrologic extremes, and climate teleconnections in major African aquifers

Water resources management is a critical issue in Africa where many regions are subjected to sequential droughts and floods. The objective of our work was to assess spatiotemporal variability in water storage and related controls (climate, human intervention) in major African aquifers and consider approaches toward more sustainable development. Different approaches were used to track water storage, including GRACE/GRACE Follow On satellites for Total Water Storage (TWS); satellite altimetry for reservoir storage, MODIS satellites for vegetation indices, and limited ground-based monitoring. Results show that declining trends in TWS (60–73 km3 over the 18 yr GRACE record) were restricted to aquifers in northern Africa, controlled primarily by irrigation water use in the Nubian and NW Saharan aquifers. Rising TWS trends were found in aquifers in western Africa (23–49 km3), attributed to increased recharge from land use change and cropland expansion. Interannual variability dominated TWS variability in eastern and southern Africa, controlled primarily by climate extremes. Climate teleconnections, particularly El Nino Southern Oscillation and Indian Ocean Dipole, strongly controlled droughts and floods in eastern and southern Africa. Huge aquifer storage in northern Africa suggests that the recent decadal storage declines should not impact the regional aquifers but may affect local conditions. Increasing groundwater levels in western Africa will need to be managed because of locally rising groundwater flooding. More climate resilient water management can be accomplished in eastern and southern Africa by storing water from wet to dry climate cycles. Accessing the natural water storage provided by aquifers in Africa is the obvious way to manage the variability between droughts and floods

Pilot and Feasibility Studies In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

Background Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could 'enrol' a family member/ 'other' to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

Background: Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods: We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could ‘enrol’ a family member/ ‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results: Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward