Hope in People With Aphasia

Background: Hope is considered to be important for health, recovery, and rehabilitation outcomes in a range of healthcare populations. Little is known about hope in people following stroke, and even less is known about hope in people with aphasia following stroke as they are commonly excluded from research in this field. Aims: This study aimed to explore how hope was experienced by people with aphasia following stroke during the post-acute period of rehabilitation, and to identify factors influencing the experience of hope. Methods & Procedures: This study utilised an Interpretive Description methodology. Data were collected through semi-structured interviews with five people with aphasia. Supported conversation techniques were used to facilitate full contribution of participants. Data were analysed using a number of approaches—coding, thematic analysis, narrative construction, diagramming, and memoing. Outcomes & Results: Hope was experienced in two ways. Simply ‘having’ hope was a broad but passive sense of hope which appeared to be the primary, constant form of hope. Actively hoping was an active, future-oriented form of hope that was experienced intermittently by participants. The experience of hope appeared dynamic and complex and seemingly influenced by three primary factors: uncertainty about the future; viewing hope as double-sided; and a sense of disruption. These were in turn influenced by a person's past experiences, present reality and perceived future. Conclusions: Hope is considered important by people with aphasia. It appears related to how people engage in rehabilitation and may be influenced by clinicians. As such, it is a concept that therapists should be aware of. Suggestions for how clinicians may consider and address hope are provided and discussed

Microbial Communities in a High Arctic polar desert landscape

The High Arctic is dominated by polar desert habitats whose microbial communities are poorly understood. In this study, we used next generation sequencing to describe the α- and β-diversity of polar desert soils from the Kongsfjorden region of Svalbard. Ten phyla consistently dominated the soils and accounted for 95 % of all sequences, with Proteobacteria, Actinobacteria and Chloroflexi being the dominant lineages. In contrast to previous investigations of Arctic soils, Acidobacterial relative abundances were low as were the Archaea throughout the Kongsfjorden polar desert landscape. Lower Acidobacterial abundances were attributed to the circumneutral soil pH in this region which has resulted from the weathering of the underlying carbonate geology. In addition, we correlated previously measured geochemical variables to determine potential controls on the communities. Soil phosphorus, pH, nitrogen and calcium significantly correlated with β-diversity indicating a landscape scale lithological control of soil nutrients which in turn influenced community composition. In addition, soil phosphorus and pH significantly correlated with α- diversity, specifically the Shannon diversity and Chao 1 richness indices

Stepping Up Psychosis: The Use of Virtual Reality in Pre-registration Mental Health Nursing Education

Background: There has been growing interest in the development of mental health-related simulation packages for pre-registration mental health nursing education. The authors will present the creation of a simulation package created for pre-registration mental health nurses during their final year. Method: The simulated experience consisted of a five-minute Virtual Reality (VR) recording which shares the experience of living with symptoms of psychoses. The package, not only looked at the hearing of voices, but in addition enhances the user's experience by simulating visual perception and placing the student within a secluded environment. This was delivered to students in their final six months of the program. Results: Students noted the increase in empathy for patients experiencing these symptoms and how it would enhance the care they gave. Conclusion: The results of this innovation demonstrate how virtual reality (VR) could be used to standardize student nurses' education in the field of mental health

Morphological characteristics of motor neurons do not determine their relative susceptibility to degeneration in a mouse model of severe spinal muscular atrophy

Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality, resulting primarily from the degeneration and loss of lower motor neurons. Studies using mouse models of SMA have revealed widespread heterogeneity in the susceptibility of individual motor neurons to neurodegeneration, but the underlying reasons remain unclear. Data from related motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), suggest that morphological properties of motor neurons may regulate susceptibility: in ALS larger motor units innervating fast-twitch muscles degenerate first. We therefore set out to determine whether intrinsic morphological characteristics of motor neurons influenced their relative vulnerability to SMA. Motor neuron vulnerability was mapped across 10 muscle groups in SMA mice. Neither the position of the muscle in the body, nor the fibre type of the muscle innervated, influenced susceptibility. Morphological properties of vulnerable and disease-resistant motor neurons were then determined from single motor units reconstructed in Thy.1-YFP-H mice. None of the parameters we investigated in healthy young adult mice - including motor unit size, motor unit arbor length, branching patterns, motor endplate size, developmental pruning and numbers of terminal Schwann cells at neuromuscular junctions - correlated with vulnerability. We conclude that morphological characteristics of motor neurons are not a major determinant of disease-susceptibility in SMA, in stark contrast to related forms of motor neuron disease such as ALS. This suggests that subtle molecular differences between motor neurons, or extrinsic factors arising from other cell types, are more likely to determine relative susceptibility in SMA

Cost-effectiveness of a novel lipoarabinomannan test for tuberculosis in patients with HIV

BACKGROUND: A novel urine lipoarabinomannan assay (FujiLAM) has higher sensitivity and higher cost than the first-generation AlereLAM assay. We evaluated the cost-effectiveness of FujiLAM for tuberculosis testing among hospitalized people with HIV irrespective of symptoms. METHODS: We used a microsimulation model to project clinical and economic outcomes of three testing strategies: 1) sputum Xpert MTB/RIF (Xpert); 2) sputum Xpert plus urine AlereLAM (Xpert+AlereLAM); 3) sputum Xpert plus urine FujiLAM (Xpert+FujiLAM). The modelled cohort matched that of a two-country clinical trial. We applied diagnostic yields from a retrospective study (yields for Xpert/Xpert+AlereLAM/Xpert+FujiLAM among those with CD4<200/µL: 33%/62%/70%; among those with CD4≥200/µL: 33%/35%/47%). Costs of Xpert/AlereLAM/FujiLAM were USD15/3/6 (South Africa) and USD25/3/6 (Malawi). Xpert+FujiLAM was considered cost-effective if its incremental cost-effectiveness ratio (USD/year-of-life saved) was <$940 (South Africa) and <$750 (Malawi). We varied key parameters in sensitivity analysis and performed a budget impact analysis of implementing FujiLAM countrywide. RESULTS: Compared with Xpert+AlereLAM, Xpert+FujiLAM increased life expectancy by 0.2 years for those tested in South Africa and Malawi. Xpert+FujiLAM was cost-effective in both countries. Xpert+FujiLAM for all patients remained cost-effective compared with sequential testing and CD4-stratified testing strategies. FujiLAM use added 3.5% (South Africa) and 4.7% (Malawi) to five-year healthcare costs of tested patients, primarily reflecting ongoing HIV treatment costs among survivors. CONCLUSIONS: FujiLAM with Xpert for tuberculosis testing in hospitalized people with HIV is likely to increase life expectancy and be cost-effective at the currently anticipated price in South Africa and Malawi. Additional studies should evaluate FujiLAM in clinical practice settings

The Sec1/Munc18 protein Vps45 regulates cellular levels of its SNARE binding partners Tlg2 and Snc2 in Saccharomyces cerevisiae

Intracellular membrane trafficking pathways must be tightly regulated to ensure proper functioning of all eukaryotic cells. Central to membrane trafficking is the formation of specific SNARE (soluble N-ethylmeleimide-sensitive factor attachment protein receptor) complexes between proteins on opposing lipid bilayers. The Sec1/Munc18 (SM) family of proteins play an essential role in SNARE-mediated membrane fusion, and like the SNAREs are conserved through evolution from yeast to humans. The SM protein Vps45 is required for the formation of yeast endosomal SNARE complexes and is thus essential for traffic through the endosomal system. Here we report that, in addition to its role in regulating SNARE complex assembly, Vps45 regulates cellular levels of its SNARE binding partners: the syntaxin Tlg2 and the v-SNARE Snc2: Cells lacking Vps45 have reduced cellular levels of Tlg2 and Snc2; and elevation of Vps45 levels results in concomitant increases in the levels of both Tlg2 and Snc2. As well as regulating traffic through the endosomal system, the Snc v-SNAREs are also required for exocytosis. Unlike most vps mutants, cells lacking Vps45 display multiple growth phenotypes. Here we report that these can be reversed by selectively restoring Snc2 levels in vps45 mutant cells. Our data indicate that as well as functioning as part of the machinery that controls SNARE complex assembly, Vps45 also plays a key role in determining the levels of its cognate SNARE proteins; another key factor in regulation of membrane traffic