Ambulatory Care for Emphysema and Chronic Bronchitis

The immense problem of chronic airway obstruction (CAO)--emphysema and chronic bronchitis--which has now reached epidemic proportions, presents to the practitioner of medicine an increasing number of suffering persons asking for care. These patients are dyspneic, anxious, bewildered by their predicament, sometimes demanding and frightened about prospects for future comfortable life

The Adult Respiratory Distress Syndrome: Clinical Features, Factors Influencing Prognosis and Principles of Management

This report redescribes the adult respiratory distress syndrome and discusses factors which influence prognosis and presents principles of management

Using parent metaphors for learning about the neonatal care experience: an interpretive perspective

© 2019 The Author(s). The final, definitive version of this paper has been published in Journal of Child Health Care by Sage Publications Ltd. All rights reserved. It is available at: https://doi.org/10.1177/1367493519875853.This study focuses on how metaphors are used by parents who have had a premature baby to describe their neonatal care experience and how these can contribute to empathic learning of health professionals. In health, metaphors are commonly used to communicate and explain difficult topics. When patients tell their story, metaphor can be a means of expression from which we can learn about their experience of illness or hospitalisation. Limited research exits on how metaphor can improve our understanding of parent’s emotional experience in neonatal care and subsequently inform education in this field. Employing narrative inquiry within an interpretive, constructivist paradigm, 20 narrative interviews with 23 parents of premature babies were analysed using a process of metaphor identification. Findings revealed common metaphors used to describe experience. Metaphor clusters used by parents in order of frequency were journeying, altered reality, darkness, breaking, connections, fighting, salvation and being on the edge. Parents widely used compelling and emotive metaphors to describe and express both difficult and challenging times as well as progression forward. Metaphors serve as a powerful way for health professionals to learn about the emotional experiences of parents and potentially enhance their empathic understanding.Peer reviewe

Longitudinal Course of Deficient Emotional Self-Regulation CBCL Profile in Youth with ADHD: Prospective Controlled Study

Background: While symptoms of deficient emotional self-regulation (DESR) have been long associated with attention-deficit/hyperactivity disorder (ADHD), there has been limited investigation of this aspect of the clinical picture of the disorder. The main aim of this study was to examine the predictive utility of DESR in moderating the course of ADHD children into adolescence. Methods: Subjects comprised 177 children with and 204 children without ADHD followed for an average of 4 years (aged 6–18 years at baseline, 54% male). Subjects were assessed with structured diagnostic interviews and measures of psychosocial functioning. DESR was defined by the presence (n = 79) or absence (n = 98) of Child Behavior Checklist (CBCL)-DESR profile (score ≥ 180 < 210 total of Attention, Aggression, and Anxious/Depressed subscales) at the baseline assessment. Results: Of subjects with DESR at baseline, 57% had DESR at follow-up. Persistent ADHD was significantly associated with DESR at follow-up (x$^{2}$$_{(1)}$ = 15.37, P < 0.001). At follow-up, ADHD + DESR subjects had significantly more comorbidities (z = 2.55, P = 0.01), a higher prevalence of oppositional defiant disorder (z = 3.01, P = 0.003), and more impaired CBCL social problems t-score (t$_{(227)}$ = 2.41, P = 0.02) versus ADHD subjects. Conclusion: This work suggests that a positive CBCL-DESR profile predicts subsequent psychopathology and functional impairments in children with ADHD suggesting that it has the potential to help identify children with ADHD at high risk for compromised outcomes

Arctic Ocean surface geostrophic circulation 2003-2014

Monitoring the surface circulation of the ice-covered Arctic Ocean is generally limited in space, time or both. We present a new 12-year record of geostrophic currents at monthly resolution in the ice-covered and ice-free Arctic Ocean derived from satellite radar altimetry and characterise their seasonal to decadal variability from 2003 to 2014, a period of rapid environmental change in the Arctic. Geostrophic currents around the Arctic basin increased in the late 2000s, with the largest increases observed in summer. Currents in the southeastern Beaufort Gyre accelerated in late 2007 with higher current speeds sustained until 2011, after which they decreased to speeds representative of the period 2003–2006. The strength of the northwestward current in the southwest Beaufort Gyre more than doubled between 2003 and 2014. This pattern of changing currents is linked to shifting of the gyre circulation to the northwest during the time period. The Beaufort Gyre circulation and Fram Strait current are strongest in winter, modulated by the seasonal strength of the atmospheric circulation. We find high eddy kinetic energy (EKE) congruent with features of the seafloor bathymetry that are greater in winter than summer, and estimates of EKE and eddy diffusivity in the Beaufort Sea are consistent with those predicted from theoretical considerations. The variability of Arctic Ocean geostrophic circulation highlights the interplay between seasonally variable atmospheric forcing and ice conditions, on a backdrop of long-term changes to the Arctic sea ice–ocean system. Studies point to various mechanisms influencing the observed increase in Arctic Ocean surface stress, and hence geostrophic currents, in the 2000s – e.g. decreased ice concentration/thickness, changing atmospheric forcing, changing ice pack morphology; however, more work is needed to refine the representation of atmosphere–ice–ocean coupling in models before we can fully attribute causality to these increases