Isotropic apparent diffusion coefficient mapping of postnatal cerebral development

Diffusion-weighted imaging (DWI) allows us to image the motion of tissue water. This has been used to demonstrate acute ischaemia. Diffusion imaging is also sensitive to water movement along neuronal tracts. Our objective was to map brain maturation in vivo using maps of apparent diffusion coefficient (ADC). We studied 22children without neurological disease aged between 2 and 720days. MRI was performed at 1.5tesla. Multislice single-shot echoplanar DWI was performed at b 0 and 1000s/mm2. ADC maps were generated automatically and measurements were performed in the basal ganglia, frontal and temporal white matter and the pons. There was a decrease over time in water diffusion in the areas examined, most marked in the frontal (0.887-1.898×10-3mm2/s) and temporal (1.077-1.748×10-3mm2/s)lobes. There was little change, after an initial decrease, in the basal ganglia (0.690-1.336×10-3mm2/s). There was a difference in water diffusion between the anterior (0.687-1.581×10-3mm2/s) and posterior (0.533-1.393×10-3mm2/s) pons. These changes correlate well with those observed in progressive myelination: the increased water content probably reflects incomplete myelination and the decrease with time in water motion reflects the increase in myelinated brai

Why do staff and family think differently about quality of life in dementia? A qualitative study exploring perspectives in care homes

Background: Quality of life is important especially in incurable illness. In dementia, we often need proxy reports of quality of life, but we know little about how individuals make their judgements. In care homes, proxies may be staff providing care or relatives, but staff rate quality of life differently to family. To our knowledge, no one has explored this qualitatively, so we used qualitative interviews to explore why staff and family think differently about quality of life. Methods: We interviewed 12 staff and 12 relatives who had provided proxy ratings of quality of life for people living with dementia in care homes in the Managing Agitation and Raising Quality of life (MARQUE) study. We asked why they had rated the resident's quality of life as “Very Good, Good, Fair, or Poor.” Using thematic analysis, we compared staff and relatives' proxy responses. Results: For staff, the concept of quality of life was often viewed synonymously with quality of care, influenced by their sense of responsibility and informed by their professional understanding. For relatives, quality of life was often judged in relation to how the person with dementia lived before diagnosis and was influenced by their perception of loss for the person with dementia and their own adjustment. Conclusions: Proxy reports were influenced by rater's own contexts and experiences. This can enhance our understanding of widely used research tools, aid the evaluation of intervention outcomes, and indicate possible targets for improving perceived and actual quality of life of people with dementia

Less is more: Antibiotics at the beginning of life

Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management

Understanding, treating, and renaming grandiose delusions : a qualitative study

Background Grandiose delusions are arguably the most neglected psychotic experience in research. Objectives We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services. Design A qualitative interview design was used to explore patients’ experiences of grandiose delusions. Method Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data. Results Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self‐identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy. Conclusions We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term ‘grandiose delusion’ is an imprecise description of the experience; we suggest ‘delusions of exceptionality’ may be a credible alternative. Practitioner points -Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly. -However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self‐identity, or make sense of unusual or difficult events. -Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours. -Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, ‘going the extra mile’, and listening carefully can help to facilitate trust

Increasing transparency through the open city toolkit

Degbelo, A., Granell, C., Trilles, S., Bhattacharya, D., & Wissing, J. (2020). Tell Me How My Open Data Is Re-used: Increasing Transparency Through the Open City Toolkit. In S. Hawken, H. Han, & C. Pettit (Eds.), Open Cities, Open Data: Collaborative Cities in the Information Era (pp. 311-330). [Chapter 14] Springer Singapore. https://doi.org/10.1007/978-981-13-6605-5_14The Open Data movement has been gaining momentum in recent years, with increasingly many public institutions making their data freely accessible. Despite much data being already open (and more to come), finding information about the actual usage of these open datasets is still a challenge. This chapter introduces two tools of the Open City Toolkit (OCT) that tackle this issue: a tool to increase transparency and interactive guidelines. Interviews with city council employees confirmed the utility of the transparency tool. Both tools can be used by city councils (for planning purposes) and by users interested to know more about the value of current open datasets (for information purposes).authorsversionpublishe

The psychological and social consequences of single-sided deafness in adulthood

Objectives: This study examined the subjective psychological and social effects of highly asymmetric hearing loss (single-sided deafness) in adults. Design: Three group interviews were conducted using the critical incidence technique and analysed using an inductive thematic analysis. Study sample: Eight adults with a clinical diagnosis of a moderately-severe hearing loss or greater in one ear and normal or near-normal hearing in the other ear. Results: A range of functional hearing difficulties associated with single-sided deafness including impaired speech in background noise and reduced spatial awareness were reported to affect social and psychological well-being. Social consequences of single-sided deafness resulted from activity limitations and participation restrictions including withdrawal from and within situations. Participants reported psychological effects including worrying about losing the hearing in their other ear, embarrassment related to the social stigma attached to hearing loss, and reduced confidence and belief in their abilities to participate. Conclusions: Single-sided deafness can be associated with many negative consequences. Counselling may help overcome the psychological consequences of hearing loss regardless of whether technological support such as a hearing aid is prescribed. The audiological management of these individuals should support the development of listening strategies and set appropriate expectations for participation in everyday listening situations

To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales

The concept of data saturation, defined as ‘information redundancy’ or the point at which no new themes or codes ‘emerge’ from data, is widely referenced in thematic analysis (TA) research in sport and exercise, and beyond. Several researchers have sought to ‘operationalise’ data saturation and provide concrete guidance on how many interviews, or focus groups, are enough to achieve some degree of data saturation in TA research. Our disagreement with such attempts to ‘capture’ data saturation for TA led us to this commentary. Here, we contribute to critical discussions of the saturation concept in qualitative research by interrogating the assumptions around the practice and procedures of TA that inform these data saturation ‘experiments’ and the conceptualisation of saturation as information redundancy. We argue that although the concepts of data-, thematic- or code-saturation, and even meaning-saturation, are coherent with the neo-positivist, discovery oriented, meaning excavation project of coding reliability types of TA, they are not consistent with the values and assumptions of reflexive TA. We encourage sport and exercise and other researchers using reflexive TA to dwell with uncertainty and recognise that meaning is generated through interpretation of, not excavated from, data, and therefore judgements about ‘how many’ data items, and when to stop data collection, are inescapably situated and subjective, and cannot be determined (wholly) in advance of analysis

A resource-based view and dynamic capabilities approach in the context of a region’s international attractiveness: The recent case of Western Australia

This exploratory study proposes a framework based on the resource view theory and the dynamic capabilities approach to further the understanding of a region’s attractiveness, particularly from an international perspective. The case of Western Australia is examined through in-depth, face-to-face interviews with nine country consuls experienced in international trade. The findings revealed significant ways in which Western Australia could enhance its future commercial appeal. The findings revealed the value of synergies between this state and other countries, particularly exchanging expertise, transferring knowledge, or exporting know-how, education, both university and industry-focused, research and development and expertise. These forms of regional attractiveness emphasise the strategic role of industry resources and dynamic capabilities, thus, underscoring the usefulness and applicability of the proposed framework. While the state’s mineral exports will continue to drive its economy, harnessing its potential in other areas is crucial to adapt to changing business environments and to build sustained competitive advantage. © 2018, The Author(s) 2018

A journey without maps—Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru

Purpose of the study: Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability. Design & methods: We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person. Results: Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a ‘journey without maps’. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched. Implications: Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation