The experiences of fathers in the perinatal period

This thesis portfolio is comprised of three parts: a systematic literature review, an empirical study and a set of appendices.Part one is a systematic literature review in which existing empirical literature relating to fathers’ representations of their unborn children during pregnancy is reviewed. A total of 15 studies is critically evaluated and assessed for quality. Their findings are then collated to examine the manner in which fathers represent their unborn children and the factors which influence the development of these representations. These findings are discussed in relation to clinical implications and directions for future research.Part two is an empirical paper which explores fathers’ experiences of the perinatal period in the context of maternal mental health problems. The study employed a narrative approach in the exploration of forty fathers’ stories of this time. Both elicited and pre-existing online stories were included. The holistic form and content of the stories was examined in an attempt to gain insight into the factors and processes that contribute to differential outcomes for families within this period. The findings are discussed in reference to the Developmental Systems Framework of Family Resilience (Walsh, 2016) and clinical implications are presented.Part three is a complete set of appendices of parts one and two. The supporting information for the systematic literature review and empirical study are presented, in addition to epistemological and reflective statements to provide further context for the undertaken research

Reported frequency of physical activity in a large epidemiological study: relationship to specific activities and repeatability over time

BACKGROUND How overall physical activity relates to specific activities and how reported activity changes over time may influence interpretation of observed associations between physical activity and health. We examine the relationships between various physical activities self-reported at different times in a large cohort study of middle-aged UK women. METHODS At recruitment, Million Women Study participants completed a baseline questionnaire including questions on frequency of strenuous and of any physical activity. About 3 years later 589,896 women also completed a follow-up questionnaire reporting the hours they spent on a range of specific activities. Time spent on each activity was used to estimate the associated excess metabolic equivalent hours (MET-hours) and this value was compared across categories of physical activity reported at recruitment. Additionally, 18,655 women completed the baseline questionnaire twice, at intervals of up to 4 years; repeatability over time was assessed using the weighted kappa coefficient (κweighted) and absolute percentage agreement. RESULTS The average number of hours per week women reported doing specific activities was 14.0 for housework, 4.5 for walking, 3.0 for gardening, 0.2 for cycling, and 1.4 for all strenuous activity. Time spent and the estimated excess MET-hours associated with each activity increased with increasing frequency of any or strenuous physical activity reported at baseline (tests for trend, P < 0.003), although the associations for housework were by far the weakest (Spearman correlations, 0.01 and -0.03 respectively for housework, and 0.11-0.37 for all other activities). Repeatability of responses to physical activity questions on the baseline questionnaire declined significantly over time. For strenuous activity, absolute agreement was 64% (κweighted = 0.71) for questionnaires administered less than 6 months apart, and 52% (κweighted = 0.51) for questionnaires more than 2 years apart. Corresponding values for any physical activity were 57% (κweighted = 0.67) and 47% (κweighted = 0.58). CONCLUSIONS In this cohort, responses to simple questions on the frequency of any physical activity and of strenuous activity asked at baseline were associated with hours spent on specific activities and the associated estimated excess MET-hours expended, reported 3 years later. The weakest associations were with housework. Agreement for identical questions asked on two occasions about the frequency of physical activity decreased over time.This work was supported by public funds from Cancer Research UK and the UK Medical Research Council

Drug-Drug Interaction Between Methotrexate and Levetiracetam Resulting in Delayed Methotrexate Elimination

Objective: To report a case of delayed methotrexate (MTX) elimination while receiving concomitant levetiracetam. Case Report: A 46-year-old man with relapsed osteosarcoma of the base of the skull receiving high-dose MTX tolerated his first cycle of MTX with elimination to nontoxic MTX levels (≤0.1 µmol/L) within 90 hours. After hospital discharge, the patient experienced seizures secondary to brain metastasis and started on levetiracetam, which was continued as maintenance therapy. The patient experienced delayed MTX elimination during cycles 2, 3, and 4 while receiving levetiracetam. On average, elimination to nontoxic MTX levels took 130 hours (106-144 hours). Before the fifth cycle of MTX, lorazepam was substituted for the levetiracetam. MTX was eliminated to nontoxic levels within 95 hours. During all cycles, the patient received standard supportive care and serum creatinine remained stable. No other drugs known to interact with MTX were administered. Discussion: This possible drug interaction has only been reported once in the pediatric population. With a score of 6 on the Drug Interaction Probability Scale for evaluating causation of drug interactions, it is probable that the delayed MTX elimination was caused by an interaction with levetiracetam. Conclusion: Coadministration of levetiracetam and MTX may result in delayed elimination of MTX, increasing the likelihood of toxicity. Consideration should be given to temporarily switching from levetiracetam to another antiepileptic (ie, lorazepam) to prevent this interaction. This is particularly important in those experiencing delayed elimination with prior cycles of concomitant MTX and levetiracetam or those at greater risk for MTX toxicity

Looking out for Lottie an inter-professional training pack

A 37 page inter-professional training pack with a literature review and worksheet

Linear law for the logarithms of the Riemann periods at simple critical zeta zeros

Each simple zero 1/2 + iγn of the Riemann zeta function on the critical line with γn > 0 is a center for the flow s˙ = ξ(s) of the Riemann xi function with an associated period Tn. It is shown that, as γn →∞, log Tn ≥ π/4 γn + O(log γn). Numerical evaluation leads to the conjecture that this inequality can be replaced by an equality. Assuming the Riemann Hypothesis and a zeta zero separation conjecture γn+1 − γn≥ γn-θ for some exponent θ > 0, we obtain the upper bound log Tn ≤ γn2 + θ Assuming a weakened form of a conjecture of Gonek, giving a bound for the reciprocal of the derivative of zeta at each zero, we obtain the expected upper bound for the periods so, conditionally, log Tn = π/ 4 γn +O(log γn). Indeed, this linear relationship is equivalent to the given weakened conjecture, which implies the zero separation conjecture, provided the exponent is sufficiently large. The frequencies corresponding to the periods relate to natural eigenvalues for the Hilbert–Polya conjecture. They may provide a goal for those seeking a self-adjoint operator related to the Riemann hypothesis

The human-animal relationship and its influence in our culture: the case of donkeys

Os jumentos (Equus asinus) estão enfrentando uma crise global. A saúde, o bem-estar e, principalmente, a sobrevivência dos jumentos está sendo comprometida à medida que a demanda por suas peles aumenta. Essa demanda por peles de jumento visa abastecer a indústria de ejiao. Ejiao é um remédio tradicional feito de colágeno de pele de jumento. Alguns acreditam que possui propriedades medicinais. Estima-se que o setor exija aproximadamente 4,8 milhões de peles de jumento por ano. Independentemente do futuro que os jumentos terão, devemos garantir uma vida com o mínimo de dignidade aos animais sob nossa responsabilidade. A preocupação ética também inclui o papel cultural dos jumentos. Os jumentos desenvolveram um papel essencial no Brasil, especialmente na Região Nordeste do país, carregando nas costas todo o tipo de material de construção, água e comida e, como consequência, ajudando o ser humano a construir as cidades no sertão. Devido à estreita relação com os seres humanos, os jumentos também estão participando da cultura. Essa importância central foi reconhecida por vários artistas brasileiros ao longo da história. Temos muitos exemplos de músicas, livros, “cordéis” (literatura típica brasileira), poemas, documentários, filmes, xilogravuras e esculturas feitos em homenagem a esse importante ator. Aqui descrevemos alguns exemplos dessa relação humano-jumento e sua influência em nossa cultura.Donkeys (Equus asinus) face a global crisis. Their health, welfare, and even their local survival are compromised as the demand for their skins increases. Such demand for donkey skins aims to supply the ejiao industry. Ejiao is a traditional remedy made from the collagen of donkey skins. Some people believe it has medicinal properties. It is estimated that the ejiao industry currently requires approximately 4.8 million donkey skins per year. Although the future of the donkeys is still uncertain, we must guarantee a life free from suffering to the animals under our responsibility. The trade of donkey skins also undermines the cultural role of donkeys. Donkeys have developed an essential role in Brazil, especially in the Northeast region of the country, carrying on their backs construction materials, water, and food, and, as a consequence, helping people build cities in the deepest hinterland. The close relationship between people and donkeys affords donkeys a unique place in the local culture. This central importance has been recognized by Brazilian artists throughout history. We have many examples of songs, books, “cordeis” (typical Brazilian literature), poems, documentaries, movies, woodcuts, paintings, and sculptures, created to honor this important actor. Here we describe some examples of this human-donkey relationship, and its influence on our culture

Breast Cancer Risk in Relation to the Interval Between Menopause and Starting Hormone Therapy

Background: Although breast cancer risk is greater in users of estrogen-progestin than estrogen-only formulations of menopausal hormonal therapy, reports on their effects have been somewhat inconsistent. We investigated whether the timing of these therapies affected breast cancer incidence. Methods: A total of 1 129 025 postmenopausal UK women provided prospective information on hormonal therapy use and other factors relevant for breast cancer risk. We used Cox regression to estimate adjusted relative risks (RRs) of breast cancer in hormonal therapy users vs never users and calculated standardized incidence rates. All statistical tests were two-sided. Results: During 4.05 million woman-years of follow-up, 15 759 incident breast cancers occurred, with 7107 in current users of hormonal therapy. Breast cancer incidence was increased in current users of hormonal therapy, returning to that of never users a few years after use had ceased. The relative risks for breast cancer in current users were greater if hormonal therapy was begun before or soon after menopause than after a longer gap (Pheterogeneity <. 001, for both estrogen-only and estrogen-progestin formulations). Among current users of estrogen-only formulations, there was little or no increase in risk if use began 5 years or more after menopause (RR = 1.05, 95% confidence interval [CI] = 0.89 to 1.24), but risk was statistically significantly increased if use began before or less than 5 years after menopause (RR = 1.43, 95% CI = 1.35 to 1.51). A similar pattern was observed among current users of estrogen-progestin formulations (RR = 1.53, 95% CI = 1.38 to 1.70, and RR = 2.04, 95% CI = 1.95 to 2.14, respectively). At 50-59 years of age, annual standardized incidence rates for breast cancer were 0.30% (95% CI = 0.29% to 0.31%) among never users of hormone therapy and 0.43% (95% CI = 0.42% to 0.45%) and 0.61% (95% CI = 0.59% to 0.64%), respectively, among current users of estrogen-only and estrogen-progestin formulations who began use less than 5 years after menopause. Conclusions: There was substantial heterogeneity in breast cancer risk among current users of hormonal therapy. Risks were greater among users of estrogen-progestin than estrogen-only formulations and if hormonal therapy started at around the time of menopause than later