Cognitive and psychological sequelae of hydrocephalus and spina bifida: turning interesting theoretical research into useful clinical intervention and guidelines

Background Ventricular shunts have significantly improved the prognosis of people with hydrocephalus and spina bifida; nevertheless, there are lifelong effects, which in many cases is associated with a cognitive profile of short term memory, attention and executive function difficulties (Iddon et al, 1996, 2001, 2003, 2004). There can also be psychological sequelae including depression and low self-esteem. The aim of this study is to develop clinical practice guidelines to inform intervention strategies to help patients and their carer to manage these difficulties. Materials and methods A three-stage project is being developed. Stage 1: A survey will be carried out to ascertain the needs of the client group, including gaps in local service provision and the impact of cognitive and psychological difficulties on everyday lives. Stage 2: Using data previously collected as well as new data, a detailed review will take place of specific cognitive difficulties and how these relate to everyday functions. Stage 3: A cognitive training programme will be developed as a guideline for practical clinical intervention. Results Data will be presented, showing the unmet need of people with hydrocephalus and spina bifida (N = 150, range of IQ's). Preliminary results of the new project will be presented and discussed. Conclusion It is not possible to provide a complete psychological support for individuals with hydrocephalus attending one London hospital clinic for their annual multi-disciplinary review. However, this project aims to bridge the theoretical/clinical gap we have previously identified in order to inform and guide their local services of the unmet needs of these clients, and to recommend appropriate interventions. This we anticipate will improve patients' quality of life

Cognitive and psychological sequelae of hydrocephalus and spina bifida: correlating subjective data and objective neuropsychological data to establish insight and inform clinical intervention and guidelines

Background Despite significant advances in treating and improving the prognosis of individuals with hydrocephalus and spina bifida, many of these individuals continue to experience specific cognitive difficulties in the areas of memory, language, attention and executive function and these can often have a significant negative impact on everyday functioning [1–3]. Materials and methods A comprehensive questionnaire was designed, based on known cognitive and emotional sequelae, to assess patient and caregiver perceptions of the specific difficulties experienced by people with hydrocephalus and spina bifida and the extent to which these are being addressed. In order to establish levels of insight, this questionnaire was correlated with detailed neuropsychological data to triangulate actual cognitive performance with subjective self-assessment obtained from patients and the objective view of caregivers. Results Questionnaire data will be presented that will highlight specific areas of discrepancy and concordance between patients and their caregivers (n = 60) and will be discussed in relation to actual performance on a range of cognitive tasks and the subsequent implications for strategic advice and intervention. Conclusion The data is being used to tailor specific cognitive strategies based on enhanced self-awareness, as part of small group and individual cognitive training interventions, within a multidisciplinary setting. It is hoped that the dissemination of the materials and methods designed for this study will inform best practice guidelines for these individuals and their caregivers and provide measurable outcomes for cognitive performance discrepancy, meta-awareness, strategy implementation and evaluation

A review of ventilation opening area terminology

This is the author accepted manuscript. The final version is available from Elsevier via https://doi.org/10.1016/j.enbuild.2016.02.053The design of a natural ventilation strategy requires the establishment of the location and size of a series of purpose provided ventilation openings (PPOs). The success of the design is dependent on knowledge of the aerodynamic performance of the PPOs often described by their geometry (normally an area) and resistance to airflow. The incorrect interpretation of this information can lead inappropriate ventilation strategies and buildings that overheat and have an excessive energy demand. Many definitions of PPO area are used by standards, guidelines, text books, and software tools. Each can be assigned multiple terms and a single term can be assigned to different definitions. There is evidence that this leads to errors in practice. An effective area of a PPO, defined as the product of its discharge coefficient and its free area, is proposed as a standard description because it is unambiguous and its measurement is governed by recognised standards. It is hoped that PPO manufacturers will provide an effective area as standard and that its use will be recognised as best practice. It is intended that these steps will reduce design errors and lead to successful natural ventilation strategies and better building

The cultural importance and international recognition of the Arctic charr Salvelinus alpinus populations of Windermere, UK

The Arctic charr Salvelinus alpinus populations of Windermere, England’s largest natural lake in the Lake District of north-west England, have been studied since the 1940s. However, the species’ cultural importance has a much longer history and these populations have been fished since 1223. As early as 1660, Arctic charr were exploited in a high-profile commercial net fishery and greatly enjoyed by locals and in a ‘potted’ form by wealthier members of UK society. However, overfishing led to substantially decreased catches and commercial netting was stopped in 1921. Local fishing for Arctic charr persists to the present as a small recreational plumb-line fishery using artificial lures. These fishing activities and resulting catches have long held great cultural interest for the local community and visiting national and international tourists. The cultural importance of the Arctic charr populations of Windermere has recently been the subject of national media interest that culminated in a 2017 documentary film highlighting environmental issues facing the Arctic charr and also celebrating the role of this iconic species in the cultural life of Windermere. In addition, international recognition of the Arctic charr populations of Windermere also contributed to the Lake District becoming a UNESCO World Heritage Site in 2017

Measurement of ventilation effectiveness and indoor air quality in toilets at mass gathering events

Mass gathering events were closed in 2020 to reduce the spread of SARS-CoV-2. These events included music concerts, theatre shows, and sports matches. It is known, however, that the long-range aerosol transmission of pathogens, such as SARS-CoV-2, can be reduced with sufficient ventilation indoors. This paper examines the risk of reopening these mass gathering events by measuring the CO2 concentration, as a proxy for ventilation effectiveness, at 58 events, with a specific focus on small enclosed spaces with short occupancy. Toilets (sanitary accommodation) are spaces that are densely and continuously occupied for short durations throughout the events, such as during theatre intervals or half-time at sports events. The results showed that the average air quality in toilets was good at most events. There were, however, considerable peaks in CO2 concentration of up to 3431 ppm in toilets at times when occupancy was presumed high, indicating that the risk of exposure to exhaled breath, which may contain virus-laden aerosols, is higher in toilets than elsewhere in the venue (although occupancy duration will be much lower). Recommendations are provided to encourage building designers and operators to be mindful of the ventilation strategies used in toilets given their occupancy and size

A three-dimensional model of primary bovine endometrium using an electrospun scaffold

Endometrial stromal and epithelial cell function is typically studied in vitro using standard two-dimensional monocultures, but these cultures fail to reflect the complex three-dimensional (3D) architecture of tissue. A 3D model of bovine endometrium that reflects the architectural arrangement of in vivo tissue would beneficially assist the study of tissue function. An electrospun polyglycolide (PGA) scaffold was selected to grow a 3D model of primary bovine endometrial epithelial and stromal cells, that reflects the architecture of the endometrium for the study of pathophysiology. Electrospun scaffolds were seeded with stromal and epithelial cells, and growth was assessed using histological techniques. Prostaglandin E2 and prostaglandin F2α responsiveness of endometrial scaffold constructs was tested using oxytocin plus arachidonic acid (OT + AA) or lipopolysaccharide (LPS). Stromal and epithelial cells growing on the electrospun scaffold had an architectural arrangement that mimicked whole tissue, deposited fibronectin, had appropriate expression of vimentin and cytokeratin and were responsive to OT + AA and LPS, as measured by prostaglandin accumulation. In conclusion, a functional 3D model of stromal and epithelial cells was developed using a PGA electrospun scaffold which may be used to study endometrial pathophysiology

Parathyroid hormone related peptide and receptor expression in paired primary prostate cancer and bone metastases

Parathyroid hormone-related peptide is a regulatory protein implicated in the pathogenesis of bone metastases, particularly in breast carcinoma. Parathyroid hormone-related peptide is widely expressed in primary prostate cancers but there are few reports of its expression in prostatic metastases. The aim of this study was to examine the expression of parathyroid hormone-related peptide and its receptor in matched primary and in bone metastatic tissue from patients with untreated adenocarcinoma of the prostate. Eight-millimetre trephine iliac crest bone biopsies containing metastatic prostate cancer were obtained from 14 patients from whom matched primary tumour tissue was also available. Histological grading was performed by an independent pathologist. The cellular location of mRNA for parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor was identified using in situ hybridization with 35S-labelled probe. Expression of parathyroid hormone-related peptide and its receptor was described as uniform, heterogenous or negative within the tumour cell population. Parathyroid hormone-related peptide expression was positive in 13 out of 14 primary tumours and in all 14 metastases. Receptor expression was evident in all 14 primaries and 12 out of 14 metastases. Co-expression of parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor was common (13 primary tumours, 12 metastases). The co-expression of parathyroid hormone-related peptide and its receptor suggest that autocrine parathyroid hormone-related peptide mediated stimulation may be a mechanism of escape from normal growth regulatory pathways. The high frequency of parathyroid hormone-related peptide expression in metastases is consistent with a role in the pathogenesis of bone metastases

The role of positive goal engagement in increased mental well-being among individuals with chronic non-cancer pain.

Individuals with chronic pain commonly report significant functional impairment and reduced quality of life. Despite this, little is known about psychological processes and mechanisms underpinning enhancements in well-being within this population. The study aimed to investigate whether (1) increased levels of pain intensity and interference were associated with lower levels of mental well-being, (2) increased positive goal engagement was associated with higher levels of mental well-being and (3) whether the relationships between pain characteristics and mental well-being were mediated by increased positive goal engagement. A total of 586 individuals with chronic pain participated in the cross-sectional, online study. Participants completed self-report measures to assess pain intensity and interference, mental well-being and goal motivation variables. Results showed that pain interference and positive goal engagement were associated with mental well-being. Moreover, the relationship between pain interference and mental well-being was partially mediated by positive goal engagement. The results provide tentative evidence for the protective role of positive goal engagement in enabling individuals with chronic pain to maintain a sense of mental well-being. The study develops the biopsychosocial model of chronic pain by examining the roles and relationships of relevant yet previously unexplored psychological constructs. The promotion of mental well-being through the enhancement of positive goal engagement is discussed, offering a platform for further research and clinical interventions