Using parent metaphors for learning about the neonatal care experience: an interpretive perspective

© 2019 The Author(s). The final, definitive version of this paper has been published in Journal of Child Health Care by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/1367493519875853.This study focuses on how metaphors are used by parents who have had a premature baby to describe their neonatal care experience and how these can contribute to empathic learning of health professionals. In health, metaphors are commonly used to communicate and explain difficult topics. When patients tell their story, metaphor can be a means of expression from which we can learn about their experience of illness or hospitalisation. Limited research exits on how metaphor can improve our understanding of parent’s emotional experience in neonatal care and subsequently inform education in this field. Employing narrative inquiry within an interpretive, constructivist paradigm, 20 narrative interviews with 23 parents of premature babies were analysed using a process of metaphor identification. Findings revealed common metaphors used to describe experience. Metaphor clusters used by parents in order of frequency were journeying, altered reality, darkness, breaking, connections, fighting, salvation and being on the edge. Parents widely used compelling and emotive metaphors to describe and express both difficult and challenging times as well as progression forward. Metaphors serve as a powerful way for health professionals to learn about the emotional experiences of parents and potentially enhance their empathic understanding.Peer reviewe

Towards a method for rigorous development of generic requirements patterns

We present work in progress on a method for the engineering, validation and verification of generic requirements using domain engineering and formal methods. The need to develop a generic requirement set for subsequent system instantiation is complicated by the addition of the high levels of verification demanded by safety-critical domains such as avionics. Our chosen application domain is the failure detection and management function for engine control systems: here generic requirements drive a software product line of target systems. A pilot formal specification and design exercise is undertaken on a small (twosensor) system element. This exercise has a number of aims: to support the domain analysis, to gain a view of appropriate design abstractions, for a B novice to gain experience in the B method and tools, and to evaluate the usability and utility of that method.We also present a prototype method for the production and verification of a generic requirement set in our UML-based formal notation, UML-B, and tooling developed in support. The formal verification both of the structural generic requirement set, and of a particular application, is achieved via translation to the formal specification language, B, using our U2B and ProB tools

A new conceptual framework for revenge firesetting

Revenge has frequently been acknowledged to account for a relatively large proportion of motives in deliberate firesetting. However, very little is actually known about the aetiology of revenge firesetting. Theoretical approaches to revenge-seeking behaviour are discussed. A brief review of how revenge is accounted for in existing theoretical explanations of deliberate firesetting and the known characteristics of revenge firesetters are provided. On this basis, the authors suggest, as a motive, revenge firesetting has to date been misconceptualised. A new conceptual framework is thus proposed, paying particular attention to the contextual, affective, cognitive, volitional and behavioural factors which may influence and generate a single episode of revenge firesetting. Treatment implications and suggestions for future research are also provided

Preclinical efficacy of azacitidine and venetoclax for infant KMT2A-rearranged acute lymphoblastic leukemia reveals a new therapeutic strategy

Infants with KMT2A-rearranged B-cell acute lymphoblastic leukemia (ALL) have a dismal prognosis. Survival outcomes have remained static in recent decades despite treatment intensification and novel therapies are urgently required. KMT2A-rearranged infant ALL cells are characterized by an abundance of promoter hypermethylation and exhibit high BCL-2 expression, highlighting potential for therapeutic targeting. Here, we show that hypomethylating agents exhibit in vitro additivity when combined with most conventional chemotherapeutic agents. However, in a subset of samples an antagonistic effect was seen between several agents. This was most evident when hypomethylating agents were combined with methotrexate, with upregulation of ATP-binding cassette transporters identified as a potential mechanism. Single agent treatment with azacitidine and decitabine significantly prolonged in vivo survival in KMT2A-rearranged infant ALL xenografts. Treatment of KMT2A-rearranged infant ALL cell lines with azacitidine and decitabine led to differential genome-wide DNA methylation, changes in gene expression and thermal proteome profiling revealed the target protein-binding landscape of these agents. The selective BCL-2 inhibitor, venetoclax, exhibited in vitro additivity in combination with hypomethylating or conventional chemotherapeutic agents. The addition of venetoclax to azacitidine resulted in a significant in vivo survival advantage indicating the therapeutic potential of this combination to improve outcome for infants with KMT2A-rearranged ALL

Methylomic analysis of monozygotic twins discordant for autism spectrum disorder and related behavioural traits

Autism spectrum disorder (ASD) defines a group of common, complex neurodevelopmental disorders. Although the aetiology of ASD has a strong genetic component, there is considerable monozygotic (MZ) twin discordance indicating a role for non-genetic factors. Because MZ twins share an identical DNA sequence, disease-discordant MZ twin pairs provide an ideal model for examining the contribution of environmentally driven epigenetic factors in disease. We performed a genome-wide analysis of DNA methylation in a sample of 50 MZ twin pairs (100 individuals) sampled from a representative population cohort that included twins discordant and concordant for ASD, ASD-associated traits and no autistic phenotype. Within-twin and between-group analyses identified numerous differentially methylated regions associated with ASD. In addition, we report significant correlations between DNA methylation and quantitatively measured autistic trait scores across our sample cohort. This study represents the first systematic epigenomic analyses of MZ twins discordant for ASD and implicates a role for altered DNA methylation in autism

SARS-CoV-2 seroprevalence among a southern U.S. population indicates limited asymptomatic spread under physical distancing measures

Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants. IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population

Enriching college students through study abroad: a case of Nepal Field Experience - Part 2

With a view of providing an unsurpassed opportunity to college students, who are mostly from Louisiana, in gaining a comprehensive understanding of Global Climate Change issues, we completed the first Nepal Field Experience Pilot Study Abroad from May 21-June 8, 2019. A total of fifteen students from the University of Louisiana at Lafayette, Louisiana, USA, and one graduate student from University of Arizona, Arizona, USA, participated in the program. Students examined and documented the effects of climate change impacts on agriculture, water resources, wildlife, local communities, forest resources, and other ecological and environmental settings of the country. They identified various climate change mitigation and adaptation measures that had been implemented and noted gaps between policy measures and ground realities. Research topics selected by the students included the following: climate change impacts on wildlife, water pollution, structural geology of Nepal, changing rainfall patterns and adaptation, climate change and agricultural production, geology of Kathmandu valley, air quality of Kathmandu valley, changing hydrology of glaciated landscape, climate change and geohazards, emerging diseases and pests on agricultural crops, climate change adaptation by local communities, green infrastructure and climate-smart technologies, climate change impact on drinking water sources, the roadside geology, and emerging diseases, parasites and zoonotics. Each student completed their individual research project, synthesized the results, and presented to local stakeholders in conference organized by a nonprofit nongovernmental organization, Asta-Ja Rsearch and Development Center (Asta-Ja RDC), Kathmandu, Nepal. Findings of the study reveal that Nepal is experiencing huge impacts of climate change in multiple fronts including atmospheric conditions and snowfall, temperature rise, occurrence of droughts and flooding, changes on monsoon pattern, emerging diseases and pests on crops and livestock, and declining drinking water sources. Environmental pollution, especially the air and water pollution and waste management, was very serious affecting public health, aesthetics, and even the tourism of the country. In order to reverse environmental degradation and enhance climate change adaptation, immediate implementation of effective, comprehensive, coordinated, and well-thought-out climate change adaptation and environmental initiatives are necessary. Nepal Field Experience was a lifetime learning experience for the students

Enriching college students through study abroad: a case of Nepal Field Experience - Part 1

With a view of providing an unsurpassed opportunity to college students, who are mostly from Louisiana, in gaining a comprehensive understanding of Global Climate Change issues, we completed the first Nepal Field Experience Pilot Study Abroad from May 21-June 8, 2019. A total of fifteen students from the University of Louisiana at Lafayette, Louisiana, USA, and one graduate student from University of Arizona, Arizona, USA, participated in the program. Students examined and documented the effects of climate change impacts on agriculture, water resources, wildlife, local communities, forest resources, and other ecological and environmental settings of the country. They identified various climate change mitigation and adaptation measures that had been implemented and noted gaps between policy measures and ground realities. Research topics selected by the students included the following: climate change impacts on wildlife, water pollution, structural geology of Nepal, changing rainfall patterns and adaptation, climate change and agricultural production, geology of Kathmandu valley, air quality of Kathmandu valley, changing hydrology of glaciated landscape, climate change and geohazards, emerging diseases and pests on agricultural crops, climate change adaptation by local communities, green infrastructure and climate-smart technologies, climate change impact on drinking water sources, the roadside geology, and emerging diseases, parasites and zoonotics. Each student completed their individual research project, synthesized the results, and presented to local stakeholders in conference organized by a nonprofit nongovernmental organization, Asta-Ja Rsearch and Development Center (Asta-Ja RDC), Kathmandu, Nepal. Findings of the study reveal that Nepal is experiencing huge impacts of climate change in multiple fronts including atmospheric conditions and snowfall, temperature rise, occurrence of droughts and flooding, changes on monsoon pattern, emerging diseases and pests on crops and livestock, and declining drinking water sources. Environmental pollution, especially the air and water pollution and waste management, was very serious affecting public health, aesthetics, and even the tourism of the country. In order to reverse environmental degradation and enhance climate change adaptation, immediate implementation of effective, comprehensive, coordinated, and well-thought-out climate change adaptation and environmental initiatives are necessary. Nepal Field Experience was a lifetime learning experience for the students