Transcutaneous Blepharoptosis Surgery - Advancement of Levator Aponeurosis

Ptosis surgery has seen many advances in the last few decades, the most important of which have emerged as a result of better understanding of the anatomy and physiology of the eyelid and orbit. Anterior approaches such as a levator aponeurosis advancement, tarsoaponeurectomy and posterior repair involving resection of Muller’s muscle have proven to be effective in most cases. The focus of this article is a discussion of the indications, operative techniques, success rates and complications of transcutaneous levator advancement in detail

Learning to breathe with Tai Chi online - qualitative data from a randomized controlled feasibility study of patients with cystic fibrosis

Introduction Tai Chi (TC), a gentle exercise, incorporates meditative movement and respiratory control. The high risk of cross infection for people with cystic fibrosis (CF) requires close management in healthcare settings, limiting group activities such as TC. A mixed-methods randomized controlled feasibility study compared teaching TC over the internet with in-person, face to face TC tuition provided to CF patients. This article explores qualitative data from patients and TC instructors on their attitudes, acceptability and engagement with the two modes of TC delivery. Methods Qualitative data from CF patients (>6 years) were collected using Skype interviews/focus groups and written feedback. TC instructors provided weekly written feedback, and took part in interviews/ focus groups at the end of the study. Patient and instructor interviews explored their experiences and engagement with TC online delivery and ability to practice. Results Irrespective of the type of TC delivery, all CF participants interviewed (n = 28) practiced between lessons and most wanted to continue TC. Teenagers were more likely to miss TC appointments. Internet delivery was well received by both patients and TC instructors. Two patients reported difficulties with screen size/camera and one with internet connectivity. Conclusion Both face-to-face and internet delivery of TC lessons were equally well received and perceived as beneficial. In the current COVID-19 pandemic, CF patients self-isolating could find this intervention provides important support, therefore the programme was made available on YouTube in April 2020 and linked to the websites of the CF charities funding the research

"Fortunate are those who take the first steps"? The psychosocial impact of novel drug development.

Novel drug development offers people with cystic fibrosis exciting opportunities but is not without challenges. Currently, there is an understandable emphasis on protecting patients' physical health when developing treatments. However, there appears to be little consideration of how novel drug development impacts on psychosocial wellbeing, or the downstream consequences of this. Using an illustrative case and reviewing the literature we explore themes regarding the psychosocial impact of trial participation and novel drug development and identify areas requiring further research. Through this, we hope to prepare healthcare professionals to better understand the needs of their patients in this rapidly evolving landscape

Profound hypotony maculopathy in a first episode of bilateral idiopathic acute anterior uveitis

BACKGROUND: We report a case of a HLA-B27 negative patient presenting with severe, bilateral, idiopathic acute anterior uveitis with acute hypotony and hypotony maculopathy as their first uveitic episode. CASE PRESENTATION: Within a week of onset of her first episode of acute anterior uveitis, a 45 year-old Caucasian lady developed profound ocular hypotony with unrecordable intraocular pressures, reduced vision and choroidal folds. All investigations were negative. Uveitic hypotony responded slowly to corticosteroids – intravenous, oral and topical – with normalization of intraocular pressure and resolution of choroidal folds after two months. Anterior uveitis and hypotony have not returned with six months of follow-up. CONCLUSION: Bilateral, profound hypotony maculopathy may present acutely in idiopathic acute anterior uveitis, may be slow to respond to treatment and should be considered as a cause of vision loss in patients with this condition

A Permanência de Mulheres em Situações de Violência:: Considerações de Psicólogas

The aim of this paper is to identify what psychologists think who attend women in situations of domestic /marital violence, about the reasons for the persistence of some of the women in these situations.In this study qualitative research methods were used including semi-structured interviews and content analysis.The results show the following motivations for women to stay in violent situations: the strength of patriarchy; the identifying marks of romantic loveand secondary gains of women in the lived experience. These results partially confirm previous studies, but something new stands out. In contrast to what some studies have pointed out,psychologists consider the determination of the sociocultural phenomenon of violence against women in the construction of psychological distress and the proposed intervention.O objetivo desse artigo é identificar o que pensam psicólogas, que atendem/atenderam mulheres em situação de violência doméstica/conjugal, sobre as motivações para a permanência de algumas delas nessas situações. A proposta metodológica é um estudo qualitativo, utilizando-se entrevistas semiestruturadas e análise de conteúdo. Os resultados apontam como motivação para as mulheres permanecerem em situação de violência: a força do patriarcado; as marcas identitárias do amor romântico e os ganhos secundários das mulheres na experiência vivida. Esses resultados confirmam em parte estudos anteriores, porém algo novo se destaca. Ao contrário do que apresentam alguns estudos, as psicólogas consideram a determinação sociocultural do fenômeno da violência contra as mulheres na construção do sofrimento psíquico e da intervenção proposta

Children and Adults Tai Chi Study: a randomised feasibility study comparing internet delivered with face to face Tai Chi lessons in cystic fibrosis

Virtual health care is fast entering medical practice. Research into the feasibility of using it to teach treatment regimens such as exercise has not been explored. Maintaining an exercise regime can be difficult in cystic fibrosis: group classes risk potential infection yet motivation is hard to maintain when alone. Tai Chi is low impact and involves gentle, demanding movements. This study aimed to assess the feasibility, safety and acceptability of learning Tai Chi via an internet based approach and compared patient reported outcomes. Methods: Children and adults with cystic fibrosis were recruited to a randomised, comparative effectiveness trial. Participants learnt eight Tai Chi movements, teaching was delivered in eight lessons over 3 months: either internet delivered or face to face. Assessments were at three monthly intervals over nine-months. Outcomes included health status, quality of life, sleep, mindfulness and instructor-led questions. Results: Forty adults and children completed the eight sets of Tai Chi lessons. The median age was 22.8 years (range 6.1 to 51.5). Twenty-seven were female. Twenty-six adults (>16 years), six teenagers and eight <12 years. The groups were well matched. Feasibility and safety were demonstrated. Participants showed significant improvements in self-reported sleep, cough (both day and night time), stomach ache and breathing. No differences in lung function, health status, QoL, sleep or mindfulness was shown before or after completing the lessons. Conclusions: Tai Chi was safe well tolerated, it was feasible to deliver individual lessons via the internet reducing concerns regarding cross infection and appeared to improve self-reported symptoms. Copyright ©ERS 201

Art work or money: Conflicts in the construction of a creative identity

The identity projects of novice creative practitioners must take account of the economy of art work. It has been suggested (McRobbie, 2002a) that in the contemporary cultural industries in the UK, a new understanding of the connection between creative work and money has replaced past 'anti-commercial' notions. This claim is investigated through a narrative-discursive analysis of interviews from a longitudinal study with current and recent Art and Design postgraduates. Their ongoing identity projects are shaped by established understandings of creative work and the prospects it offers for earning and employment, and also by more local discursive resources given by personal life contexts. An analysis of two interviews with a single speaker shows how these resources are taken up within her ongoing and distinctive identity project. Both old and new repertoires of art and money are in play in her talk. She must negotiate dilemmas and potentially troubled positionings in order to reconcile a creative identity with relationships and responsibilities towards others. Coherence is only achieved momentarily and is disrupted by new life circumstances. By investigating an identity project at the level of talk, the analysis shows the complexity of the speaker's work to construct and claim a creative identity

Young people today: news media, policy and youth justice

The new sociology of childhood sees children as competent social agents with important contributions to make. And yet the phase of childhood is fraught with tensions and contradictions. Public policies are required, not only to protect children, but also to control them and regulate their behaviour. For children and young people in the UK, youth justice has become increasingly punitive. At the same time, social policies have focused more on children's inclusion and participation. In this interplay of conflict and contradictions, the role the media play is critical in contributing to the moral panic about childhood and youth. In this article, we consider media representations of “antisocial” children and young people and how this belies a moral response to the nature of contemporary childhood. We conclude by considering how a rights-based approach might help redress the moralised politics of childhood representations in the media

Self-harm in young people with perinatal HIV and HIV negative young people in England: cross sectional analysis.

BACKGROUND: Self-harm in adolescents is of growing concern internationally but limited evidence exists on the prevalence of self-harm in those living with HIV, who may be at higher risk of poor mental health outcomes. Therefore our aim was to determine the prevalence and predictors of self-harm among young people with perinatally-acquired HIV (PHIV) and HIV negative (with sibling or mother living with HIV) young people living in England. METHODS: 303 PHIV and 100 HIV negative young people (aged 12-23 years) participating in the Adolescents and Adults Living with Perinatal HIV cohort study completed an anonymous self-harm questionnaire, as well as a number of standardised mental-health assessments. Logistic regression investigated predictors of self-harm. RESULTS: The median age was 16.7 years in both groups, and 40.9% of the PHIV and 31.0% of the HIV negative groups were male. In total 13.9% (56/403) reported having ever self-harmed, with no difference by HIV status (p = 0.089). Multivariable predictors of self-harm were female sex (adjusted odds ratio (AOR) 5.3, (95% confidence interval 1.9, 14.1), p = 0.001), lower self-esteem (AOR 0.9 (0.8, 0.9) per 1 point increase, p < 0.001) and having ever used alcohol (AOR 3.8 (1.8, 7.8), p < 0.001). Self-esteem z-scores for both PHIV and HIV negative participants were 1.9 standard deviations below the mean for population norms. CONCLUSIONS: Self-harm is common among PHIV and HIV negative adolescents in England. Reassuringly however, they do not appear to be at an increased risk compared to the general adolescent population (15-19% lifetime prevalence). The low level of self-esteem (compared to available normative data) in both groups is worrying and warrants further attention

Elevated plasma CXCL12 alpha is associated with a poorer prognosis in pulmonary arterial hypertension.

Recent work in preclinical models suggests that signalling via the pro-angiogenic and proinflammatory cytokine, CXCL12 (SDF-1), plays an important pathogenic role in pulmonary hypertension (PH). The objective of this study was to establish whether circulating concentrations of CXCL12α were elevated in patients with PAH and related to mortalit