Making Memory Sites: Extending opportunities for people with profound and multiple learning disabilities to participate in life story work.

People with profound and multiple learning disabilities (PMLD) experience considerable difficulties communicating and develop idiosyncratic repertoires of communication that are understood and interpreted only by those closest to them. It is difficult to access their stories or to find out how they are living their lives via orthodox life story research practices and consequently their experiences remain hidden from history. This practice-led research was driven by the need to address a lack of methodological tools that enable the inclusion of people with PMLD as participants in life story work. The research sought to contribute to: 1. An understanding of the barriers, challenges and benefits of doing participatory life story work with people with PMLD. 2. The development of a range of methods that invite people with PMLD to participate in life story work, with specific, but not exclusive reference to rich media and digital tools. 3. A broader understanding of the every day social and cultural lives of three adults with PMLD. Researching alongside three adults with PMLD and their circles of support for an extended period of time using a qualitative mix of life history and ethnographic methods - including the shared examination of personal archive materials, participation in every day activities and interviews with close family and friends - revealed opportunities for them to engage in their pasts. Barriers of access and communication were identified and addressed. The deconstruction of narrative norms together with framing participatory life story work within a cultural, as opposed to an individual, context invited a reinterpretation of what it means to participate in life story work. Thematic analysis of the rich body of material generated by the project identified that opportunities to participate in life story work were dependent on particular qualities of people, time and environment. Participation in life story work was found to be beneficial to the participants with PMLD because it challenged perceptions, demonstrated their value as people living socially and culturally rich lives, provided a platform for shared remembering and was a catalyst for new narratives. The findings indicate possibilities for including people with PMLD as participants in other research areas including mental health and wellbeing

Identification and bisection of temporal durations and tone frequencies: Common models for temporal and non-temporal stimuli.

Two experiments examined identification and bisection of tones varying in temporal duration (Experiment 1) or frequency (Experiment 2). Absolute identification of both durations and frequencies was influenced by prior stimuli and by stimulus distribution. Stimulus distribution influenced bisection for both stimulus types consistently, with more positively skewed distributions producing lower bisection points. The effect of distribution was greater when the ratio of the largest to smallest stimulus magnitude was greater. A simple mathematical model, temporal range frequency theory, was applied. It is concluded that (a) similar principles describe identification of temporal durations and other stimulus dimensions and (b) temporal bisection point shifts can be understood in terms of psychophysical principles independently developed in nontemporal domains, such as A. Parducci's (1965) range frequency theory

Recent advances in pre-exposure prophylaxis for HIV

Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation

Atypical expression of smooth muscle markers and co-activators and their regulation in rheumatic aortic and calcified bicuspid valves

Objective: We have previously reported that human calcified aortic cusps have abundant expression of smooth muscle (SM) markers and co-activators. We hypothesised that cells in bicuspid aortic valve (BAV) cusps and those affected by rheumatic heart valve (RHV) disease may follow a similar phenotypic transition into smooth muscle cells, a process that could be regulated by transforming growth factors (TGFs). Aims: Cusps from 8 patients with BAV and 7 patients with RHV were analysed for ealy and late SM markers and regulators of SM gene expression by immunocytochemistry and compared to healthy aortic valves from 12 unused heart valve donors. The ability of TGFs to induce these markers in valve endothelial cells (VECs) on two substrates was assessed. Results: 7 out of 8 BAVs and all the RHVs showed an increased and atypical expression of early and late SM markers α-SMA, calponin, SM22 and SM-myosin. The SM marker coactivators were aberrantly expressed in 6 of the BAV and 6 of the RHV, in a similar regional pattern to the expression of SM markers. Additionally, regions of VECs, and endothelial cells lining the vessels within the cusps were found to be positive for SM markers and coactivators in 3 BAV and 6 RHV. Both BAVs and RHVs were significantly thickened and HIF1α expression was prominent in 4 BAVs and 1 RHV. The ability of TGFβs to induce the expression of SM markers and myocardin was greater in VECs cultured on fibronectin than on gelatin. Fibronectin was shown to be upregulated in BAVs and RHVs, within the cusps as well as in the basement membrane. Conclusion: BAVs and RHVs expressed increased numbers of SM marker-positive VICs and VECs. Concomittantly, these cells expressed MRTF-A and myocardin, key regulators of SM gene expression. TGFβ1 was able to preferentially upregulate SM markers and myocardin in VECs on fibronectin, and fibronectin was found to be upregulated in BAVs and RHVs. These findings suggest a role of VEC as a source of cells that express SM cell markers in BAVs and RHVs. The similarity between SM marker expression in BAVs and RHVs with our previous study with cusps from patients with aortic stenosis suggests the existance of a common pathological pathway between these different pathologies. Abbreviations: BAV, bicuspid aortic valve; RHV, rheumatic heart valve; SM, smooth muscle; TGF, transforming growth factor; MRTF-A, myocardin related transcription factor A; VIC, valve interstitial cell; VEC, valve endothelial cell; PCNA, proliferating nuclear cell antigen; HIF1α, hypoxia inducible factor 1α

Ample consumption period available until use-by dates: a potential, marketing position for store brands

Traditionally store brands in Australia are viewed with suspicion in regard to their quality and are usually purchased because of the "value for money" that they offer. Australian supermarket majors are considering introducing a new suite of store brands in the higher price brackets. The danger of moving upscale however is that these store brands are relinquishing their value for money appeal and will come head to head with the manufactured brands. Store brands will now require some quality dimension to compete. This paper after studying the attitudes and behavioural response of grocery shoppers to use by dates, is proposing that that the promise of "generous" use-by dates as a surrogate for quality, could be considered as a positioning plank to promote store brands as alternatives to manufactured brands. Logit analysis is employed to explain shoppers' perception and response to use-by dates, of products that they regularly buy, and of alternative products which they have never bought before if the use-by dates of their regular items are perceived to be too shor

Risks and benefits HIV preexposure prophylaxis with tenofovir/emtricitabine in an older male with comorbidities

Renal toxicity in a 73 year old man using tenofovir/emtricitabine (TDF/FTC) as pre-exposure prophylaxis (PrEP) is described. Reduced renal reserve, a higher exposure to co-medications and co-morbidities can present a challenge when assessing the risks and benefits of tenofovir based PrEP in the ageing population

Results of cross-faculty 'capstone' assessments involving nursing and performing arts students

This article describes how ‘capstone’ assessments were created to provide two different student groups, nursing and performing arts students, with a lived experience of learning together about their own fields of practice. Capstone assessments combine ‘live’ human simulation with self‑reflection and peer review. A capstone assessment is the integration of a body of relatively fragmented knowledge and learning to form a unified whole and can be used as a transitional assessment and a bridging experience to connect knowledge between modules or courses. The capstone assessments involved two faculties and four modules, three nursing and one performing arts. Case studies were designed to represent real-life situations that students were likely to encounter during their careers, either playing a patient as an actor or performing a caring role as a nurse. Assessments for the capstone simulation were formative, and involved the students engaging in self-reflection and peer review. Videos were available to enhance the self-reflection and peer-review process. Evaluation was undertaken through verbal feedback during debrief, written feedback, video footage and nursing student and acting student peer review. The experience of capstone assessments for two diverse student groups provided valuable learning from their own and from a different group outside their subject area

Strategies to Prevent Occupational Fraud in the Financial Sector

Financial business leaders who experience significant occupational fraud lose substantial profits. With a greater understanding of the antifraud strategies needed to protect profit margins, leaders may be able to improve the long-term sustainability of their firms. Grounded in the fraud diamond theory, the purpose of this qualitative single-case study was to explore strategies financial business managers use to prevent occupational fraud in Kingston, Jamaica. Data were collected from semistructured interviews and documents such as annual reports, training and development manuals, policy and procedure manuals, and financial performance reports. The participants were four managers who worked in a Kingston-based financial organization for a minimum of 3 years and experienced at least one fraud case. Using thematic analysis, three themes were identified, including auditing, internal controls, and human resource intervention. A key recommendation for action is for leaders to develop a robust ethical culture supported by a whistleblowing policy. The results may provide local and international financial sector business managers with insight on best implementing anti-fraud strategies, allowing them to experience greater profitability and business sustainability. Implementing these strategies may enable business leaders to create additional jobs and increase their investment in corporate social responsibility activities in their immediate communities

Modulation of human valve interstitial cell phenotype and function using a fibroblast growth factor 2 formulation

Valve interstitial cells (VICs) are fibroblastic in nature however in culture it is widely accepted that they differentiate into a myofibroblastic phenotype. This study assessed a fibroblast culture media formulation for its ability to maintain the phenotype and function of VICs as in the intact healthy valve. Normal human VICs were cultured separately in standard DMEM and in fibroblast media consisting of FGF2 (10 ng/ml), insulin (50 ng/ml) and 2% FCS for at least a week. Cell morphology, aspect ratio, size, levels and distribution of protein expression, proliferation, cell cycle, contraction and migration were assessed. Some VICs and some valve endothelial cells expressed FGF2 in valve tissue and this expression was increased in calcified valves. VICs in DMEM exhibited large, spread cells whereas VICs in fibroblast media were smaller, elongated and spindly. Aspect ratio and size were both significantly higher in DMEM (p<0.01). The level of expression of α-SMA was significantly reduced in fibroblast media at day 2 after isolation (p<0.01) and the expression of α-SMA, SM22 and EDA-fibronectin was significantly reduced in fibroblast media at days 7 and 12 post-isolation (p<0.01). Expression of cytoskeletal proteins, bone marker proteins and extracellular matrix proteins was reduced in fibroblast media. Proliferation of VICs in fibroblast media was significantly reduced at weeks 1 (p<0.05) and 2 (p<0.01). Collagen gel contraction was significantly reduced in fibroblast media (p<0.05). VICs were found to have significantly fewer and smaller focal adhesions in fibroblast media (p<0.01) with significantly fewer supermature focal adhesions in fibroblast media (p<0.001). Ultrastructurally, VICs in fibroblast media resembled native VICs from intact valves. VICs in fibroblast media demonstrated a slower migratory ability after wounding at 72 hours (p<0.01). Treatment of human VICs with this fibroblast media formulation has the ability to maintain and to dedifferentiate the VICs back to a fibroblastic phenotype with phenotypic and functional characteristics ascribed to cells in the intact valve. This methodology is fundamental in the study of normal valve biology, pathology and in the field of tissue engineering