Quality of life in long-term conditions (ViPER)

There is an increasing policy drive for nurses to encourage and operationalise self-management and collaborative partnerships with people with long-term conditions. Central to this is a development of understanding of the premises to a good quality of life. This presentation reports on a project in which the quality of life of people with Multiple Sclerosis (MS) was assessed. In parallel, the researchers examined the meaning attributed to the term in policy documentation such as the NSF for Long-Term conditions (2005) (Lhussier 2009). It emerges that quality of life is premised upon an understanding of six oppositional pairs of: • Life and death (because to talk about ‘quality of life’ is to assume a clear and fundamental difference between the two concepts) • Health and disease (because people with long-term conditions are often assumed to have a poorer quality of life) • Independence and dependence (because maintaining independence is one of the key aim of health care practice in long-term conditions) • Empowerment and disempowerment (because patient empowerment is a key policy driver) • Certainty and uncertainty (as the uncertainty of an illness trajectory impacts greatly on people’s perception of their quality of life) • Ability and disability (because disability is to be avoided for as long as possible in MS) Drawing on the data collected, this presentation aims to expose and critique these six oppositional pairs so that understanding of quality of life in long-term conditions can be enhanced and contextualised. Thus this presentation does not aim at solving definitional or measurement issues, but at engaging practitioners in critical thinking about such a key concept as quality of life. Such an engagement in questioning of pre-understandings is crucial for nursing practice to evolve and adapt to changing population needs, as the prevalence of long-term conditions continues to increase

A comparison of methods for making buttermilk using traditional fermentation and direct acidification

Buttermilk was made by three methods: conventional fer-mentation, direct acidification, and a combination of both. The conventional method involved adding a culture to skim milk followed by incubation at 23±1°C until a pH of 4.5 was reached; the direct acidification method involved the addition of lactic acid to skim milk to reduce the pH to 4.5; in the combination method the pH of the skim milk was reduced to 5.2 with lactic acid followed by inoculation with a bacterial culture as in the traditional fer-mentation. Two frozen concentrated starter cultures were used. The first contained Streptococcus lactis and/or S. cremoris and the second contained S. lactis and/or S. cremoris plus a strain of Leuconostoc. After fermentation, 0.1% (w/v) potassium sorbate was added to half of each of the cultured samples. The samples were then stored at 4°C and analyzed for various microbiological, chemical, and physical attributes at 0, 2, 4, 6, and 8 days. A 62 member consumer taste panel ranked the samples by preference. The psychrotrophic count and viscosity were not affected by the processing methods, the presence of potassium sorbate, or the culture used (P\u3e0.G5). No coliforms were found in any butter milk samples. The number of lactic acid bacteria was affected only by culture type (P\u3c0.01), and not by processing method or the presence of potassium sorbate (P\u3e0.05). The use of the titratable acidity test appeared to be a more reliable means of measuring acid development than pH because of less variation in the former. The processing method (P\u3c0.01), culture type (P\u3c0.01) and presence of potassium sorbate (P\u3c0.10) had significant effects on the amounts of diacetyl and acetoin found. The concentration of acetoin increased significantly over time, while the concentration of diacetyl remained fairly constant. Those sensory panel members who normally consume buttermilk were able to detect the presence of potassium sorbate and tended to prefer the samples without the added sorbate, but the buttermilk non-consumers were not able to detect a difference in the samples. The consumer panel was not able to distinguish between the methods of production. The direct acidification-fermentation technique appeared to be a viable alternative to the conventional processing method for buttermilk. This method could result in a reduced processing time and a more consistent product through closer supervision

From Ancestral Knowledge to Clinical Practice: The Case of \u3cem\u3eAgonias\u3c/em\u3e and Portuguese Clinicians in America

Cultures have varying notions about symptom expression and the treatment of mental health issues. Consequently, clients and psychotherapists may or may not share a similar worldview. In the psychotherapy literature there has been increased attention to these complex processes. This survey descriptive study aims to understand how therapists working with culturally diverse clients incorporate sensitivity to cultural differences. Fifteen culturally sensitive mental health care providers working with the Portuguese immigrant community were interviewed about their practices. Specifically, we investigated their understanding of the symptoms, causes and cures for agonias, a culture specific phenomenon. It was found that even though the providers are all Portuguese themselves, the meaning that they ascribed to agonias (anxiety and/or depression) was very different than the meaning ascribed to agonias by community members. The community member’s meanings ranged from indigestion to being on the brink of death. A cluster analysis revealed that clinicians who stated that agonias is anxiety, conducted cognitive behavioral therapy or psychopharmacology, and those that stated agonias had a depressive component tended to use family therapy or psychoanalysis

Women’s voices, precarity, and commercialism in selected dystopian South African fiction.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.This dissertation examines the use and effects of women’s voices, precarity, and commercialism in selected dystopian South African fiction, namely Moxyland (2008) by Lauren Beukes, For the Mercy of Water (2012) by Karen Jayes, and Selling LipService (2017) by Tammy Baikie. All three of these texts have female focalisers whose experiences of precarity can be linked to their gender. These women also attempt to share their stories with their society despite the censorship within their societies. For this reason, the analyses of the texts will use a feminist perspective during the textual analysis. The novels’ societies also all have an extreme corporate influence which will be discussed following Naomi Klein’s No Logo (2000), which has not been used previously in literary analysis of fictional corporate control. A discussion of the elements of hope within the texts will show that they can be considered critical dystopias. This dissertation will reveal that the selected texts can be linked through the experiences of precarity that are partially caused by the corporate influence and control of each text’s societies. This highlights that speculative South African fiction uses and exaggerates subconscious fears of corporate influence when creating a dystopian setting, though the appearance of this influence may differ. It also suggests that women are more likely to suffer from the experiences of precarity that result from these dystopias. The women do however, attempt, with some success, to combat this control with varying methods. The chronological examination of the novels reveals the different appearances this corporate control has taken, from obvious privilege and downplayed governmental influence, to obvious interference with the government, and finally, to having infiltrated every corner of society without mention of an independent government

Experience in Imaging Medullary Thyroid Carcinoma Using 99mTc (V) Dimercaptosuccinic Acid (DMSA)

99mTc (V) dimercaptosuccinic acid (DMSA) is a new tumor imaging agent that has been successfully used to image patients with medullary thyroid carcinoma (MTC). Since 1986, studies have been performed in 32 patients with histologically proven MTC at Guy\u27s Hospital, London, England. Five patients with primary tumor were studied prior lo surgery, four patients were studied after successful removal of the primary tumor, and 26 patients with biochemical evidence of recurrence were studied. Eight patients were studied serially to assess progression of disease, and four patients were studied before and after surgery. Twenty-one of the 26 patients with disease had positive scans with four false negative scans and three true negative scans. One patient had a false-positive scan (sensitivity 80%, specificity 75%). Two of the false-negative scans were obtained in patients with moderate but stable elevations of calcitonin but no other evidence of recurrence. One false-negative scan was obtained in a patient who was discovered on screening to have an abnormal pentagastrin response, and a small 1 cm tumor was subsequently removed. Uptake in local neck recurrence was frequently intense, but uptake at sites of bone metastases was less marked. 99mTc (V) DMSA is an inexpensive radiopharmaceutical which produces good quality images and has been shown to have an acceptable sensitivity and specificity in the follow-up of patients with MTC and thereby contributes significantly to the management of these patients