The experience of adults living with chronic pain in the context of a neurological condition

Background: Sudden onset neurological conditions, such as spinal cord injury and stroke, are unexpected, life-changing events. Research suggests that survivors grieve the life they knew, while commonly trying to cope with significant impairments impacting their everyday life. Some impairments are condition specific while others are shared across conditions, such as chronic pain. Aim: This research portfolio aimed to increase understanding of the experience of chronic pain following two sudden onset neurological conditions, namely spinal cord injury and stroke, in adults. Design: The portfolio consists of two main research papers, a systematic review which thematically synthesises qualitative findings on adults’ experience of chronic neuropathic pain following spinal cord injury and an interpretative phenomenological analysis (IPA) study which investigates the experience of working age adults living with chronic post-stroke pain. These are presented alongside an introduction, bridging section, extended methodology, and overall discussion. Findings: The systematic review identified six themes; ‘The pain as an unusual, intense, unpredictable and uncontrollable sensation’, ‘The pain’s influence on life’, ‘Trying to understand the pain’, ‘The challenge of describing the pain to others’, ‘The search for pain relief’ and ‘Learning pain acceptance over time’. The IPA study identified three master themes: ‘The solitude of the pain experience’, ‘Unsatisfactory healthcare and the need for self-care’ and ‘The development of pain acceptance’. Conclusions: The findings suggest that spinal cord injury and stroke patients have similar experiences of living with chronic pain. The pain is described as an invisible impairment, which is difficult to relate to others and can easily be overlooked in the context of other visible, more prototypical impairments. Primary healthcare settings are described as lacking specialist knowledge, leading to unsatisfactory identification, diagnosis and treatment. Recommendations for clinical applications and future research are provided

Urinary cholesterol in cancer screening

Cholesterol determinations in morning urine samples were taken in 235 selected patients with a positive test for microscopic hematuria. Values ranged from 0.2 to 76.0 mg (median 5.5) in 23 patients with urologic malignancies and from 0.1 to 33.4 mg (median 1.1) in 38 patients with various benign diseases of the kidney or urogenital tract. In the 28 patients with urinary tract infections and 146 subjects without evidence of disorders of the kidney and the urogenital system, urinary cholesterol excretion was usually normal (0.1 to 1.9 mg; median 0.35). Using 1.0 mg urinary cholesterol per morning urine as a cutoff point, sensitivity for urologic carcinomas is about 80 per cent with a comparable high specificity of 90 per cent. Therefore, subsequent measurements of urinary cholesterol in populations with microscopic hematuria could define two groups, one with high prevalence and one with low prevalence of urologic malignancies. The less complicated colorimetric instead of gas-liquid chromatographic determination of urinary cholesterol can be recommended as a screening test for urologic carcinomas in populations with microscopic hematuria

Age, growth, food habits, and reproduction of bonefish, Albula vulpes, in south Florida waters

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Studies on the clinical significance of nonesterified and total cholesterol in urine

Gas-liquid chromatographic determinations of nonesterified and total urinary cholesterol were performed in 137 normals, 264 patients with various internal diseases without evidence of neoplasias or diseases of the kidney or urinary tract, 497 patients with malignancies and 236 patients with diseases of the kidney, urinary tract infections or prostatic adenoma with residual urine. A normal range (mean±2 SD) of 0.2–2.2 mg/24 hours nonesterified cholesterol (NEC) and of 0.3–3.0 mg/24 hours total cholesterol (TC) was calculated. Values of urinary cholesterol excretion were independent of age and sex and did not correlate with cholesterol levels in plasma. Patients with various internal diseases, without evidence of neoplasias nor diseases of the kidney or obstruction of the urinary tract, showed normal urinary cholesterol excretions, as did patients with infections of the urinary tract. However, elevated urinary cholesterol was found in patients with diseases of the kidney or urinary tract obstruction (prostatic adenoma with residual urine), malignant diseases of the urogenital tract and metastasing carcinoma of the breast. In patients with other malignant diseases urinary cholesterol was usually normal. Lesions of the urothelial cell membranes are considered to be the most likely cause of urinary cholesterol hyperexcretion. The clinical value of urinary cholesterol determinations as a possible screening test for urogenital carcinomas in unselected populations is limited by lacking specificity, expensive methodology and low prevalence of the mentioned carcinomas, although elevated urinary cholesterol excretions have been observed in early clinical stages of urogenital cancers

“I will try anything” the experience of working age stroke survivors living with chronic post-stroke pain: an interpretative phenomenological analysis

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods: Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results: The analysis led to three Group Experiential Themes: “The Solitude of the Pain Experience,” “Unsatisfactory Healthcare and the Need for Self-Care” and “The Development of Pain Acceptance.” Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions

Competencias de Tecnología e Innovación en la Enseñanza Híbrida

En el presente artículo se realizó una revisión bibliográfica que tuvo por objetivo investigar las  competencias de tecnología e innovación en la enseñanza de la educación hibrida, siendo esta la integración de procesos virtuales que reemplazaran algunos de los procesos de la tradicional educación presencial, de tal manera que tanto la educación tradicional como la virtual estén integrados de forma conjunta. Para esto se realizó una revisión del estado del arte sobre las competencias de tecnologías e información indagando en la importancia de las mismas e identificándolas y a su vez expandiendo el contenido del tema de enseñanza híbrida a fin de poder dar referencias para futuros proyectos, concluyendo en la importancia de estas competencias de tecnologías e informaciónpara la enseñanza virtual

Competencias de Tecnología e Innovación en la Enseñanza Híbrida

En el presente artículo se realizó una revisión bibliográfica que tuvo por objetivo investigar las  competencias de tecnología e innovación en la enseñanza de la educación hibrida, siendo esta la integración de procesos virtuales que reemplazaran algunos de los procesos de la tradicional educación presencial, de tal manera que tanto la educación tradicional como la virtual estén integrados de forma conjunta. Para esto se realizó una revisión del estado del arte sobre las competencias de tecnologías e información indagando en la importancia de las mismas e identificándolas y a su vez expandiendo el contenido del tema de enseñanza híbrida a fin de poder dar referencias para futuros proyectos, concluyendo en la importancia de estas competencias de tecnologías e informaciónpara la enseñanza virtual

The past and future of experimental speciation

Speciation is the result of evolutionary processes that generate barriers to gene flow between populations, facilitating reproductive isolation. Speciation is typically studied via theoretical models and “snap-shot” tests in natural populations. Experimental speciation enables real-time direct tests of speciation theory and has been long-touted as a critical complement to other approaches. We argue that, despite its promise to elucidate the evolution of reproductive isolation, experimental speciation has been underutilised and lags behind other contributions to speciation research. We review recent experiments and outline a framework for how experimental speciation can be implemented to address current outstanding questions that are otherwise challenging to answer. Greater uptake of this approach is necessary to rapidly advance understanding of speciation

Uncovering the multifaceted roles played by neutrophils in allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a life-saving procedure used for the treatment of selected hematological malignancies, inborn errors of metabolism, and bone marrow failures. The role of neutrophils in alloHSCT has been traditionally evaluated only in the context of their ability to act as a first line of defense against infection. However, recent evidence has highlighted neutrophils as key effectors of innate and adaptive immune responses through a wide array of newly discovered functions. Accordingly, neutrophils are emerging as highly versatile cells that are able to acquire different, often opposite, functional capacities depending on the microenvironment and their differentiation status. Herein, we review the current knowledge on the multiple functions that neutrophils exhibit through the different stages of alloHSCT, from the hematopoietic stem cell (HSC) mobilization in the donor to the immunological reconstitution that occurs in the recipient following HSC infusion. We also discuss the influence exerted on neutrophils by the immunosuppressive drugs delivered in the course of alloHSCT as part of graft-versus-host disease (GVHD) prophylaxis. Finally, the potential involvement of neutrophils in alloHSCT-related complications, such as transplant-associated thrombotic microangiopathy (TA-TMA), acute and chronic GVHD, and cytomegalovirus (CMV) reactivation, is also discussed. Based on the data reviewed herein, the role played by neutrophils in alloHSCT is far greater than a simple antimicrobial role. However, much remains to be investigated in terms of the potential functions that neutrophils might exert during a highly complex procedure such as alloHSCT