Narratives of brain injury and self-management after hospital discharge

Specific processes for supporting self-management, as prioritised in contemporary Western healthcare policy, generally focus on biomedical aspects of managing a condition that is constructed as a separate entity from the rest of a person’s life. However, uncertainties in supporting self-management for long term conditions like traumatic brain injury (TBI) persist, including a mismatch between patient and professional contexts, and under-theorisation of the concepts ‘self’ and ‘agency’. To better grasp these issues, I gathered accounts of TBI-related experiences since hospital discharge, using a qualitative longitudinal design. I specifically relied on narrative interviews with ten dyads, consisting of one person who had recently sustained a TBI and their chosen ‘significant other’ person, at two time intervals. I undertook iterative narrative analyses, initially identifying discourses portrayed by participants and tensions, conflicts or emotional connections across our interactions. I drew upon insights from Michael Bamberg’s positioning analysis of the self in brief moments of talk-in-interaction, and Judith Butler’s work on performativity, to explore how people are bound by positions or create possibilities within socially instituted and maintained norms and expectations. The findings illustrate how the subject position ‘you are your brain injury’ brings an agentive gap. The self is made and remade through co-constructed narrative scaffolds that shift in collaborative storytelling, enabling the (re)claiming of a desired sense of self. This research offers insights into dynamics of consistency and change, rather than the assumed disruption to the self, when cognitive and communicative functions alter following TBI. In conclusion, I suggest implications for healthcare professionals’ conceptualisation of supported self-management interactions. Rather than ‘having’ individualistic agency that is bolstered by the clinical intervention, agency is understood as a relational co-construction, offering a shift away from positioning of the ‘clinician as expert’ and opening possibilities to reaffirm a sense of self

Starting early: integration of self-management support into an acute stroke service.

Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of self-management support in acute stroke settings has not been evaluated. The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit. The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating self-management support into ways of working in the acute stroke setting. Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed. Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care. Staff initiated an audit of washing and dressing practices pre- and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training. This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further work is required to evaluate sustainability of the Bridges stroke SMP, to understand the barriers and opportunities involved in engaging all professional groups in integrated self-management support in acute stroke settings, and to assess patient reported outcomes

Genomic relatedness within five common Finnish Campylobacter jejuni pulsed-field gel electrophoresis genotypes studied by amplified fragment length polymorphism analysis, ribotyping and serotyping

Thirty-five Finnish Campylobacter jejuni strains with five SmaI/SacII pulsed-field gel electrophoresis (PFGE) genotypes selected among human and chicken isolates from 1997 and 1998 were used for comparison of their PFGE patterns, amplified fragment length polymorphism (AFLP) patterns, HaeIII ribotypes, and heat-stable (HS) serotypes. The discriminatory power of PFGE, AFLP, and ribotyping with HaeIII were shown to be at the same level for this selected set of strains, and these methods assigned the strains into the same groups. The PFGE and AFLP patterns within a genotype were highly similar, indicating genetic relatedness. The same HS serotypes were distributed among different genotypes, and different serotypes were identified within one genotype. HS serotype 12 was only associated with the combined genotype G1 (PFGE-AFLP-ribotype). These studies using polyphasic genotyping methods suggested that common Finnish C. jejuni genotypes form genetic lineages which colonize both humans and chickens

Properties of DH Type II Radio Bursts and Their Space Weather Implications

We report on the properties of type II radio bursts observed by the Radio and Plasma Wave Experiment (WAVES) onboard the Wind spacecraft over the past two solar cycles. We confirm that the associated coronal mass ejections (CMEs) are fast and wide, more than half the CMEs being halos. About half of the type II bursts extend down to 0.5M hertz, corresponding to a heliocentric distance of tens of solar radii. The DH (Decametric-Hectometric) type II bursts are mostly confined to the active region belt and their occurrence rate follows the solar activity cycle. Type II bursts occurring on the western hemisphere of the Sun and extending to lower frequencies are good indicators of a solar energetic particle event

Written medical discharge communication from an acute stroke service: a project to improve content through development of a structured stroke-specific template

Specific guidelines for the content of discharge summaries from acute stroke services do not currently exist. The aims of this project were to assess the strengths and weaknesses of stroke discharge communication from Imperial College Healthcare NHS Trust, to develop a structured template to guide completion, and to re-audit discharge communication following its implementation. The audit compared local performance against record standards from the Academy of Medical Royal Colleges (1), which was augmented by criteria generated from the British Association of Stroke Physicians (BASP) Stroke Service Standards (2). Discharge information was examined within the Trust’s Electronic Discharge Communication (EDC) system to determine the recording of selected items for consecutively discharged patients from the hyperacute and acute stroke units. The audit was repeated following implementation of a newly developed stroke-specific discharge summary template. Fifty-one EDC summaries were examined at baseline (July 2012) and 30 summaries at re-audit (January 2013). The criteria which showed low adherence initially and which showed the most significant improvement following the introduction of the template were the guidance on blood pressure and lipids targets (increased from 2% and 0% respectively at baseline, to 93% post intervention), and the driving and flying advice (from 3% to 79%). Documentation was also seen to improve for measures of physical and cognitive function, discharge arrangements, and follow up plans. This audit cycle has demonstrated improvement in the consistency of content within written discharge communication following the introduction of a structured stroke-specific template adhering to combined criteria from identified standards

Ground Level Enhancement in the 2014 January 6 Solar Energetic Particle Event

We present a study of the 2014 January 6 solar energetic particle (SEP) event, which produced a small ground level enhancement (GLE), making it the second GLE of this unusual solar cycle 24. This event was primarily observed by the South Pole neutron monitors (increase of ~2.5%) whereas a few other neutron monitors recorded smaller increases. The associated coronal mass ejection (CME) originated behind the western limb and had the speed of 1960 km/s. The height of the CME at the start of the associated metric type II radio burst, which indicates the formation of a strong shock, was measured to be 1.61 Rs using a direct image from STEREO-A/EUVI. The CME height at the time of GLE particle release (determined using the South Pole neutron monitor data) was directly measured as 2.96 Rs, from the STEREO-A/COR1 white-light observations. These CME heights are consistent with those obtained for the GLE71, the only other GLE of the current cycle as well as cycle-23 GLEs derived using back-extrapolation. GLE72 is of special interest because it is one of the only two GLEs of cycle 24, one of the two behind-the-limb GLEs and one of the two smallest GLEs of cycles 23 and 24

Increased alpha-actinin-1 destabilizes E-cadherin-based adhesions and associates with poor prognosis in basal-like breast cancer

The controlled formation and stabilization of E-cadherin-based adhesions is vital for epithelial integrity. This requires co-operation between the E-cadherin-based adhesions and the associated actin cytoskeleton. In cancer, this co-operation often fails, predisposing cells to migration through molecular mechanisms that have only been partially characterized. Here, we demonstrate that the actin filament cross-linker alpha-actinin-1 is frequently increased in human breast cancer. In mammary epithelial cells, the increased alpha-actinin-1 levels promote cell migration and induce disorganized acini-like structures in Matrigel. This is accompanied by a major reorganization of the actin cytoskeleton and the associated E-cadherin-based adhesions. Increased expression of alpha-actinin-1 is particularly noted in basal-like breast cancer cell lines, and in breast cancer patients it associates with poor prognosis in basal-like subtypes. Downregulation of alpha-actinin-1 in E-cadherin expressing basal-like breast cancer cells demonstrate that alpha-actinin-1-assembled actin fibers destabilize E-cadherin-based adhesions. Taken together, these results indicate that increased alpha-actinin-1 expression destabilizes E-cadherin-based adhesions, which is likely to promote the migratory potential of breast cancer cells. Furthermore, our results identify alpha-actinin-1 as a candidate prognostic biomarker in basal-like breast cancer.Peer reviewe

Type III Radio Burst Duration and SEP Events

Long-duration (>15 min), low-frequency (25 MeV. The 1-MHz duration of the type III burst (28 rein) is near the median value of type III durations found for gradual SEP events and ground level enhancement (GLE) events. Yet, there was no sign of SEP events. On the other hand, two other type III bursts from the same active region had similar duration but accompanied by WAVES type 11 bursts; these bursts were also accompanied by SEP events detected by SOHO/ERNE. This study suggests that the type III burst duration may not be a good indicator of an SEP event, consistent with the statistical study of Cliver and Ling (2009, ApJ )