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

The Primary Care Electronic Library: RSS feeds using SNOMED-CT indexing for dynamic content delivery

BACKGROUND: Rich Site Summary (RSS) feeds are a method for disseminating and syndicating the contents of a website using extensible mark-up language (XML). The Primary Care Electronic Library (PCEL) distributes recent additions to the site in the form of an RSS feed. When new resources are added to PCEL, they are manually assigned medical subject headings (MeSH terms), which are then automatically mapped to SNOMED-CT terms using the Unified Medical Language System (UMLS) Metathesaurus. The library is thus searchable using MeSH or SNOMED-CT. Our syndicate partner wished to have remote access to PCEL coronary heart disease (CHD) information resources based on SNOMED-CT search terms. OBJECTIVE: To pilot the supply of relevant information resources in response to clinically coded requests, using RSS syndication for transmission between web servers. METHOD: Our syndicate partner provided a list of CHD SNOMED-CT terms to its end-users, a list which was coded according to UMLS specifications. When the end-user requested relevant information resources, this request was relayed from our syndicate partner's web server to the PCEL web server. The relevant resources were retrieved from the PCEL MySQL database. This database is accessed using a server side scripting language (PHP), which enables the production of dynamic RSS feeds on the basis of Source Asserted Identifiers (CODEs) contained in UMLS. RESULTS: Retrieving resources using SNOMED-CT terms using syndication can be used to build a functioning application. The process from request to display of syndicated resources took less than one second. CONCLUSION: The results of the pilot illustrate that it is possible to exchange data between servers using RSS syndication. This method could be utilised dynamically to supply digital library resources to a clinical system with SNOMED-CT data used as the standard of reference

Air regurgitation in patients on continuous positive airway pressure (CPAP) therapy following dacrocystorhinostomy with or without Lester-Jones tube insertion

Aim: To describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester–Jones tube (LJT) insertion. Methods: A retrospective review of all patients with air regurgitation on CPAP therapy who previously underwent a DCR/LJT procedure. Patient demographics, lacrimal surgical history, CPAP therapy and outcome were recorded. Results: Four male patients were identified. The mean age at presentation was 54 years. Two patients had an LJT inserted, and two patients had a DCR procedure, one was external, and one was endonasal. All four patients had resolution of their epiphora. Three patients had superficial epithelial keratopathy requiring lubricant therapy. All patients attempted using ointment to act as a barrier over the neo-ostium, which was unsuccessful. One patient had the LJT removed with resolution of the air regurgitation. Two patients changed their CPAP machines to variable, and three patients reduced the pressure of their CPAP therapy without any improvement. All three patients had persistence of air regurgitation at a mean follow-up of 18 months. Conclusions: Air regurgitation can occur following naso-lacrimal surgery in patients on CPAP therapy. Although this is an unusual complication, it should be discussed with the patient at the time of obtaining informed consent.Paul S. Cannon, Simon N. Madge, Dinesh Selv

Exploring views on satisfaction with life in young children with chronic illness: an innovative approach to the collection of self-report data from children under 11

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge

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

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

<i>WhatsApp</i> use among African international distance education (IDE) students: transferring, translating and transforming educational experiences

Much of the research on how social media is embedded into the educational practices of higher education students has a Western orientation. In concentrating on a case study of the varied ways in which African International Distance Education (IDE) students actively use social media to shape their learning experiences, we discuss an under-researched group. The paper draws on analysis of 1295 online questionnaires and 165 in-depth interviews with IDE students at UNISA, South Africa, one of the largest providers of IDE globally. WhatsApp emerges as ‘the’ key social media tool that opens up opportunities for IDE students to transfer, translate and transform their educational journey when studying ‘at a distance’. Although WhatsApp does provide a ‘space of opportunity’ for some students, this is framed through socio-technical marginalisation, itself a reflection of demographic legacies of inequality. Exploring social media practices though the case of African IDE students places these students centre stage and adds to the awareness of the multiple centres from which international education is practiced

Dise?o y construcci?n del edificio de vivienda multifamiliar Las Cumbres

El proyecto de tesis ?Dise?o y construcci?n del edificio de vivienda multifamiliar Las Cumbres? consta de 20 pisos, 320 departamentos y tiene una duraci?n de 22 meses, es un proyecto que se plantea ejecutar por primera vez en la ciudad de Lima. El prop?sito de la presente tesis es desarrollar la gesti?n del proyecto de acuerdo a la gu?a del PMBOK 6ta edici?n, de tal forma que podamos obtener informaci?n?n relevante de c?mo gestionar proyectos multifamiliares en Lima ,aplicarlos a proyectos reales y tener ?xito en ellos. En la actualidad para que un proyecto pueda tener ?xito tiene que haber una planificaci?n que contemple las 10 ?reas de conocimiento de la Gu?a PMBOK como son: Plan de gesti?n del alcance, de los plazos, de los costes, de calidad, de recursos, de comunicaciones, de riesgos, de interesados, de adquisiciones e integraci?n de todas la ?reas, si solo nos enfocamos en alcance, costo y tiempo, podr?amos llegar a fracasar y dejar de trabajar factores cr?ticos de ?xito. El sector de la construcci?n en el Per? es un motor de la econom?a y reacciona de manera inmediata con el crecimiento y es generador de empleo, estando en un mercado cada vez mas competitivo resulta imprescindible para las empresas implementar la gesti?n de proyectos para asegurar en mayor medida el ?xito de las estrategias. Adem?s, ?sta tesis se desarroll? contando con un equipo interdisciplinario y as? contribuy? a analizar desde puntos de vista diferentes, enriqueciendo a?n m?s el documento