Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: a systematic review

Objectives: Medicines play a key role in the lives of people with dementia, primarily to manage symptoms. Managing medicines is complex for people with dementia and their family carers and can result in multiple problems leading to harm. We conducted a systematic review to identify and model medication issues experienced and coping strategies used by people with dementia and/or family carers. Methods: Eleven general databases and four systematic review databases were searched. Studies were quality assessed using an established framework and thematically analysed. Results: 21 articles were included in this study and four domains affecting medication use were identified: cognitive, medication, social and cultural and, knowledge/educational and communication. People with dementia reported medication issues in all four domains but few coping strategies were developed. Family carers reported issues and coping strategies related to the medication and knowledge/educational and communication domains. Common issues with regards to knowledge and communication about medicines remain unresolved. The ‘voices’ of people with dementia appeared largely missing from the literature so were in-depth understanding of how, whether and in which circumstances coping strategies work in managing medicines. Conclusions: Medicines management is a complex set of activities and although current coping strategies exists, these were primarily used by family carers or the person with dementia-carer dyad. Health and social care practitioners and researchers should seek to understand in-depth, the ‘mechanisms of action’ of existing coping strategies and actively involve people with dementia as co-producers of knowledge to underpin any further work on medicines management

Analysis of myocardial contractility with magnetic resonance

Heart failure has considerable morbidity and poor prognosis. An understanding of the underlying mechanics governing myocardial contraction is a prerequisite for interpreting and predicting changes induced by heart disease. Gross changes in contractile behaviour of the myocardium are readily detected with existing techniques. For more subtle changes during early stages of cardiac dysfunction, however, it requires a sensitive method for measuring, as well as a precise criterion for quantifying, normal and impaired myocardial function. Cardiovascular Magnetic Resonance (CMR) imaging is emerging as an important clinical tool because of its safety, versatility, and the high quality images it produces that allow accurate and reproducible quantification of cardiac structure and function. Traditional CMR approaches for measuring contractility rely on tagging of the myocardium with fiducial markers and require a lengthy and often subjective dependant post-processing procedure. The aim of this research is to develop a new technique, which uses velocity as a marker for the visualisation and assessment of myocardial contractility. Two parallel approaches have been investigated for the assessment of myocardial velocity. The first of these is haimonic phase (HARP) imaging. HARP imaging allows direct derivation of myocardial velocity and strain without the need of further user interaction. We investigated the effect of respiration on the accuracy of the derived contractility, and assessed the clinical applicability and potential pitfalls of the technique by analysing results from a group of patients with hypertrophic cardiomyopathy. The second technique we have investigated is the direct measurement of myocardial velocity with phase contrast myocardial velocity mapping. The imaging sequence used employs effective blood saturation for reducing flow induced phase errors within the myocardium. View sharing was used to improve the temporal resolution, which permitted acquisition of 3D velocity information throughout the cardiac cycle in a single breath-hold, enabling a comprehensive assessment of strain rate of the left ventricle. One key factor that affects the derivation of myocardial contractility based on myocardial velocity is the practical inconsistency of the velocity data. A novel iterative optimisation scheme by incorporating the incompressibility constraint was developed for the restoration of myocardial velocity data. The method allowed accurate assessment of both in-plane and through-plan strain rates, as demonstrated with both synthetic and in vivo data acquired from normal subjects and ischaemic patients. To further enhance the clinical potential of the technique and facilitate the visual assessment of contractile abnormality with myocardial velocity mapping, a complementary analysis framework, named Virtual Tagging, has been developed. The method used velocity data in all directions combined with a finite element mesh incorporating geometrical and physical constraints. The Virtual Tagging framewoik allowed velocity measurements to be used for calculating strain distribution within the 3D volume. It also permitted easy visualisation of the displacement of the tissue, akin to traditional CMR tagging. Detailed validation of the technique is provided, which involves both numerical simulation and in vitro phantom experiments. The main contribution of this thesis is in the improvement of the effectiveness and quality of quantitative myocardial contractility analysis from both sequence design and medical image computing perspectives. It is aimed at providing a sensitive means of detecting subtle as well as gross changes in contractile behaviour of the myocardium. The study is expected to provide a clinically viable platform for functional correlation with other functional measures such as myocardial perfusion and diffusion, and to serve as an aid for further understanding of the links between intrinsicOpen acces

“The idea of self in the land of self-help”: Globalization and a structure of feeling in Mohsin Hamid’s How to Get Filthy Rich in Rising Asia

Focusing on the novel, How to Get Filthy Rich in Rising Asia, this paper examines Mohsin Hamid’s experimentation with narrative structure and the idea of the split self through the context of Frederic Jameson’s dialectic of the cultural and economic dimensions of globalization and David Harvey’s take on Postmodernism

A case study addressing trauma needs during COVID-19 remote learning from an ecological systems theory framework

Mental health conditions related to trauma among American children are a concern, particularly because of the impacts of the COVID-19 pandemic. Children, as students, carry the trauma they encounter with them into the classroom. Students impacted by trauma learn differently due to effects on the brain that relate to several impairments, causing them to perform poorly in school. However, teachers may not always understand this issue. This case study shows how certain dynamics within the EST layers impacted one school during the pandemic. The purpose of this study was to examine how teachers at the school experienced a trauma-informed online PD and SEL program intended to improve student outcomes, teacher perceptions, and teacher–student relationships. The six participants included teachers in a K-8 low-income, minority population charter school. The assessment tools used were the Teacher–Student Relationship Scale, Teacher Perception Scale, and Student Outcomes Survey. The teachers’ outlook on SEL improved, particularly online. This improvement helped the teachers implement community circles and SEL infused with mindfulness in their online classrooms, which may have helped them maintain their relationships with the students and may have helped the students with academic and stress outcomes. During unprecedented times, the maintenance, rather than the deterioration, of student outcomes and teacher–student relationships is an accomplishment and an area that necessitates further research

Politics Of Development And Articulation Of Indigenous Identity: The Formation Of Munda Identity In Barind, Bangladesh

This paper is about the identity formation of an ethnic group – the Munda of Bangladesh. The key issue of this paper is how the Munda identity has been constructed by the state and by the development agencies, covering historical as well as current trends. Throughout colonial and postcolonial periods in the academic and policy discourse, the Munda/Adibashi were represented as "primitive," "backward" and "underdeveloped." Here, I argue that the images contribute to the making of the "category" of Adibashi as "primitive," "backward" or "underdeveloped" are actually a perception, not a representation of reality. The representation of Munda identity articulated by the academician or the development practitioner ignores the complexities, dynamism and history of these peopl

Vogt-koyanagi-harada syndrome

ABSTRACT Vogt-Koyanagi-Harada (VKH) syndrome is a rare multisystem disease of melanocyte containing organs. It is characterized by diffuse granulomatous inflammation involving various organs including eye. VKH syndrome is usually sporadic, but some familial cases have also been reported indicating a hereditary basis. VKH is not associated with mortality but it may result in long-term complications such as decreased vision associated with cataract, glaucoma and choroidal neovascularization. For successful outcomes, early aggressive treatment using systemic steroids with gradual tapering is essential. This report describes a case of VKH syndrome in a 26-year-old male of Pakistan origin who was successfully treated with systemic steroids. The case is briefly contextualised within wider literatur

Examining the Factors that Moderate and Mediate the Effects on the Relationship between Depression and Anxiety and Major Pregnancy Complications and Birth Outcomes

Background Depression is one of the common mental illnesses among women during their child bearing age. Though there is a high level of comorbidity, anxiety is often more prevalent than depression across pregnancy which complicate the pregnancy and birth outcomes. Given potential adverse consequences of depression or anxiety, little is known about the interaction effects as well as causal directionality of the risk factors for pregnancy complications and negative birth outcomes. Thus, the present study will explore the specific roles of the risk factors either as a moderator or as a mediator on the relationship between depression and anxiety and major pregnancy complications and poor birth outcomes. Moderator is defined as an independent variable which influences the strength or the direction of a relationship. On the other hand, mediator variable is defined as an explanatory link and conceptualized as a mechanism to better understand the relationship between a predictor and outcome variable in direct or indirect pathways. The objective of this paper is to understand how the relationship between depression or anxiety, and pregnancy complications and poor birth outcomes could be modified or mediated by other variables. The longitudinal and prospective nature of this study will allow us to examine the moderating and mediating effects more accurately at different time points. Therefore, the current thesis will add empirical evidence on moderating and mediating effects of the risk factors for pregnancy complications and birth outcomes. The findings of this study will be helpful for caregivers and health care professionals in shaping better interventions for women with mental health issues in pregnancy with the aim for bringing about total well-being of the mother. Methods Secondary data was used from the Feelings in Pregnancy and Motherhood (FIP) study. The study included a cohort of 646 high-risk women in Saskatoon. The participants were invited to take part in longitudinal follow up at 3 times: Time 1 = early pregnancy (17.4 ±4.9 weeks), Time 2 = later pregnancy (30.6 ±2.7 weeks) and time 3 = once after their babies were born (4.2 ±2.1 weeks). Self-reported data were collected through face to face interview. Edinburgh Postnatal Depression Scale (EPDS) was used to assess the depression and anxiety. Depression and anxiety are considered as primary predictors while pregnancy complications and poor birth outcomes as outcome variables. For moderation and mediation analysis, sociodemographic factors such as age, education, income, ethnicity, abuse are examined as moderator variables. Behavioural and psychosocial factors are considered as mediator variables. A series of logistic regression analysis was used to analysis the moderation and mediation effects. Results In bivariate analysis, our results found that pregnancy complications and negative birth outcomes were significantly associated with depression, anxiety, education, income, marital status, ethnicity, abuses, social support, smoking, exercise, drinking alcohol, stress, quality of relationship with the current partner, in both the early and the late pregnancy. In mediation analysis, stress in late pregnancy was found to be partially mediating the pathway between depression and pregnancy complications. Moreover, stress showed a full mediation effect on the relationship between anxiety and pregnancy complications. In modelling moderating effects, women who reported depression or anxiety were more likely to have pregnancy complications if they also had experienced sexual abuse before or during early pregnancy, compared to those who did not. Women who reported anxiety in early pregnancy were more likely to experience pregnancy complications if they were non-partnered compared to partnered women. In moderating analysis, in late pregnancy, sexual abuse, emotional abuse, ethnicity and age of the mother were identified as significant moderators. The findings suggest that sexually abused women who experienced depression or anxiety in their late pregnancy were more likely to report more than one pregnancy complications. Similarly, younger mothers were more likely to report anxiety in their late pregnancy resulting in more obstetric complications. Moreover, emotional abuse and ethnicity significantly moderated the relationships between depression or anxiety and poor birth outcomes (i.e. preterm delivery and low birth weight). Conclusion This study provides greater detail about how the risk factors during pregnancy may affect the relationships between maternal mental illness and adverse consequences. Results of this study could inform clinicians who treat and manage women during pregnancy and also promote targeted prevention and intervention programs. Finally, in light of this study, effective community intervention could help to improve physical and psychological well-being of both mother and baby, during and after pregnancy

An Atypical Case of Atypical Teratoid Rhabdoid Tumor (ATRT)

Introduction: Atypical Teratoid Rhabdoid tumors are rare pediatric tumors that usually occur at age \u3c3 years. These tumors are scarcely seen in adults, with the first adult case appearing in 1992. Since then, about 64 cases have been reported in the literature. As such, much what has been learned about adultATRT cases has come from case reports and extrapolation frompediatric cases. The loss of INI1 (SMARCB1) or BRG1 (SMARCA4) genes are implicated in pathogenesis of ATRT3. Specifically, the INI1/SMARCB1 gene is classified as a tumor-suppressor gene that encodes a core subunit protein of the ATP-dependent SWI/SNF chromatin remodeling complex. Case Presentation: A 62-year-old Caucasian right-handed female with history of hypertension and sinusitis presented with 2-month history of bilateral, frontal headaches reaching 5/10 in severity with associated nausea, emesis, polydipsia and polyuria. Polyuria occurred every hour while polydipsia included drinking (15-20) 16 oz. bottles per day.She presented to a local hospital and was found to have hypernatremia (Sodium 154 mEq/mL). Non-contrast brain computerized tomorgraphy (CT) revealed a 1.2cm x 1.1cm x 1.7 cm sellar mass with suprasellar extension. Urine studies diagnosed central diabetes insipidus, responsive toD-amino D-arginine vasopressin (DDAVP). However, she developed seizures and Abducen’s nerve palsy. Magnetic resonance imaging (MRI) of the brain demonstrated intraventricular and subarachnoid hemorrhage along with optic nerve edema. Prior to surgery,she was found on the floor of her room in pool of urine with incoherent speech and a sluggish pupillary reflex on right side. STAT non-contrast head CT revealed 2.7 x 1.8 x 2.5 cm extension of hemorrhage into interpeduncular cisterns and ventricles with associated 3rd ventricle & lateral ventricle. There was no midline shift or impending herniation. She received bi-coronal craniotomy with excision of sellar mass and right frontal external ventricular drain placement. Hydrocephalus and hemorrhage improved on subsequentMRI a few days later. The pathology report came back positive for a malignant epithelioid neoplasm, specifically sellar ATRT, WHO grade V. Tumor was shown to be SMARCB1/INI1 deficient and no metastatic lesions were found. Recommendations were made for craniospinal radiation and chemotherapy afterward. Discussion: ATRTs remain rare and aggressive brain tumors seen in both the pediatric and adult population. The management of ATRT remains a difficult challenge with multimodal approaches to treatment remaining the mainstay. Resection followed by radiation and chemotherapy has been shown to significantly increase 5-year overall survival rate, yet median time to progression remains in the range of 6-10 months. Much more standardization is required in the treatment of disease, since patients continue to get variable approaches to treatment. Additionally, radiation doses and optimal chemotherapy regimens have yet to be determined. A promising step towards these answers have been in-vitro studies of Insulin-growth factor receptor (IGF-1R) inhibition in sensitizingthe tumor to chemotherapy and radiation.https://scholarlycommons.henryford.com/merf2019caserpt/1050/thumbnail.jp