On Learning and Unlearning

I remember passing our lunch lady–the nice one with a big bleach-blond afro. She was perched on an elementary-school-sized desk, eyes fixated to the television. I glanced at the screen on the way into my classroom while my teacher hesitated in the hallway, whispering to the other adults. She reentered the room a few minutes later to explain. In the following months, my television provided me with one of the most formative, practical and comprehensive educational experiences of my life. First it was vocabulary building, with the words like “hi-jacker,” and “terrorist.” Then it was physics, learning that inertia is the reason for absolute devastation when your plane crashes into a building. Soon, “Al-Qaeda,” “the Taliban,” and “Osama bin Laden” became part of my reality, as I watched a broadcast of young men in the “Middle East” (I was learning geography too!) burning American flags. [excerpt

An Equal Opportunity Rejection

Let’s talk about applications. We’ve all been there. You write your application, work on draft after draft and then you send it all off to the college or job of your dreams. And you wait…and wait…and wait. You wait for some sort of letter or phone call that says something along the lines of, “We love you! You’re awesome, and smart and special, and we think you’d be a great asset!” And maybe you’re lucky and you do get that letter, but let’s be real - that doesn’t always happen. It can be frustrating to receive a rejection letter (or nothing at all), because in all honesty, who wants to be told that they’re “not good enough”? Not me. [excerpt

I Don\u27t Want to Save Your Children

A few weeks ago, the moment that I’ve been dreaming of for almost half of a year finally arrived. I started the Heston Summer Experience as an intern in Gettysburg. An embarrassing amount of my winter break was devoted to writing and rewriting my applications. After receiving an invitation for an interview, I convened my roommates to help me choose an outfit and ask me practice questions, which is not something I do…ever. Getting my acceptance letter in the mail was the ultimate highlight of a long and difficult year. When I was home for the first few weeks of summer and people were asking me about my plans, I was initially really excited to share. (Who wouldn’t be?) The more time I spent explaining the internship to my friends and family though, the more embarrassed I became. [excerpt

Sexism - LMFAO

So I have a confession to make, one that I’m really not proud of, but part of being a mature person is acknowledging, accepting, and learning from your past mistakes. Here it is: I told a sexist joke. [excerpt

Fearless: The Next Wave of Insurgents

As we close out on another school year, the Surge staff is looking back on an awesome semester and preparing for a new year with new leadership. Katie Patterson ’15, Rashida Aluko-Roberts ’15,Steph Adamczak ’15, and Kathryn Bucolo ’14 are fearlessly taking the reigns and will continue bringing thought-provoking, challenging, and creative articles each week to Surge, and we can’t wait to see what they will do! [excerpt

Depression and mortality: Artifact of measurement and analysis?

Background Previous research demonstrates various associations between depression, cardiovascular disease (CVD) incidence and mortality, possibly as a result of the different methodologies used to measure depression and analyse relationships. This analysis investigated the association between depression, CVD incidence (CVDI) and mortality from CVD (MCVD), smoking related conditions (MSRC), and all causes (MALL), in a sample data set, where depression was measured using items from a validated questionnaire and using items derived from the factor analysis of a larger questionnaire, and analyses were conducted based on continuous data and grouped data. Methods Data from the PRIME Study (N=9798 men) on depression and 10-year CVD incidence and mortality were analysed using Cox proportional hazards models. Results Using continuous data, both measures of depression resulted in the emergence of positive associations between depression and mortality (MCVD, MSRC, MALL). Using grouped data, however, associations between a validated measure of depression and MCVD, and between a measure of depression derived from factor analysis and all measures of mortality were lost. Limitations Low levels of depression, low numbers of individuals with high depression and low numbers of outcome events may limit these analyses, but levels are usual for the population studied. Conclusions These data demonstrate a possible association between depression and mortality but detecting this association is dependent on the measurement used and method of analysis. Different findings based on methodology present clear problems for the elucidation and determination of relationships. The differences here argue for the use of validated scales where possible and suggest against over-reduction via factor analysis and grouping. CrownCopyright © 2013PublishedbyElsevierB.V.Allrightsreserved

Feasibility and outcomes of Fibreoptic Endoscopic Evaluation of Swallowing following prophylactic swallowing rehabilitation in head and neck cancer

Objectives Investigate the feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing (FEES) following a programme of prophylactic swallowing exercises in head and neck cancer (HNC) patients treated with radiotherapy. Design Prospective, single cohort, feasibility study. Setting Three head and neck cancer centres in Scotland. Participants Pre‐radiotherapy HNC patients who consented to participate in a prophylactic swallowing intervention. Outcome measures FEES recruitment and retention rates, assessment acceptability and compliance, qualitative process evaluation. Results Higher rates of recruitment and retention were achieved in centres where FEES equipment was available on site. Travel and anticipated discomfort were barriers to recruitment. Data completion was high for all rating scales, with goo d reliability. Following radiotherapy, swallowing safety significantly deteriorated for liquid boluses (p=0.005‐0.03); pharyngeal residue increased for liquid and semi‐solid boluses. Pharyngo‐laryngeal oedema was present pre‐treatment and significantly increased post‐radiotherapy (p=0.001). Patients generally reported positive experience of FEES for their own learning and establishing a baseline. Conclusions FEES is an acceptable method of assessing patients for a prophylactic swallowing intervention and offers some additional information missing from VF. Barriers have been identified and should be taken into account in order to maximise recruitment for future trials

Predictive Value of Depressive Symptoms for All-Cause Mortality: Findings From the PRIME Belfast Study Examining the Role of Inflammation and Cardiovascular Risk Markers.

OBJECTIVES: To improve understanding about the potential underlying biological mechanisms in the link between depression and all-cause mortality and to investigate the role that inflammatory and other cardiovascular risk factors may play in the relationship between depressive symptoms and mortality. METHODS: Depression and blood-based biological markers were assessed in the Belfast PRIME prospective cohort study (N = 2389 men, aged 50-59 years) in which participants were followed up for 18 years. Depression was measured using the 10-item Welsh Pure Depression Inventory. Inflammation markers (C-reactive protein [CRP], neopterin, interleukin [IL]-1 receptor antagonist [IL-1Ra], and IL-18) and cardiovascular-specific risk factors (N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, C-terminal pro-endothelin-1 [CT-proET]) were obtained at baseline. We used Cox proportional hazards modeling to examine the association between depression and biological measures in relation to all-cause mortality and explore the mediating effects. RESULTS: During follow-up, 418 participants died. Higher levels of depressive symptoms were associated with higher levels of CRP, IL-1Ra, and CT-proET. After adjustment for socioeconomic and life-style risk factors, depressive symptoms were significantly associated with all-cause mortality (hazard ratio = 1.10 per scale unit, 95% confidence interval = 1.04-1.16). This association was partly explained by CRP (7.3%) suggesting a minimal mediation effect. IL-1Ra, N-terminal pro-b-type natriuretic peptide, midregion pro-atrial natriuretic peptide, midregion pro-adrenomedullin, and CT-proET contributed marginally to the association between depression and subsequent mortality. CONCLUSIONS: Inflammatory and cardiovascular risk markers are associated with depression and with increased mortality. However, depression and biological measures show additive effects rather than a pattern of meditation of biological factors in the association between depression and mortality

Shielding, hospital admission and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic: A cross-sectional survey from the first national lockdown

BackgroundPeople with a total laryngectomy (PTL) rely on a permanent opening in their neck (stoma) to breathe. This altered anatomy may increase susceptibility to contracting and transmitting SARS-CoV-2.AimsTo report on (1) the frequency and characteristics of PTL who tested positive for COVID-19, (2) the receipt of advice regarding shielding and patient self-reports of shielding, (3) hospital admissions and length of stay, and (4) mortality rates in this group during the first UK national lockdown.Methods & proceduresThis is a cross-sectional survey and case note review. National Health Service (NHS) centres providing care to PTL were invited to participate via the Royal College of Speech and Language Therapists' (RCSLT) Head & Neck Clinical Excellence Networks and through social media. PTL were reviewed by their speech and language therapist either in person or via telehealth between 30 March and 30 September 2020. Data were collected within the time frame covered by the Control of Patient Information (COPI) notice issued for COVID-19 and included information on COVID-19 testing, shielding, hospital admissions, length of stay and deaths. Information was submitted to the lead NHS site using a custom designed data-capture worksheet. Analysis was performed using descriptive statistics, including proportions and frequency counts. Pearson's Chi squared tests were used to compare categorical data using a 5% significance level.Outcomes & resultsData were obtained from 1216 PTL from 26 centres across the UK. A total of 81% were male; mean age was 70 years (28-97 years). Of the total group, 12% received a COVID-19 test. A total of 24 (2% of total sample) tested positive for COVID-19. Almost one-third of PTL (32%) received a government letter or were advised to shield by a healthcare professional. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1-133 days), interquartile range (IQR) = 17 days. A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days, IQR = 49 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19.Conclusions & implicationsThis study highlighted the lack of routine national data for neck-breathers with which to compare the current findings. Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation.What this paper addsWhat is already known on the subject? People with total laryngectomy (PTL) have an altered anatomy for breathing and speaking. The presence of a neck stoma poses an additional virus entry point aside from the nose, mouth and conjunctiva. This could increase the susceptibility to COVID-19 for PTL. What this paper adds? This is the first national audit to provide data on shielding, hospital admissions and mortality for patients with total laryngectomy in the UK over the pandemic. The overall mortality in PTL over the first lockdown did not appear to be higher than the "best case" estimates from previous years. However, one in three PTL who acquired COVID-19 and were admitted to hospital, died within 28 days of testing positive. These findings are relevant to the current care and management of PTL over the pandemic but also highlights important knowledge gaps. What are the potential or actual clinical implications of this work? This study highlights gaps in the collection of baseline information on hospital admissions, length of stay and mortality for people with laryngectomy in the UK, restricting comparisons between the current data and historical data. The need for further research on whether neck-breathers should be tested via both nasopharyngeal and tracheal aspirates is important not just currently, but also in case of any future respiratory epidemics