'TIDieR-ing up' the reporting of interventions in stroke research:The importance of knowing what is in the 'black box'

Evidence-based interventions cannot be provided unless there is a clear understanding of what the intervention is. Many published randomized trials, systematic reviews, and guidelines contain incomplete intervention descriptions. For non-pharmacological interventions, such as stroke rehabilitation, the reporting is particularly poor. Contributors to this problem include lack of attention to this issue and awareness of what constitutes a complete intervention description by authors, reviewers, journals, and editors. Part of the solution is for authors to follow guidance about how to describe interventions, such as the Template for Intervention Description and Replication statement. Improving stroke interventions reporting will remove one of the current barriers to evidence-based care. </jats:p

The Human Body is Not Designed for Ambivalence: Odes

The critical analysis section of this dissertation seeks to define the ode using examples in translation from Greek and Latin odes and examples in English written from the 1500s to the 2000s. Although most definitions of the ode contend that this subgenre of the lyric is an occasional poem of praise that includes a meditative or mythological element, the ode is far more complex. An ode is an occasional poem, but it works to privilege rather than strictly praise its subject, allowing for the speaker's ambivalence toward the subject. Meditation is a key element of the ode, since the poet uses the subject as a means for moving to the meditation or as a conduit through which the meditation occurs. The meditation in the poem is also a way for the poet or speaker to negotiate the relationship between the subject and herself; thus, the ode is concerned with power, since the poet must place herself or the speaker in relation to the subject. Power thus may be granted to either the speaker or the subject; the poet names and speaks of the subject, and often the poet names and speaks of himself in relation to the subject. Additionally, odes usually contain some exhortation, generally directed to the subject if not to those surrounding the reader or capable of "listening in" to the performance of the poem. This definition, it should be noted, is intended to be fluid. In order for a poem to be relevant to its age, it must either adhere to or usefully challenge the contemporary concerns. Thus, while many of the odes discussed will contain the elements of this definition, others will work against the definition. In the remainder of the introduction, I examine ancient models and twentieth- and twenty-first century examples of the ode as a means of exploring what an ode is and how it can undermine the elements of the definition and still work as a poem of this subgenre. In the second section of the dissertation are lyric poems, many of which fit in varying degrees the definition laid out in the critical analysis

Empathy: a discursive psychological exploration of the construct within the context of the therapeutic relationship

Introduction: Empathy is considered to be an important therapist offered condition. Historically the exploration of empathy has employed quantitative methodologies. It is argued that these methodologies cannot capture the socially constructed nature of psychological concepts and instead regard empathy as problematic due to its inconsistently applied definition. Objectives: This study aimed to explore therapists' discourse around empathy by employing a qualitative methodology and acknowledging the importance of context. A further objective was to encourage a theoretical and methodological shift in the way that psychological concepts are conceptualised and investigated. Design: A discursive psychological approach was taken in the analysis of data from discussion groups. Method: Discourse was collected from two discussion groups conducted at an NHS Primary Care Trust: the first with a group of clinical psychologists and the second with a group of cognitive behaviour therapists. In addition some documentary information was collected from the research site in order to contextualise the service. Results: In both discussion groups, empathy was considered fundamental to the therapeutic relationship between the client and therapist. Therapists constructed empathy in two ways: as a limited therapist experience and as a quality that might develop over time. Further patterns emerged in the data; the clinical psychologists made frequent use of case studies whereas the cognitive behavioural therapists cited research evidence and made use of theoretical models. Discussion: The results are discussed with reference to a particular model of discursive psychology where the activity done through discourse is emphasised. It is argued that through particular constructions of empathy, therapists were working up their professional accountability. It is suggested that therapists work up their constructions of empathy as factual and therefore indisputable through discursive devices, identified as the use of case studies and research evidence

Timeliness of EHDI benchmarks in infants with a NICU admission greater than five days: Analysis from a retrospective cohort

The purpose of this study was to examine the timeline of early hearing healthcare in infants with a history of lengthy (\u3e 5 days) admission to a neonatal intensive care unit (NICU) compared to non-NICU peers. We compiled four years of state Early Hearing Detection and Intervention (EHDI) records from 156,335 infants using a statewide administrative database. We compared age at the time of newborn hearing screening, diagnostic audiological evaluation, and entry into early intervention in NICU infants and non-NICU infants. We also compared the proportion of NICU and non-NICU infants meeting prescriptive EHDI timing benchmarks based on the Joint Committee on Infant Hearing position statement. Results indicated that NICU infants experienced delayed newborn hearing screening and diagnostic evaluation compared to non-NICU peers and reached both benchmarks in lower proportions. NICU and non-NICU infants entered early intervention at equivalent ages and met the early intervention benchmark in similar proportions. Considering the important medical factors that drive lengthy NICU admissions, our results suggest that specific clinical guidelines for the timing of early hearing healthcare in NICU infants may be warranted

Breast Health and Preventive Screening

Breast health and its importance in every stage of a woman’s life is discussed from adolescence, across the life span, and addressing the aging process. The importance of self-breast exams, clinical breast exam, and screening mammograms play an integral part of ensuring early detection of breast cancer. The risk factors, genetic mutations, and how breast cancer is triggered is discussed. The advancements in screening recommendations, genetic testing, and treatments is explored and what innovative approaches are being taken to prevent, treat, and cure breast cancer

Empathy: a discursive psychological exploration of the construct within the context of the therapeutic relationship

Introduction: Empathy is considered to be an important therapist offered condition. Historically the exploration of empathy has employed quantitative methodologies. It is argued that these methodologies cannot capture the socially constructed nature of psychological concepts and instead regard empathy as problematic due to its inconsistently applied definition. Objectives: This study aimed to explore therapists' discourse around empathy by employing a qualitative methodology and acknowledging the importance of context. A further objective was to encourage a theoretical and methodological shift in the way that psychological concepts are conceptualised and investigated. Design: A discursive psychological approach was taken in the analysis of data from discussion groups. Method: Discourse was collected from two discussion groups conducted at an NHS Primary Care Trust: the first with a group of clinical psychologists and the second with a group of cognitive behaviour therapists. In addition some documentary information was collected from the research site in order to contextualise the service. Results: In both discussion groups, empathy was considered fundamental to the therapeutic relationship between the client and therapist. Therapists constructed empathy in two ways: as a limited therapist experience and as a quality that might develop over time. Further patterns emerged in the data; the clinical psychologists made frequent use of case studies whereas the cognitive behavioural therapists cited research evidence and made use of theoretical models. Discussion: The results are discussed with reference to a particular model of discursive psychology where the activity done through discourse is emphasised. It is argued that through particular constructions of empathy, therapists were working up their professional accountability. It is suggested that therapists work up their constructions of empathy as factual and therefore indisputable through discursive devices, identified as the use of case studies and research evidence

Functional Neurological Disorder: A Qualitative Study Exploring Individuals' Experiences of Psychological Services

Objectives: Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND. Methods: This study utilised a qualitative approach with data collected from semi-structured interviews (n = 15) and analysed using reflexive thematic analysis. Results: One superordinate theme, 'the stigmatised self within the therapeutic relationship', and five interrelated subthemes were identified: 'internalised stigma and self-doubt', 'selective disclosure to professionals', 'perceptions of psychological explanations', 'having to educate the professionals' and 'attunement and trust within the therapeutic relationship'. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes. Conclusions: Intra-personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level

Chemical Abundances of the Leo II Dwarf Galaxy

We use previously-published moderate-resolution spectra in combination with stellar atmosphere models to derive the first measured chemical abundance ratios in the Leo II dSph galaxy. We find that for spectra with SNR > 24, we are able to measure abundances from weak Ti, Fe and Mg lines located near the calcium infrared triplet (CaT). We also quantify and discuss discrepancies between the metallicities measured from Fe I lines and those estimated from the CaT features. We find that while the most metal-poor ([Fe/H] <-2.0]) Leo II stars have Ca and Ti abundance ratios similar to those of Galactic globular clusters, the more metal-rich stars show a gradual decline of Ti, Mg and Ca abundance ratio with increasing metallicity. Finding these trends in this distant and apparently dynamically stable dSph galaxy supports the hypothesis that the slow chemical enrichment histories of the dSph galaxies is universal, independent of any interaction with the Milky Way. Combining our spectroscopic abundances with published broadband photometry and updated isochrones, we are able to approximate stellar ages for our bright RGB stars to a relative precision of 2-3 Gyr. While the derived age-metallicity relationship of Leo II hints at some amount of slow enrichment, the data are still statistically consistent with no enrichment over the history of Leo II.Comment: Accepted to A

Uremic solutes and risk of end stage renal disease in type 2 diabetes

Here we studied plasma metabolomic profiles as determinants of progression to ESRD in patients with Type 2 diabetes (T2D). This nested case-control study evaluated 40 cases who progressed to ESRD during 8-12 years of follow-up and 40 controls who remained alive without ESRD from the Joslin Kidney Study cohort. Controls were matched with cases for baseline clinical characteristics; although controls had slightly higher eGFR and lower levels of urinary albumin excretion than T2D cases. Plasma metabolites at baseline were measured by mass spectrometry-based global metabolomic profiling. Of the named metabolites in the library, 262 were detected in at least 80% of the study patients. The metabolomic platform recognized 78 metabolites previously reported to be elevated in ESRD (uremic solutes). Sixteen were already elevated in the baseline plasma of our cases years before ESRD developed. Other uremic solutes were either not different or not commonly detectable. Essential amino acids and their derivatives were significantly depleted in the cases, whereas certain amino acid-derived acylcarnitines were increased. All findings remained statistically significant after adjustment for differences between study groups in albumin excretion rate, eGFR or HbA1c. Uremic solute differences were confirmed by quantitative measurements. Thus, abnormal plasma concentrations of putative uremic solutes and essential amino acids either contribute to progression to ESRD or are a manifestation of an early stage(s) of the disease process that leads to ESRD in T2D

Use of glacier river-fed estuary channels by juvenile Coho Salmon: transitional or rearing habitats?

Abstract Estuaries are among the most productive ecosystems in the world and provide important rearing environments for a variety of fish species. Though generally considered important transitional habitats for smolting salmon, little is known about the role that estuaries serve for rearing and the environmental conditions important for salmon. We illustrate how juvenile coho salmon Oncorhynchus kisutch use a glacial river-fed estuary based on examination of spatial and seasonal variability in patterns of abundance, fish size, age structure, condition, and local habitat use. Fish abundance was greater in deeper channels with cooler and less variable temperatures, and these habitats were consistently occupied throughout the season. Variability in channel depth and water temperature was negatively associated with fish abundance. Fish size was negatively related to site distance from the upper extent of the tidal influence, while fish condition did not relate to channel location within the estuary ecotone. Our work demonstrates the potential this glacially-fed estuary serves as both transitional and rearing habitat for juvenile coho salmon during smolt emigration to the ocean, and patterns of fish distribution within the estuary correspond to environmental conditions