A thematic synthesis of the experiences of adults living with hemodialysis

Background and objectives In-center dialysis patients spend significant amounts of time on the dialysis unit; additionally managing ESKD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesise the experiences of patients receiving in-center hemodialysis. Design, setting, participants, and measurements Embase, MEDLINE, CINAHL and PsychINFO, Google scholar and reference lists were searched for primary qualitative studies exploring the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted. Results 17 studies involving 576 patients were included in the synthesis. 4 analytical themes were developed. The first theme “a new dialysis dependent self” describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme, “a restricted life”, describes the physical and emotional constraints patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future and these contributed to the third theme, “regaining control”. The first three themes describe a potential for change through acceptance, adaption and re-gaining a sense of control. The final theme, “relationships with health professionals” describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity and personalized support. Conclusions This synthesis has resulted in a framework that can be utilized to consider interventions to improve patients’ experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships patients have with their health care professionals may enable patients’ to progress towards a sense of control and improve satisfaction with care

An Intersectional Feminist Perspective of Emmett Till in Young Adult Literature

Emmett Till’s murder inspired many novelists, poets, and artists. Recently, Till has inspired several feminist young adult novelists who are introducing his case in an intersectional way to a new generation of readers. The works that I have studied are A Wreath for Emmett Till (2003) by Marilyn Nelson, The Hunger Games Trilogy (2008-2010) by Suzanne Collins, and Midnight without a Moon (2017) by Linda Jackson. By examining how the authors employ a feminist perspective, readers can understand how they are striving for a more inclusive, intersectional feminist movement. This is significant because the publishing industry, specifically for Young Adult Literature, is not diverse. These works, while often overlooked by critics, may be the first exposure most young readers have to Emmett Till. Each of these novels could be used to teach readers not only about Till’s case, but also about current events to help foster a multicultural consciousness

Feasibility and acceptability of a multi-components intervention (PDConnect) to support physical activity in people living with Parkinson's: a mixed methods study.

The benefits of physical activity (PA) for people with Parkinson's are widely acknowledged. To date, research has focussed on the effectiveness of PA interventions, with limited research exploring the optimum means of supporting people living with Parkinson's to change their PA behaviour. A narrative review was undertaken to provide context and underpin the development of a multi-component PA intervention (PDConnect) for people with Parkinson's. PDConnect combines specialist physiotherapy, group-based PA, and self-management with the aim of promoting increased PA and PA self-management. This study was undertaken to determine the feasibility and acceptability of the PDConnect intervention. This study adopted a pragmatist worldview and employed mixed methods. A convergent sequential mixed-methods design was adopted and delivered online via Microsoft Teams. A convenience sample of 31 people with Parkinson's were recruited and randomised into two groups: (i) the usual care group received standard physiotherapy once a week for six-weeks. (ii) the PDConnect group received once a week for six weeks physiotherapy that combined PA, education and behaviour change interventions delivered by a Parkinson's specialist physiotherapist. This was followed by 12 weekly sessions of group-based PA by a fitness instructor specially trained in Parkinson's. Participants were then contacted by the fitness instructor once a month for three months to support PA engagement. Primary feasibility data were collected during the study, with acceptability assessed via semi-structured interviews. Secondary outcomes encompassing motor, non-motor, PA, and health and well-being measures were assessed at baseline, and at six, 18 and 30 weeks. PDConnect was shown to be feasible and safe. The sample was recruited in 12 weeks, and the retention rate was 74%. Outcome measure response and activity diary return rate was high (>95%, 84% respectively). PDConnect attendance was high: 100% for the physiotherapy component and 83% for the group-based exercise component. Participants were very satisfied with PDConnect and perceived that participation increased exercise confidence and knowledge and understanding of Parkinson's. Participation positively impacted Parkinson's symptoms, with perceived improvements in flexibility, muscle strength, PA levels and endurance. Fifty percent of participants receiving PDConnect reported that they were much improved compared to 10% in the usual care group. PDConnect study resources were deemed acceptable. Intervention fidelity was high, with 89% of the physiotherapy and 88% of the group-based exercise delivered as planned. All progression criteria were met, except for participant retention which fell one percent below the a priori criterion. PDConnect is feasible to deliver and rated as highly acceptable among people with Parkinson's. A large-scale trial is required to fully evaluate the effectiveness of PDConnect. Sampling within a future trial needs to include under-represented groups and broader cultural and ethical diversity. In addition, appropriate funding is required to minimise digital exclusion and optimise digital literacy. Minor modifications to the participant manual to support personalisation, and further consideration of type of PA monitor is also recommended. Further consultation with the Parkinson's community is required to guide how to optimise social connection when delivering PA online and to inform the selection of future outcome measures

Under the Covers? Commerce, Contraceptives and Consumers in England and Wales, 1880–1960

This article provides a much needed commercial perspective to the gradual growth in consumption of birth control appliances in England and Wales between 1880 and 1960. By drawing on underutilized parliamentary sources and the hitherto neglected business records of manufacturers, vendors and distributors, this new approach reveals that consumption patterns were more varied in terms of class, gender and geographical location than scholars have generally recognized. In particular, its analysis of the production, promotion and distribution of birth control appliances alongside medical goods intended for domestic use during this period demonstrates the importance of consumption both among and beyond the primary married couple of the household. In doing so, this article aims to provide the medical historian with a new analytic tool for investigating neglected but potentially important sites of medical decision making

Sex ratio influences the motivational salience of facial attractiveness

The sex ratio of the local population influences mating-related behaviours in many species. Recent experiments show that male-biased sex ratios increase the amount of financial resources men will invest in potential mates, suggesting that sex ratios influence allocation of mating effort in humans. To investigate this issue further, we tested for effects of cues to the sex ratio of the local population on the motivational salience of attractiveness in own-sex and opposite-sex faces. We did this using an effort-based key-press task, in which the motivational salience of facial attractiveness was assessed in samples of faces in which the ratio of male to female images was manipulated. The motivational salience of attractive opposite-sex, but not own-sex, faces was greater in the own-sex-biased (high competition for mates) than in the opposite-sex-biased (low competition for mates) condition. Moreover, this effect was not modulated by participant sex. These results present new evidence that sex ratio influences human mating-related behaviours. They also present the first evidence that the perceived sex ratio of the local population may modulate allocation of mating effort in women, as well as men

Vernacular literacy in late-medieval England: the example of East Anglian medical manuscripts

This thesis is an examination of vernacular literacy in late-medieval East Anglia, using the evidence supplied by English medical texts datable to between 1350-1500- It addresses not only the texts, but also the manuscripts in which they survive and the people who wrote, owned and read them. By this means I have been able to examine the literacy of a group of readers in a specific region. This thesis is divided into three main parts. The first describes the spproach taken, and critically assesses the field of historical literacy before examining the value to the study of modern theories of literacy. It includes an overview of late-medieval medical practice in order to place the manuscripts in their immediate context. The second section consists of a detailed examination of the primary material and presents a corpus of some thirty-seven manuscripts dating from the nid-fourteenth to the late-fifteenth centuries. Each manuscript is described in terms of its physical appearance and the types of texts it contains. Provenance information is supplied for owners and readers in the Middle Ages. The third section draws together these findings in the light of the literacy theories adopted, analysing the information in terms of the types of text included (both medical and non-medical), the types of book (whether basic or luxurious productions), and the types of owner (graduate physicians, rural practitioners or interested laypeople). My conclusion shows that the vernacular medical literature from late-medieval East Anglia provides a picture of literacy that is more complex than previously suggested. Several shifts in literacy practices for groups and individuals can be discerned from the evidence of this survey. The increase in production and use of vernacular texts cannot be simply described as a broadening of literacy and increased accessibility of texts. Rather than a growth of literacy per se, the vernacularisation of medicine in late-medieval East Anglia seems to have been both the cause and effect of shifts in literacy practices. The increased use of written texts in medicine during this period can be shown to be a process that involves participation in literacy events, broadening of background knowledge and the acquisition and development of practical skills in reading and writing

Ezekiel 36:24-28: God Promises Salvation for the Sake of His Name

Ezekiel 36:24-28 is an important passage both for the original audience and for modern day Christians. In this paper, the connections between this passage and the rest of the biblical narrative will be addressed. Why is God saying that He will give Israel a new heart? What is the motivation of God\u27s action? How should we respond today? What led Israel to be in this position? These are all questions that will be addressed