No Sunshine When She’s Gone: The Shared Experiences of African American Men Who Have Undergone Divorce

The purpose of this transcendental phenomenological study is to chronicle the shared experiences of working-class/middle-class African American men who have gone through a divorce in Hampton Roads, Virginia. Vygotsky’s sociocultural theory of cognitive development, which highlights the essential roles of language and culture, and Kurt Lewin’s field theory, which suggests the field as a practical framework for researching divorce, guided this study. The research questions were as follows: How do working-class/middle-class African American men describe their experience with divorce? How do participants describe their initial understanding of the divorce process? How do participants describe the level of social support they received during the divorce process? How do participants describe the effect divorce had on their sense of self-actualization (motivation)? What benefits do participants describe that arose from going through their divorce? The participants were divorced African American men who were married for a minimum of two years. Data was collected through semi-structured interviews, focus groups, and cognitive representations. Data was analyzed utilizing Moustakas’ (1994) standards for transcendental phenomenology to synthesize the crux of the participants’ recollections. Two major themes emanated through data analysis: (a) divorce is a multifarious emotional ordeal that is exacerbated by a lack of knowledge of the divorce process, and (b) elevated levels of diverse post-traumatic growth and self-actualization in the wake of divorce due to high levels of social support. Data analysis revealed three subthemes of the primary theme - a convolution of feelings, a painful and horrific experience, and stress compounded by a negligible understanding of the divorce process. Two subthemes emerged from theme two: the importance of multi-layered social support and self-actualization as evidenced by positive post-divorce transformations

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

N-of-1 clinical trials in nutritional interventions directed at improving cognitive function

Longer life expectancy has led to an increase in the prevalence of age-related cognitive decline and dementia worldwide. Due to the current lack of effective treatment for these conditions, preventive strategies represent a research priority. A large body of evidence suggests that nutrition is involved in the pathogenesis of age-related cognitive decline, but also that it may play a critical role in slowing down its progression. At a population level, healthy dietary patterns interventions, such as the Mediterranean and the MIND diets, have been associated with improved cognitive performance and a decreased risk of neurodegenerative disease development. In the era of evidence-based medicine and patient-centered healthcare, personalized nutritional recommendations would offer a considerable opportunity in preventing cognitive decline progression. N-of-1 clinical trials have emerged as a fundamental design in evidence-based medicine. They consider each individual as the only unit of observation and intervention. The aggregation of series of N-of-1 clinical trials also enables population-level conclusions. This review provides a general view of the current scientific evidence regarding nutrition and cognitive decline, and critically states its limitations when translating results into the clinical practice. Furthermore, we suggest methodological strategies to develop N-of-1 clinical trials focused on nutrition and cognition in an older population. Finally, we evaluate the potential challenges that researchers may face when performing studies in precision nutrition and cognition