Clinical and financial consequences of setting up an asthma clinic at St. Luke’s Hospital

The effects of setting up an asthma clinic were assessed in an audit study. A comparison was made between the quality and quantity of medication used by patients before and after attending the asthma clinic. The number and severity of exacerbations during a six month period before and a six month period after attending were also assessed. The cost of treatment before and after was also calculated. In 14% of patients, occupational factors, drugs or underlying lung disease were significant contributors to asthma. The number of acute episodes of severe asthma were reduced from 98 to 47, with hospital admissions falling from 26 to 1. Pulmonary function (%FEV1) improved in the group as a whole with the number of patients having their best FEV above 80% improving from 44 to 71. In spite of the expense of high cost drugs and the running costs of the clinic there were substantial savings largely from the reduced number of hospital admissions. The calculated annual cost fell from Lm 22,769 to Lm 10,654.peer-reviewe

Media internalization and conformity to traditional masculine norms in relation to body image concerns among men

Previous studies have separately examined conformity to masculine norms and internalization of body ideals in the media in relation to the drive for muscularity (DM). This study was designed to examine these factors together in relation to DM, and further examine how they may differ in relation to drive for thinness (DT) and drive for leanness (DL). Participants were 284 Australian males between ages 18 to 42. They completed validated measures that assessed DM, DT, DL, male gender role norms, and internalization of body ideals. The findings showed that internalization of body ideals mediated the relationship between masculine role norms and body image in the case of both DM and DL. However, masculine norms and internalization were independent predictors of DT. Our findings contribute to further understanding of the roles that the media and masculine norms have in shaping men’s drive for muscularity, leanness, and thinness. Longitudinal research is needed to confirm the nature and direction of these relationships

(Re)acting Medicine: applying theatre in order to develop a whole-systems approach to understanding the healing response.

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Research in Drama Education: The Journal of Applied Theatre and Performance on 30/09/2014, available online: http://www.tandfonline.com/10.1080/13569783.2014.928007UK health and care provision is in crisis. Dominant practices, ideologies and infrastructure need to change. Our research team is investigating how performance-led research and creative practice is able to positively shape that change. Presently biomedicine holds the power; its reductionist research approach and acute medical model dominate. Neither are well-equipped to engage with increasing non-communicable, long-term, multi-issue, chronic ill-health. We believe that creative practitioners should be using their own well-established approaches to trouble this dominant paradigm to both form and inform the future of healing provision and wellbeing creation. Our transdisciplinary team (drama and medicine) is developing a methodology that is rooted in productive difference; an evolving synergy between two cultural and intellectual traditions with significant divergences in their world-view, perceptions, approaches and training methods. This commonality is underpinned by four assumptions that; (1) human-to-human interactions matter, (2) context matters, (3) the whole person and their community matters and (4) interpretation matters. Initially, we are using this methodology to investigate the fundamental human-to-human interaction of a person seeking healing (a healee) with a healer: we believe that this interaction enables the Healing Response - the intrinsic ability of the human organism to self-heal and regain homeostasis. In this paper we reflect on the project’s early stages

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Is implicit motor learning preserved after stroke? A systematic review with meta-analysis

© 2016 Kal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Many stroke patients experience difficulty with performing dual-tasks. A promising intervention to target this issue is implicit motor learning, as it should enhance patients' automaticity of movement. Yet, although it is often thought that implicit motor learning is preserved poststroke, evidence for this claim has not been systematically analysed yet. Therefore, we systematically reviewed whether implicit motor learning is preserved post-stroke, and whether patients benefit more from implicit than from explicit motor learning. We comprehensively searched conventional (MEDLINE, Cochrane, Embase, PEDro, PsycINFO) and grey literature databases (BIOSIS, Web of Science, OpenGrey, British Library, trial registries) for relevant reports. Two independent reviewers screened reports, extracted data, and performed a risk of bias assessment. Overall, we included 20 out of the 2177 identified reports that allow for a succinct evaluation of implicit motor learning. Of these, only 1 study investigated learning on a relatively complex, whole-body (balance board) task. All 19 other studies concerned variants of the serial-reaction time paradigm, with most of these focusing on learning with the unaffected hand (N = 13) rather than the affected hand or both hands (both: N = 4). Four of the 20 studies compared explicit and implicit motor learning post-stroke. Meta-analyses suggest that patients with stroke can learn implicitly with their unaffected side (mean difference (MD) = 69 ms, 95% CI[45.1, 92.9], p < .00001), but not with their affected side (standardized MD = -.11, 95% CI[-.45, .25], p = .56). Finally, implicit motor learning seemed equally effective as explicit motor learning post-stroke (SMD = -.54, 95% CI[-1.37, .29], p = .20). However, overall, the high risk of bias, small samples, and limited clinical relevance of most studies make it impossible to draw reliable conclusions regarding the effect of implicit motor learning strategies post-stroke. High quality studies with larger samples are warranted to test implicit motor learning in clinically relevant contexts

Measurements of top-quark pair differential and double-differential cross-sections in the ℓ +jets channel with pp collisions at s = 13 TeV using the ATLAS detector

Abstract: Single- and double-differential cross-section measurements are presented for the production of top-quark pairs, in the lepton + jets channel at particle and parton level. Two topologies, resolved and boosted, are considered and the results are presented as a function of several kinematic variables characterising the top and tt¯ system and jet multiplicities. The study was performed using data from pp collisions at centre-of-mass energy of 13 TeV collected in 2015 and 2016 by the ATLAS detector at the CERN Large Hadron Collider (LHC), corresponding to an integrated luminosity of 36fb-1. Due to the large tt¯ cross-section at the LHC, such measurements allow a detailed study of the properties of top-quark production and decay, enabling precision tests of several Monte Carlo generators and fixed-order Standard Model predictions. Overall, there is good agreement between the theoretical predictions and the data

Erratum to: Measurements of top-quark pair differential and double-differential cross-sections in the ℓ +jets channel with pp collisions at s = 13 TeV using the ATLAS detector [Eur. Phys. J. C 79 (2019) 1028]

Corrections for five figures and six tables are noted for the paper, which do not affect the conclusions reported

Measurements of top-quark pair differential and double-differential cross-sections in the ℓ +jets channel with pp collisions at s = 13 TeV using the ATLAS detector

Abstract: Single- and double-differential cross-section measurements are presented for the production of top-quark pairs, in the lepton + jets channel at particle and parton level. Two topologies, resolved and boosted, are considered and the results are presented as a function of several kinematic variables characterising the top and tt¯ system and jet multiplicities. The study was performed using data from pp collisions at centre-of-mass energy of 13 TeV collected in 2015 and 2016 by the ATLAS detector at the CERN Large Hadron Collider (LHC), corresponding to an integrated luminosity of 36fb-1. Due to the large tt¯ cross-section at the LHC, such measurements allow a detailed study of the properties of top-quark production and decay, enabling precision tests of several Monte Carlo generators and fixed-order Standard Model predictions. Overall, there is good agreement between the theoretical predictions and the data

Erratum to: Measurements of top-quark pair differential and double-differential cross-sections in the ℓ +jets channel with pp collisions at s = 13 TeV using the ATLAS detector [Eur. Phys. J. C 79 (2019) 1028]

Corrections for five figures and six tables are noted for the paper, which do not affect the conclusions reported