Pharmacy intervention at an intensive care rehabilitation clinic

Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal Infirmary. Within this programme a medication review by the critical care pharmacist provided an opportunity to identify and resolve any pharmaceutical care issues and also an opportunity to educate patients and their caregivers about changes to their medication. Methods: During the medication review we identified ongoing pharmaceutical care issues which were communicated to the patient’s primary care physician (GP) by letter or a telephone call. The patients were also encouraged to discuss any issues raised with their GP. The significance of the interventions was classified from those not likely to be of clinical benefit to the patient, to those which prevented serious therapeutic failure. Results: Data was collected from 47 of the 48 patients who attended the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67%). The pharmacist made 69 recommendations; including 20 relating to drugs which had been withheld and not restarted, dose adjustments were suggested on 13 occasions and new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission was clarified on 12 occasions. Lastly adverse drug effects were reported on 4 occasions and the incorrect drug was prescribed on 2 occasions. Of the interventions made 58% were considered to be of moderate to high impact. Conclusions: The pharmacist identified pharmaceutical care issues with 18.6% of the prescribed medications. Just over half of the patients reported that they were not made aware of any alterations to their prescribed medication on discharge. Therefore a pharmacy intervention is an essential part of an intensive care rehabilitation programme to address any medication related problems, provide education and to ensure patients gain optimal benefit from their medication

Indicating verbs in British Sign Language favour motivated use of space

Sign languages have traditionally been described as having a distinction between (1) arbitrary (referential or syntactic) space, considered to be a purely grammatical use of space in which locations arbitrarily represent concrete or abstract subject and/or object arguments using pronouns or indicating verbs, for example, and (2) motivated (topographic or surrogate) space, involving real-world mapping of locations of concrete referents onto the signing space via classifier constructions. Some linguists have suggested that it may be misleading to see the two uses of space as being completely distinct from one another. In this study, we use conversational data from the British Sign Language Corpus (www.bslcorpusproject.org) to look at the use of space with modified indicating verbs – specifically the directions in which these verbs are used as well as the co-occurrence of eyegaze shifts and constructed action. Our findings suggest that indicating verbs are frequently produced in conditions that use space in a motivated way and are rarely modified using arbitrary space. This contrasts with previous claims that indicating verbs in BSL prototypically use arbitrary space. We discuss the implications of this for theories about grammaticalisation and the role of gesture in sign languages and for sign language teaching

Bivariate stochastic modeling of functional response with natural mortality

A correction due to Abbott (1925) is the standard method of dealing with control mortality in insect bioassay to estimate the mortality of an insect conditional on control mortality not having occurred. In this article a bivariate stochastic process for overall mortality is developed in which natural mortality and predation are jointly modeled to take account of the competing-risks associated with prey loss. The total mortality estimate from this model is essentially identical with that from more classical modeling. However, when predation loss is estimated in the absence of control mortality the results are somewhat different, with the estimate from the bivariate model being lower than that from using Abbott’s formula in conjunction with the classical model. It is argued that overdispersion in observed mortality data corresponds to correlated outcomes (death or survival) for the prey initially present, while Abbott’s correction relies implicitly on independence

Sign languages and sociolinguistic typology

This paper examines the possible relationship between proposed social determinants of morphological ‘complexity’ and how this contributes to linguistic diversity, specifically via the typological nature of the sign languages of deaf communities. We sketch how the notion of morphological complexity, as defined by Trudgill (2011), applies to sign languages. Using these criteria, sign languages appear to be languages with low to moderate levels of complexity. This may partly reflect the influence of key social characteristics of communities on the typological nature of languages. Although many deaf communities are relatively small and may involve dense social networks (both social characteristics that Trudgill claimed may lend themselves to linguistic ‘complexification’), the picture is complicated by the highly variable nature of the sign language acquisition for most deaf people, and the ongoing contact between native signers, hearing non-native signers, and those deaf individuals who only acquire sign languages in later childhood and early adulthood. These are all factors that may work against the emergence of linguistic complexification. The relationship between linguistic typology and these key social factors may lead to a better understanding of the nature of sign language grammar. This perspective stands in contrast to other work where sign languages are sometimes presented as having complex morphology despite being young languages (e.g., Aronoff et al., 2005); in some descriptions, the social determinants of morphological complexity have not received much attention, nor has the notion of complexity itself been specifically explored

A comparison of three outcome measures of the impact of vasomotor symptoms on women’s lives

Objective: Measures of the impact of vasomotor symptoms (VMS) have been used as outcomes in clinical trials but have not been compared. This study compares the Hot Flush Rating Scale (HFRS), the Hot Flash Related Daily Interference Scale (HFRDIS), and the shorter Hot Flash Interference (HFI) scale.Methods: Baseline data were taken from two studies including healthy women (menopause transition or postmenopause) and breast cancer patients experiencing VMS. Participants completed questionnaires on sociodemographics, the HFRS, the HFRDIS, the HFI, the Work and Social Adjustment Scale (WSAS), on depression (Generalized Anxiety Disorder 7), on anxiety (Patient Health Questionnaire 9), and on use of medical services.Results: A total of 169 women (129 with history of breast cancer and 40 without) aged 54.47 (standard deviation [SD] = 9.11) years took part. They had an average of 66 (SD = 40.94) VMS per week, with a mean HFRS problem-rating of 6.53 (SD = 1.99), HFRDIS score of 5.36 (SD = 2.22), and HFI score of 6.13 (SD = 2.30). The HFRS problem-rating, HFRDIS, and HFI were significantly associated (r = 0.61–0.85), had good internal reliability (α = 0.76–0.91), and had significant concurrent validity with mood, the WSAS, and use of medical services. VMS frequency was not associated with mood, the WSAS, or use of medical services.Conclusion: The HFRS problem-rating scale and the HFI are two brief, three-item measures that measure a similar concept of VMS interference/impact, with evidence of reliability and validity.</p

Using conversational data to determine lexical frequency in British Sign Language: The influence of text type

This paper presents findings from an objective lexical frequency study in British Sign Language (BSL) based on 24,823 tokens collected as part of the BSL Corpus Project. The BSL study is only the fourth objective frequency study involving sign languages to be reported and is also the first study for any sign language to be based on entirely on spontaneous conversational data. When compared to previous frequency studies (both spoken and signed), some similarities can be observed although differences that may be attributed to text type are also recorded. When compared with subjective frequency ratings collected for BSL, a positive relationship is reported (similar to what has been observed for spoken languages). This is in contrast to a previous study which suggested a much weaker relationship between the two; however, this conclusion was based on a frequency count derived from narratives. These differences highlight the importance of using frequency measures derived from natural and spontaneous data, an opinion that has been emphasised in the spoken language literature

On verb ‘agreement’ in sign languages: Indicating verbs as typologically unique constructions

In this paper, we present arguments for an analysis of indicating verbs, building on Liddell (2000), as a typologically unique, unimodal fusion of signs and pointing gestures used for reference tracking. This contrasts with many formalist analyses that assume that directionality in indicating verbs constitutes an agreement marking system. While exploring some of the debate in the literature about these forms, we propose a model of indicating verbs within a Construction Grammar framework that compares them to multimodal constructions in spoken languages. We explain how our model of indicating verbs appear to align with a growing body of research on co-speech gesture and is supported by some recent findings about these verbs from corpus-based studies of sign languages

Factors contributing to late presentation of breast cancer in Africa: a systematic literature review

Background: Over 50% of people diagnosed with breast cancer in most African countries present late and report to the hospital with advanced stage III and IV disease, a major reason for the poor survival rate. This study reviewed studies focusing on patient-related factors or reasons contributing to the late presentation or delayed diagnosis of breast cancer in Africa. Method: A rigorous literature search was conducted with search terms “Breast Neoplasms” AND “Late Presentation” OR “Delayed Diagnosis” AND “Africa” OR “the name of any of the African countries” within CINAHL, African Index Medicus, MEDLINE, Web of Science and PsycINFO electronic databases. Additional hand searching of reference lists of included articles was conducted. A thematic synthesis was conducted. Result: Of the eighty-two studies identified, nine were eligible and included in the review. Studies included were conducted in Egypt, Nigeria, Ghana, Kenya and Libya. The factors identified as contributing to late presentation of breast cancer among most African women were negative symptom interpretation, fear, belief in alternative medicine, social relations and networks, lack of trust and confidence in orthodox medicine, and access to healthcare. Conclusion: A complex matrix of factors were identified that contribute to the late presentation or delayed diagnosis of breast cancer among most African women. The orthodox medical system in most African countries is gradually losing their relationship and credibility because of false reassurance, frequent misdiagnosis and strike actions, which is leading to late presentation of breast cancer

Modification of indicating verbs in British Sign Language: A corpus-based study

Indicating verbs can be directed towards locations in space associated with their arguments. The primary debate about these verbs is whether this directionality is akin to grammatical agreement or whether it represents a fusion of both morphemic and gestural elements. To move the debate forward, more empirical evidence is needed. We consider linguistic and social factors in 1679 indicating verb tokens from the BSL Corpus. Results reveal that modification is not obligatory and that patient modification is conditioned by several factors such as constructed action. Our results suggest that indicating verbs represent a fusion of morphemic and gestural elements

Balanced interhemispheric cortical activity is required for correct targeting of the corpus callosum

Bilateral integration of sensory and associative brain processing is achieved by precise connections between homologous regions in the two hemispheres via the corpus callosum. These connections form postnatally, and unilateral deprivation of sensory or spontaneous cortical activity during a critical period severely disrupts callosal wiring. However, little is known about how this early activity affects precise circuit formation. Here, using in utero electroporation of reporter genes, optogenetic constructs, and direct disruption of activity in callosal neurons combined with whisker ablations, we show that balanced interhemispheric activity, and not simply intact cortical activity in either hemisphere, is required for functional callosal targeting. Moreover, bilateral ablation of whiskers in symmetric or asymmetric configurations shows that spatially symmetric interhemispheric activity is required for appropriate callosal targeting. Our findings reveal a principle governing axon targeting, where spatially balanced activity between regions is required to establish their appropriate connectivit